5 Steps to community engagement
house calls threat or opportunity? Shame-Free Care
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In This Issue... 04 PLANTING SEEDS Why community visibility should be a cornerstone of your marketing plan
22 TIPPING THE SCALES Why it’s good business to market to people of size
30 THE BIG PICTURE Find a digital x-ray system that supports your bottom line
IS THERE A DOCTOR IN THE HOUSE? House call apps create competition and opportunity for urgent care centers
EDITOR’S NOTE We’re pleased to welcome you to this issue of Urgent Care Magazine. As the year comes to a close, it’s time to look forward to pinpoint goals and objectives for 2016. It may be time to double down on what worked this year, or to explore new strategies and tactics. It may even be time to think outside of the box. To that end, “Is There a Doctor in the House?” delivers insight into the technologyfueled business of house calls. House call apps take urgent care’s consumer-driven model to the next level and may become a disruptor to the healthcare landscape. While there are many factors at play, forward-thinking urgent care centers may want to consider offering house calls in addition to clinic visits. In large part, an urgent care center’s success is tied to its visibility in the community. Social media is great for outreach, but community engagement sometimes requires a physical presence. “Planting Seeds” explores the ways in which urgent care centers can reap a variety of benefits from getting involved in their communities. Five urgent care centers share their experiences, which range from participating in College Night at a local middle school to sponsoring a team of 20 cyclists in a ride to benefit the National Multiple Sclerosis Society. Communities can be formed by physical proximity; they can also be formed by shared experience. Unfortunately, there are some communities that are marginalized when it comes to healthcare. “Tipping the Scales” explores the ways in which the fat community (“fat” being their preferred term) delays or avoids medical care, and the opportunities that exist for urgent care centers that choose to partner with the community in delivering judgment-free care. I hope that the articles in this issue help inspire your goals for 2016. If there are stories you’d like to see within the pages of Urgent Care Magazine, drop me a note at firstname.lastname@example.org. It would be great to hear from you. Sally E. Smith Editor
Publisher Howard Borgen Editor-in-Chief Sally E. Smith Advertising Director Chris Sanford Ad Sales Wayne Laszlo Andrea Feinberg
Contributors Susan Cooper Cheryl McCarron Art Director Stephanie Bergmann Circulation Director Michael Evan UC Media, LLC Robert Rosen, CEO
Copy Editor Beth Taylor Urgent Care Magazine, Vol. 1, No. 3, November 2015. Published by UC Media, LLC. 734 Walt Whitman Road, Suite 307, Melville, NY 11747. Copyright (c) 2015 by UC Media, LLC. All rights reserved. Nothing may be reprinted in whole or in part without written permission of the publisher. Editorial queries and information should be sent to email@example.com. Products advertised are not endorsed by Urgent Care Magazine and views expressed are not necessarily those of Urgent Care Magazine. All correspondence to Urgent Care Magazine will be treated as unconditionally assigned for publication and copyright purposes and as subject to Urgent Care Magazine’s right to comment editorially. Subscriptions to Urgent Care Magazine are complementary to qualified subscribers. Subscribe at www. UrgentCareMagazine.com. POSTMASTER: Send change of address to Urgent Care Magazine, 734 Walt Whitman Road, Suite 307, Melville, NY 11747. Periodicals postage paid at Melville, NY and at additional mailing offices. Printed in the USA.
EFFECTIVE MARKETING HAS LOCAL ROOTS BY SALLY E. SMITH
ith the 2016 presidential primary season well underway, we’re hearing a lot about “retail politics” as candidates shake hands, kiss babies, and eat endless amounts of fried food at a seemingly never-ending series of county fairs. That retail mantra should be a bellwether to urgent care centers. While an online presence and social media marketing campaigns certainly have their place, Dr. John Kulin has found that an urgent care center’s success can be tied to its visibility in the community it serves. “The more opportunities we have to be involved in the local community, the better,” says Kulin, CEO and chief medical officer of Urgent Care Group. “The payoff is that our primary site logs 28,000 visits a year because of our community involvement,” he says. That is almost double the national average of 15,000 patient visits per year. Kulin says that Urgent Care Group, which currently operates three Urgent Care Now locations in New Jersey and has one more in the pipeline, has planted seeds of goodwill with a variety of community stakeholders. “We gave out 1,000 high-quality backpacks to high school athletes,” he says. “Over the course of the year, we’ll give out 5,000 backpacks.”
