IdeaLab: Walk-Ins This Way

About 10 years ago, we started using hospitalist physicians for our adult patients. This was a very hard decision, as I had been trained mainly in the inpatient setting (internal medicine/pediatrics). Still, the time it took to see patients in the hospital and the burden of going in after hours became too much to justify the meager compensation we got for our work.

To compensate for the decreased income and to take advantage of the open hours, we started a walk-in clinic from 7:30 a.m. to 9 a.m. every weekday morning. We went on to add an evening walk-in clinic from 5:30 p.m. to 7 p.m. every weekday evening, as well as Saturday morning hours.

This turned out to be one of the smartest decisions we ever made. From a business standpoint, we actually prefer the quick walk-in types of visits. We nearly always can code them as a Level 3 (99213) visit and they take us an average of five minutes to see. The average complex adult visit, on the other hand, is usually coded as a Level 4 (99214) and takes between 15 and 20 minutes to see. Clearly, the profit margins are higher on the five-minute visit. We make more than 20 percent of our income from this type of visit, seeing anywhere from 15 to 60 walk-in patients daily (for a five-physician practice).

We had noticed that the 20 percent of our patients who come in repeatedly for chronic care don’t seem to mind waiting for available appointment slots. However, the other 80 percent - who only occasionally need care - want a convenient and timely appointment when a problem does arise. A walk-in clinic serves both purposes perfectly: When a child has an earache in the middle of the night or a fever in the late afternoon, our patients don’t have to call to bring them in; they just show up at the clinic. Also, people with full-time jobs don’t have to miss work.

The word-of-mouth advertising our patients give us from bragging to friends about these clinics has been a very good source for new patients in the practice. And since most other area practices are not running this type of clinic, patients who do leave us often find they are their disappointed with their new practices.

So how do you incorporate a walk-in clinic into your practice?

• Define the quick-sick visit. Post rules for specific types of visits you’ll handle on a walk-in basis, and have your nurses triage patients who fall outside of those parameters. That way people don’t come to walk-in clinic with chest pain, for diabetes, or for an ADHD assessment. When patients object to these terms, say, “Your problem is too important to be given only five minutes. Let’s schedule you for more time.”

• Create an efficient system to prepare patients to be seen. There’s no need to do a big work-up for a small problem.

• Set up a revenue-sharing physician compensation plan based on production. This way, there will be few complaints about staying late or coming in early if the pay is good enough. Compensate your staff too.

• Scratch each other’s backs. Get all your physicians to agree to help with the overflow from a busy morning clinic, even if it’s not their “turn.”

• Negotiate additional reimbursement from your payers. Many managed-care plans will reimburse additional dollars for after-hours care because it decreases ER usage.

Oh, and here’s one more added bonus: You won’t have to worry so much about competition from the minute-clinics that seem to be spreading through the country like MRSA.

Robert Lamberts, MD, is a primary-care physician with Evans Medical Group, in Evans, Ga. He is board-certified in internal medicine and pediatrics and he specializes in the care of adults, pediatrics, diabetes, high blood pressure, asthma, preventive medicine, attention deficit disorder, and emotional/behavior disorders. Dr. Lamberts serves on multiple committees at several national organizations for the promotion of computerized health records, for which he is a recognized national speaker. He can be reached at rlamberts@EvansMedicalGroup.com.

This article originally appeared in the June 2008 issue of Physicians Practice.