A backpack is an appendage for a high school student. Five thousand backpacks co-branded with an urgent care center’s logo and the school logo, and worn on the backs of sports team members, the cheerleading squad, and the marching band, is akin to having 5,000 walking billboards. But Kulin says that backpacks also give a boost to student athletes. “It’s something tangible for them,” he says. “These are kids who are highly involved in sports, school, and other good things.” According to David Fink, president and chief communications officer at DavidHenry Marketing & Media, co-branding can be a valuable facet of a multipronged approach to marketing. “Being involved in the community and having good brand alignment can keep you top-of-mind for your audience,” he says. Fink says that urgent care and sports are a natural fit. “Urgent care centers should be involved at the places where the need for urgent care occurs – at schools and on soccer fields, for example,” he says. In contrast, Fink advises against what he cites as inappropriate cobranding. “A dentist and a bowling team isn’t a good fit,” he notes. In Kulin’s world, backpacks are just one facet of his strategy to support people and initiatives that promote health and wellness. At
“In the increasingly competitive world of urgent care, community education and outreach are two sides of the same coin." last year’s Bike MS: City to Shore Ride, Urgent Care Now organized a team of eight riders and four volunteers. At this year’s October ride, the company sponsored 20 cyclists sporting jerseys branded with the clinic’s name. The company is also a sponsor for local 5K runs. “We encourage as many people on our staff to participate as possible,” he says. In addition, they have participated in and contributed to Rotary Club and Chamber of Commerce events, charity basketball games, and charity golf tournaments. Urgent Care Now also shines a light on often-overlooked community partners. “We host annual picnics for local EMS squads to show our appreciation,” says Kulin. “We bring out tents, grills, and games, and make a donation for equipment.” Kulin says that community involvement confers multiple benefits. “We need to do advertising no matter what,” he says. “If we can tie those ad dollars into things that are doing good, it’s better than throwing money at a billboard.”
David Fink believes that, in the increasingly competitive world of urgent care, community education and outreach are two sides of the same coin. “You must have a strong communications program and presence so that people know about you and are motivated to use you when something comes up,” he says.
Texan Urgent Care puts education efforts front and center, in part because Medical Director Dr. Sean Wang is a professor at University of Texas Health Science Center. Although Texan Urgent Care opened its first clinic in late 2014, Wang’s team wasted no time in lining up opportunities to work with local schools. For College Night at a local middle school, Texan Urgent Care not only sponsored the pizza provided to the attendees, but also presented a PowerPoint video. “We gave students and parents insight into the medical positions at an urgent care center, and the schooling needed to fulfill the various roles,” Wang says. The company partners with a different middle school to sponsor a monthly “Principal’s Coffee” event, where parents can meet with the principal to ask questions or share concerns. “We’re able to introduce the clinic and our services, as well as discuss ways in which we can help the school,” says Wang. Because San Antonio has a rich history, Wang says that it was important for Texan Urgent Care to participate in the city’s cultural events. “The San Antonio Cultural Arts Festival and Parade are near our clinic, so we staffed an interactive educational booth,” he says. “We had visual presentation boards, a toddler’s anatomy vest, and trivia games.” Texan Urgent Care has also honed in on the type of marketing that Fink says is crucial in today’s crowded urgent care marketplace. “Urgent cares often look at other urgent cares and do and say exactly the same things,” Fink says. You have to differentiate your brand.”
At 2014’s Bike MS: City to Shore Ride, Urgent Care Now organized a team of eight riders and four volunteers. At this year’s ride, the company sponsored 20 cyclists. Urgent Care Now also holds an annual appreciation picnic for EMS squads and makes a donation for equipment. 6
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“Five thousand backpacks co-branded with an urgent care center’s logo and the school logo, and worn on the backs of sports team members, the cheerleading squad, and the marching band, is akin to having 5,000 walking billboards.”
Texan Urgent Care uses anatomy vests and presentation boards to engage families and help children learn about the body
San Antonio mayor Ivy Taylor favorited Texan Urgent Care’s tweet featuring staff members with the mayor 8
The differentiating factor for Texan Urgent Care is that, according to Wang, “On the south side of San Antonio, there are not many urgent cares or hospitals. Our philosophy is to only use board-certified ER doctors,” he says. “We communicate that we can deliver emergency room care at urgent care prices.” Fink also advises that urgent care centers leverage local media. “Get good publicity out of newsworthy events and activities,” he says. Wang says that Texan Urgent Care did just that via a booth at a Health & Wellness Expo with 10,000 attendees. “We received great exposure with local media and across social media platforms,” Wang says.
Defining Urgent Care
Fink opines that the rapid expansion of healthcare services has caused confusion among consumers. “Knowing the name and location of an urgent care center isn’t enough,” he says. “People have to know how and when to utilize an urgent care’s services.” He says that, when centers connect with communities and explain the function of urgent care in the larger healthcare space, the pieces fall into place. “Then people are coming to the urgent care at the right time for the right reasons, and expectations are being met and exceeded,” Fink says. Having that kind of connection and exceeding expectations are GoHealth’s bread and butter. According to Christine Hildebrand, head of marketing and community engagement, the company’s vision is to locate clinics in communities where people live and work, so that the clinic is not a destination visit, but rather one of convenience. “That community approach naturally bridged into our marketing strategy to be a part of the communities we serve,” she says. GoHealth currently has 16 clinics in New York and eight in Portland, Ore., with plans to open additional clinics. “In all new locations, we do a community open house for people to learn about our services, tour our facilities, and learn about the insurances we accept,” Hildebrand says. GoHealth is an active sponsor of youth sports teams, 5K and 10K runs, and school PTAs. The company has built partnerships with local fire and police departments, and has hosted movie nights in a nearby park. GoHealth also works with its health system partners, who have established and extensive connections in the communities they serve. To Hildebrand, community involvement is much more than a sponsorship banner. “We’re building partnerships with community groups. We’re building relationships with key influencers in the community,” she says. “We then become a resource for healthcare information and a destination to serve people’s immediate healthcare needs when they don’t know where to go.”
ExpressDocs places signage on a sponsored middle schoolâ€™s fence, and staffs booths at community events
PM Pediatrics is visible in the community, sponsoring a day of building for Habitat for Humanity and curing sick teddy bears during a Family Fun Fest at a local community center.
5 STEPS TO START
If you’re ready to up your community engagement game, GoHealth’s Head of Marketing and Community Engagement Christine Hildebrand recommends beginning with these five steps: Get involved with your local Chamber of Commerce, and then host the next member mixer at your location. Sponsor local youth sports, and offer classes or presentations on sports injury prevention. Partner with local school districts, PTAs, and booster clubs to offer sports physicals or flu shots. Sponsor popular community events, and participate in local parades and street fairs. Partner with local businesses, such as day care centers, dance and martial arts studios, fitness centers, and pharmacies.
While most urgent care centers don’t require staff members outside of the marketing department to participate in community outreach efforts, many clinics encourage staff participation – and are the better for it. Steve Katz, founder and managing partner of PM Pediatrics, which has 11 locations in New York, five in New Jersey, and one in the District of Columbia, says that community engagement is part of the company’s mission. “We started in order to find a better way to deliver healthcare to kids,” he says. “Being involved in the community is a natural extension of that.” PM Pediatrics participates in a host of community events, from street fairs and school fairs, to charitable events like Relay for Life, to new baby and special needs expos.
Katz says that all employees are aware of PM Pediatrics’ corporate values and mission, and that community involvement may play a role in recruiting and retaining great employees. “We’ve drawn people to the company who care about making a difference in the lives of kids,” he says. “Our outreach efforts provide another way for them to participate in that.” At PM Pediatrics, employees can also help drive the company’s outreach efforts. “One of our office managers volunteers for Habitat for Humanity,” Katz says. “She brought it to us and we decided it was something we should do. We had a very enthusiastic response from our team.” Urgent Care Now’s John Kulin adds that community service gives employees the opportunity to interact with one another in a healthy environment. “Our registration staff is in their 20s and
GoHealth sponsors 5K and 10K races and is a regular presence at community events
30s,” he says. “Participating in community events is team building, allowing them to do healthy things instead of going out for a night of drinking.”
The Elusive ROI
Can an urgent center measure its return on investment (ROI) for the resources it puts into engaging the community? The short answer is no. Nevertheless, urgent care center operators across the spectrum agree that community involvement is valuable. John Kulin says that it remains to be seen whether or not the backpack project delivers new patients to his clinics. Upticks in visits can be attributed to vacationers, seasonal illnesses, and other factors. “There is so much variation month-to-month that we’ll look at quarters and end-of-year to see what kind of impact it’s had.” Steve Katz isn’t bothered by the lack of metrics. “Being at the grassroots level makes a big difference for the community and for us,” he says. “It definitely does yield benefits, but it provides benefits to the company as well.” Katz says that community involvement helps fulfill PM Pediatrics’ mission, and helps provides added value to employees. “It’s a nice confluence of things,” he says. “It’s a natural thing to do, which is why we do so much of it.” GoHealth’s Christine Hildebrand says, “In general, community engagement is an awareness building activity and is mission driven.
It’s an expression of who we are as a company.” Nevertheless, they do try and gauge impact for some events by handing out postcards that can be exchanged for a free first aid kid when a patient comes in for a visit. Still, Hildebrand is quick to point out that measurable ROI isn’t the goal. “We believe that community goodwill activities will pay off in spades for awareness prior to an urgent care need,” she says.
According to Hildebrand, the centerpiece and best possible outcome of community involvement is connection. “Community events are an essential component of building trust in the communities we serve,” she says. “In general, healthcare hasn’t been very intimate. We want to build a more intimate connection with our patients. To do that, we have to go to the community to build those relationships.” Lindsay Musoff, office manager at ExpressDocs, attests to the value of those personal connections. She says of her father, who is a doctor and who owns the clinic, “He’s from New York and we’re in South Florida. He talks to everyone about Brooklyn, so they bond.” Face-to-face meetings with a doctor at a neighborhood health fair are sure to plant seeds that will grow into meaningful relationships. ■
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IS THERE A DOCTOR IN THE HOUSE? BY SALLY E. SMITH
HOUSE CALL APPS CREATE COMPETITION AND OPPORTUNITY FOR URGENT CARE CENTERS
all it coming full circle. House calls are roaring back to life, but in an incarnation that’s light years away from the buggy-driving physician with a black bag by his side. Just as taxicabs are being supplanted by Uber, urgent care centers run the risk of being displaced by the likes of Heal, Pager, and PediaQ – mobile apps that deliver medical care to a consumer’s doorstep. Urgent care’s patient-centered, retail-inspired model was a disruptor to the healthcare delivery system. House call apps leverage technology to take healthcare access and customer service to the next level, catering to those who can’t or choose not to make the trip to the neighborhood urgent care center. The renaissance of the house call is innovative, but sometimes the inspiration behind innovation is intensely personal. A year ago, Dr. Renee Dua and Nick Desai, her serial entrepreneur husband, were at loose ends when they couldn’t readily access pediatric care for their infant. After spending what they felt was an unnecessary day in the emergency room, the couple had a light bulb moment. “We knew there had to be an affordable way to bring a doctor to your door,” Dua says. Without Dua’s knowledge, Desai and a friend developed Heal, an app that enables patients to arrange for house calls to their homes, offices, or wherever they might be. “It was so simple and sophisticated,” says Dua. The duo found an angel investor within the first six weeks, launched Heal in Los Angeles in February 2015, and expanded to San Francisco two months later. “We’ve had 100 percent growth month after month,” Dua says.
Apples and Oranges
The growing demand for house calls at the touch of a fingertip is qualitatively and quantitatively different when compared to a century ago – or even a decade ago. In 1930, 40 percent of doctors’ visits were house calls. By the mid 20th century, that plummeted to 10 percent. By 1980, house calls accounted for only 0.6 percent of all doctors’ visits. That trend started to reverse after 1988, the year that Medicare home healthcare reimbursements were restructured. Since then, house calls have been on the rise. The American Academy of Home Care Medicine (AAHCM), which has tracked Medicare-reimbursed house calls for the past decade, notes a strong upward trajectory, from 1.5 million house calls in 1995 to 2.6 million in 2014. Toby Hervey, vice president of expansion for Pager, says that Medicare-reimbursement statistics of geriatric and homebound
patients don’t tell the on-demand house call story. “Those are not relevant to the sore throats and acute episodic conditions that we are treating,” he says. Indeed, Pager doesn’t typically see geriatric or palliative patients. “While there are lots of use cases for our technology among groups that are doing care for geriatric patients, we’re focused on improving care delivery that’s akin to an urgent care or retail clinic,” he says. Heal’s Dua says that the elderly and those with special needs utilize Heal’s services, but that the patient pool is much broader. “I thought it would be housewives and moms with multiple children,” she says. It turns out that having a doctor on demand appeals to a range of patients, including those who don’t have time to leave their workplace, “or the man who doesn’t want to go to the doctor because he doesn’t think there’s a need,” she says.
Getting Patients on Board
Dua says that the biggest hurdle faced by house call apps is shifting the healthcare paradigm in the patient’s mind. “It’s strange for people to think that you can get a great doctor in your house,” she says. “Patients have to begin thinking, ‘Wait a minute. I don’t have to leave to get taken care of.’” Hervey acknowledges that using technology to manage healthcare is a new frontier for most people. “There’s an undercurrent of being an early adopter” among Pager’s patient population, he says. Beyond serving early adopters, Pager attracts four primary demographics. One segment consists of parents who call at night when their children have conditions typically seen in an urgent care setting, such as ear infections, conjunctivitis, and fevers. “Then there are the 20- or 30-something busy urban professionals who are treated for upper respiratory infections and UTIs,” Hervey says. “Busy executives who are a little older and trying to get on top of their health” also want to save time and appreciate the convenience of a house call. Finally, Pager serves travelers who find that they’re ill in an unfamiliar city and don’t have access to their primary care physicians. Heal provides more than urgent care. “We’re absolutely set up to do primary care,” Dua says. It’s not uncommon for a patient to schedule a follow-up appointment and ask the physician to administer flu shots to the patient’s kids. “Thirty percent of our patients are re-users,” says Dua. “The patient recognizes that house calls are far more convenient and far more affordable.” While Heal and other house call apps screen out medical emergencies, if an emergency does arise during the course of a visit, UrgentCareMagazine.com
HOUSE CALL PRACTICES NEED TECH PLUS
The engines running house call apps are more than just a point of entry for patients. They fuel efficiencies that can mean the difference between profit and loss for a house call practice or for an urgent care center’s ancillary house call service. Yet technology is just one piece of the house call puzzle. When mobile healthcare platform Medicast (www.medicast.com) first launched, it delivered house calls to consumers. Now Medicast supplies its technology and expertise to urgent care centers and other healthcare organizations intent upon going mobile. Co-founder and CEO Sam Zebarjadi says that its direct-to-consumer experience positions the tech company to provide soup-to-nuts expertise to urgent care centers that want to expand into house calls. He outlined the steps Medicast takes in helping an urgent care center launch a mobile practice:
Medicast provides a white label technology platform for mobile healthcare practices.
1. Exploratory conversation looking at the urgent care center’s proposed mobile geographic reach and scope of services. “We know what makes people tick and we know the driving factors for patients who use house calls,” Zebarjadi says.
2. Draft a plan for launching the mobile service. “We can take on the heavy lifting,” says Zebarjadi. That can include branding, project management, and digital marketing campaigns. “We can also take on customer support, back office support, and billing,” he says.
3. Recruiting staff. “It depends on the organization, but typically you don’t want your brick-and-mortar staff doing house calls,” Zebarjadi says. Medicast can recruit physicians and lower-cost providers like nurse practitioners, and then help them get credentialed. There can be both full-time contractors and per diem employees who work as their schedules permit.
4. Get up and running. Zebarjadi says the time between contract signing and launch is typically 90 days or less.
Heal doctors smooth the transition to emergency care. “You might not know that you need to call 911,” says Dua. “When you’re making that decision, having a doctor with you can give you invaluable peace of mind.”
Centering the Patient Experience
The patient’s experiences of a clinic visit and a house call can be radically different. Dua says the provider sets the stage, which is why Heal physicians are trained to treat every patient as a VIP. “I encourage our doctors to take as much time as they need with
patients,” she says. “When you get to know your patients, you need to maintain a different bedside manner” than what she terms “the mill, every nine minutes, going from room to room.” Pager goes the extra mile, equipping physicians with the 20 most common pharmaceuticals prescribed in an urgent care setting. “If a doctor shows up and you have strep, they’ll leave you with the first dose, then e-prescribe the rest,” Hervey says. Pager has partnered with Zipdrug, a company with a prescription delivery app, to deliver the remainder of the prescription to the patient.
“I encourage our doctors to take as much time as they need with patients.” - Renee Dua, Heal Co-Founder and Chief Medical Officer
Many physicians choose to moonlight at house calls for a change of pace. According to Hervey, “Many doctors want a different practice environment, one where they’re not seeing patients back-to-back.” As Heal’s Chief Medical Officer, Dua is proud of the company’s 100-plus physicians who go on house calls. Staff run the gamut from pediatricians to family practitioners to internists, and Dua is happy to accommodate their needs. “I’m big on flexibility,” she says. “Some doctors want to work full-time with no overhead, and what they make they take home.” Others simply want to pick up a few shifts during the week. “They may be pediatricians who are full-time moms, or fathers who want to be there to pick up their kids,” she says. Heal’s willingness to adapt to its workforce may be why there’s a waiting list of physicians who want to work for the company. Yet not everyone passes muster. “I want them to be visionaries and entrepreneurs,” Dua says. While Heal sends only physicians on house calls, Pager, which launched in New York City and now also serves San Francisco, augments its family and emergency medicine physicians with nurses who administer flu shots, conduct health screenings, and perform follow-up care. Hervey reports that the company works with 60 medical providers and says, “We’re experimenting with physician assistants and nurse practitioners to see how they work with this care model.”
Competition or Opportunity?
Heal’s Dua doesn’t view urgent care centers and house call apps as competitors. “We’re allies and partners, trying to do the same thing,” she says. Sam Zebarjadi, co-founder and CEO of Medicast, disagrees. A tech company that now offers organizations a logistics and management platform to optimize remote healthcare, Medicast made house calls in four U.S. markets when it launched in 2013 – directly competing with urgent care centers. Hervey says that Pager also views itself as a tech company, rather than as a healthcare provider. “[Delivering house calls] is a way of getting started, but we see ourselves partnering with provider organizations,” he says. “GrubHub is a bridge, a platform that connects restaurants and consumers. We want to be the bridge that makes the delivery of ondemand healthcare viable and efficient, ultimately empowering existing organizations to fulfill on-demand care.” Medicast has already crossed that bridge, offering a turnkey solution that supports robust house call practices. Patients can access house calls via a white label mobile app, a web portal created by Medicast, or a practice’s front office staff. The clinician going on the house call uses a Medicast-supplied tablet that, in addition to providing schedule management, driving directions, and charting, “uses customized workflows to capture 95 percent of cases urgent care patients are seen for,” says Zebarjadi. UrgentCareMagazine.com
THE CASE FOR THE HOUSE CALL Proponents quoted in this story say that house calls make sense for a number of reasons, including: • They relieve emergency room overcrowding • Patients can be seen at a time and place convenient to them • Patients can be treated for injuries that would make driving difficult
• Physicians can spend as much time as needed with a patient • Patients can avoid exposure to other patients’ viruses • Physicians can learn more about a patient’s well-being from seeing their environment than they can in an office visit
• No exposure to germs in the waiting room • Patients don’t have to leave home when they’re feeling ill
Medicast also delivers on the administrative front. “All of the data is pushed back into the health organization’s EMR, so providers don’t have to do double charting,” Zebarjadi says. The platform also has a dispatch engine that takes into account current traffic, as well as a patient’s proximity, symptoms, and preference for a provider’s gender or language. Medicast can also handle billing, cash pay, or direct pay. “We can process insurance claims or push back the data through the organization’s revenue cycle system,” says Zebarjadi. In theory, processing house call insurance claims means smooth sailing; in reality, the road to house call reimbursement is more than a little rocky.
Revenue and the Insurance Quagmire
So far, payors – whether insurance companies or Medicare – are on the sidelines of the latest iteration of the house call. As a result, apps typically require payment by credit card, though what they charge for house calls varies widely. Pager charges an all-inclusive $200 per visit, but offers a $50 visit to new patients. PediaQ, a pediatric house call app, starts with a baseline $150 per visit, but charges a
“If a doctor shows up and you have strep, they’ll leave you with the first dose, then e-prescribe the rest.” - Toby Hervey, Pager VP of Expansion
$100 premium for visits after 10:00 p.m. and a $50 premium for holidays. PediaQ also tacks on separate charges for on-site tests ($25), injections ($40), lab work ($50), and other services. Heal is trying to corner the market by charging $99 per patient per visit. Dua says that patients are happy to pay Heal’s flat fee because they see it as a bargain compared to the alternative. “Over 60 percent of people who go to the ER don’t have an emergency,” she
says. According to Dua, 60 percent of Heal’s patients say that they would otherwise go to the emergency room. “By the time you’re out of the ER, you’re looking at a $2,500 bill plus a co-pay,” Dua says. That’s a distinction that can be lost on patients. According to Hervey, “A lot of consumers don’t understand how much they’d be charged in an urgent care or emergency room – even for a copay. They don’t know what a deductible is or if they’ve met it.” UrgentCareMagazine.com
IN THE FIELD:
MICHAEL FARZAM, MD In contrast to the tech-fueled house call app and the urgent care-house call hybrid, Dr. Michael Farzam has contentedly worked his concierge house call practice, House Call Doctor Los Angeles (www.HouseCallDoctorLA.com) for more than a decade. “Everything that an urgent care center does, we do in the home,” says Farzam. “We’re able to do on-site testing, strep, urine, blood work, injectable and oral medications, ultrasounds, x-rays, and EKGs – all in the privacy of the patient’s home.” Farzam’s is a solo practice, and he’s available to patients 24/7 via mobile phone. He treats everyone from infants who can’t get in to see a pediatrician to elderly people who have mobility issues. The majority of his patients, however, are younger and healthier. “They either want convenience, because they’re too busy to go to a doctor’s office, or they want privacy,” Farzam says. “Many patients seen on an initial sick visit transition over and use house calls for primary care as well.” As is the case with house call apps, Farzam’s practice is cash pay. “We charge a fee and then provide the patient with a superbill,” he says. “Their insurance can reimburse them a portion of the fee.” He enjoys being able to spend time with patients in a setting where he doesn’t feel rushed, and has found that the home provides insights into the patient that a clinical setting lacks. “I get to meet family members and get to see a patient’s home environment, which can help with diagnoses,” Farzam says. Farzam welcomes the entry of house call apps into the marketplace, saying, “They create more awareness for house calls as a viable option for medical care.” His perspective is that house calls benefit sick and elderly patients who would otherwise require transport, and that they cut out unnecessary testing that’s often performed in urgent care and emergency room settings. “Studies show that house calls in general save the healthcare system money because they save trips to the ER, unnecessary testing, and unnecessary hospitalizations,” he says. Still, Farzam is quick to differentiate his practice from the services offered by house call apps. “Ours is a concierge service,” always with the same provider and with 48-hour follow-up, he says. “Their model is different, with different doctors coming to your door each time you call.”
Convincing insurers of the house call value proposition has also been an uphill battle. “We want to say we take insurance, but that might not make the most sense long-term,” says Hervey. Nevertheless, he says that Pager is collecting data to build the case. “We’ve had promising conversations with all the major carriers,” he says. So has Medicast. Zebarjadi says that, as a third party, Medicast’s presence lends credibility when providers meet with insurers. “We’re actively in discussions with large payor groups about the value
of reimbursement for house calls versus the cost of going to the ER for non-acute cases,” he says. Because Medicast’s platform already has the capability to run eligibility and claims processing, it’s primed for the time when insurance companies give house calls the green light. Heal is wasting no time getting ahead of the curve. “We’re going to be in network with Anthem,” Dua says. The app will tell the Anthem patient the amount of their copay, but won’t require payment until the patient is happy with their house call. “That’s
how much we believe in what we’re doing,” says Dua. “If you’re not satisfied, we want to make it right.” In the meantime, both the Heal and Pager apps take the patient’s payment information, charge their credit card at the end of the visit, and provide a receipt that the patient can then submit for reimbursement.
Making the Leap
With an emphasis on convenience, access, and the patient-centered experience, and with core competencies in local marketing
and community outreach, urgent care centers are uniquely positioned to add house calls to the services they offer. Medicast’s Zebarjadi sees it as a seamless fit. “House calls are an overlay service meant to augment brick-and-mortar offerings,” he says. Zebarjadi notes that an urgent care center draws patients from a two- to fivemile radius and sees a finite number of patients in a year due to the limitations imposed by the physical space and staffing. In contrast, “A virtual practice is elastic,” he says. “You’re not bound by geography, and you can start with a couple of providers and grow from there.” For urgent care centers that are engaged in acquisitions or expansion, Zebarjadi says that launching a house call practice simply means building one less brick-andmortar center. “When we’ve looked at the investment, we’ve found that building a virtual practice costs about a quarter to a third of what it costs to build an urgent care clinic,” he says. “And that cost is recouped in the first three months of operation.” Mindful of increasing competition from health systems entering the urgent care space with an eye toward clawing back patients they’ve lost over the past several years, Zebarjadi says, “It doesn’t make sense to have brick-and-mortar centers as your sole strategy.”
Working out the Kinks
While visionaries are leading the technological charge that will make the house call business viable, they’re still working out the kinks. In a brick-andmortar facility, clinicians can see patients back-to back. “What remains to be proven is profitability,” Pager’s Hervey says. Pager is working to introduce efficiencies in the house call process to make up for the loss that occurs with a clinician’s travel time. “If you can save on overhead and facility maintenance, is it viable to see fewer patients?” he asks. Hervey says the backend of the operation – especially the ability to triage – is key. “You have to efficiently determine
APPS IN THE HOUSE Heal (www.getheal.com)
Patients can access Heal doctors in California locations including San Francisco, Palo Alto, Los Angeles, Santa Monica, and Orange County. Chief Medical Officer and Co-founder Dr. Renee Dua says that the company’s goal is to expand into a dozen more major metropolitan markets in 2016. With 10,000 registered users, Heal is available on Android and iOS devices, or patients can connect online or over the phone. The app asks what kind of medical help is being sought, and the patient can choose on-demand or scheduled visits between 8:00 a.m. and 8:00 p.m. For on-demand service, the doctor can typically be at the patient’s door within one hour. Heal delivers both urgent and primary care, and provides the user with a biography of the doctor they will see.
Patients in New York City’s five boroughs can connect with Pager doctors, as can those in San Francisco. Vice President of Expansion Toby Hervey says that, in the short term, Pager will expand coverage to California’s Marin County and East Bay, as well as to New York’s broader DMA, which includes parts of New Jersey, Connecticut, and Pennsylvania. Pager is available on iOS devices and via the Web. Practitioners deliver on-demand adult urgent care, pediatric urgent care, health checks, and physicals. The service includes complimentary prescription delivery. Pager visits are available between 8:00 a.m. and 10:00 p.m., and the app promises care within two hours. Follow-up visits are conducted the next day via phone call or text message.
Available on iOS devices, PediaQ sends nurse practitioners on pediatric house calls in Dallas and surrounding areas, including Plano and Frisco. Services are available from 4:00 p.m. to midnight on weekdays and 8:00 a.m. to midnight on weekends. PediaQ guarantees that a clinician will arrive within an hour, and provides parents with profiles and reviews of nurse practitioners. Following the visit, a quality assurance nurse reviews the records and sends the records and lab results to the child’s pediatrician. The pediatrician follows up with the parent.
IN THE FIELD:
CAESAR DJAVAHERIAN, MD, MS, FACEP As chief medical officer of the Oakland, Calif.-based ER Direct (www.er-direct.com), Dr. Caesar Djavaherian is on the cutting edge of the hybrid urgent care-house call practice. Why? “We’re really trying to empower our patients to have alternatives,” he says. Djavaherian launched his house call practice three years ago, and opened up his urgent care clinic in Berkeley a year later. “Initially I thought that consumers needed an alternative to the emergency room,” he says. “I thought the most convenient answer was to have a provider come to their homes.” But Djavaherian quickly realized that the house call model created gaps in care. “Consumers need choice,” he says. “They occasionally need someone to come to the house, but it’s more convenient for patients to drop into the clinic.” There’s considerable crossover between the patients seen through house calls and those seen at the clinic. “We’re seeing a similar demographic,” Djavaherian says. “Our typical patients are young professionals, often women with families, and people whose time is very important.” The types of illnesses and injuries treated by ER Direct’s house call and clinic practices also overlap considerably. “We do mobile x-rays, mobile ultrasounds, point-of-care testing, and write prescriptions in the home,” says Djavaherian. “Rather than waiting for two or three days to get a result back from a lab, we can take care of it when we see patients.” There are distinctions, however; when patients need gynecological services or in-depth care, for example, they’re seen in the clinic. When it comes to staffing, it’s a case of never the twain shall meet. ER Direct’s house call staff, which consists of physician assistants and nurse practitioners, are separate from the physicians, physician assistants, and nurse practitioners who work in the clinic. From the back office perspective, Djavaherian says that the biggest difference between the house call and clinic facets of the business relates to insurance and reimbursements. Most insurance companies will pay only part of house call visit fees, he says. While most house call practices are cash-only, Djavaherian made the decision to tackle insurance reimbursements and bill insurance companies directly. “We do it because the patient’s already having a hard time with billing,” he says. “But it does create a lot of back office work that we essentially do for free.” Djavaherian feels that patients aren’t well served by the insurance industry’s posture on house calls. “At least in the current state of healthcare, patients are often having to make a choice based on what their insurance companies mandate,” Djavaherian says. “If any forward-thinking insurance company would adopt house call reimbursements, they’d find that it makes sense both financially and from a patient satisfaction point of view.” While Djavaherian believes that the hybrid urgent care-house call model is “viable and the right thing for consumers,” he admits that it hasn’t been easy to pull off. “We spent a lot of time asking, how do we break into the house call business when insurance companies essentially don’t realize the degree of care we can provide?” he says. “It’s a missed opportunity to reduce the overall cost of the healthcare system.” On the flip side, Djavaherian gets enormous satisfaction from patients’ responses to ER Direct’s house calls. “Even though it’s an old-fashioned idea, in this generation house calls are quite novel and innovative,” he says. “When patients are vulnerable and feeling bad, and then someone comes to their house and makes them feel better, they just love having that experience.” Djavaherian says that many house call patients say that they’ll never go to the emergency room again.
“We’re actively in discussions with large payor groups about the value of reimbursement for house calls versus the cost of going to the ER for non-acute cases.” - Sam Zebarjadi, Medicast Co-Founder and CEO what the patient needs and what is clinically appropriate care in the most cost-effective setting,” he says. That might mean the patient is seen by a nurse practitioner rather than a physician. Or that the visit is a video chat rather than a trip to the patient’s home. “Having technology that matches the patient to the right provider is the secret sauce,” says Hervey. Pager is experimenting with care efficiency models that “will make house calls as viable as the urgent care center, if not more so,” he says. Medicast’s Zebarjadi emphasizes the power of a single tech platform to enable hybrid telemedicine and house call visits that increase efficiency. “Video visits can be used for triage or for followup care,” he says. “Telemedicine alone isn’t going to do it. That’s losing the human touch. House calls fill an important void.” Hervey agrees. “You need the contingency of sending in a provider if needed,” he says. “That’s currently a gap in telemedicine.”
The Future of House Calls
Dua says that the future of house calls is bright. She feels that, with time, it will become obvious to a patient that there’s no reason to get in the car or miss work when there’s a doctor who can come to their house. Zebarjadi sees the potential for exponential growth in house calls. He notes that 60 percent of the services and procedures performed in an urgent care center can be replicated in a mobile setting. “With advances in mobile equipment and technology, that percentage will go up,” he says. While the buggy and the black bag may be relics of days gone by, enabling technology means that urgent care centers may soon start offering house calls. “The number of convenience patients is growing,” says Zebarjadi. “We haven’t begun to scratch the surface.” ■
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Tipping the Scales
WHEN IT COMES TO PATIENTS OF SIZE, RESPECT IS GOOD BUSINESS BY SUSAN COOPER
“Body positivity” may be in contention for
buzzword of the year. On social media and in mainstream media, body positivity pushes back against society’s narrow standard of ideal feminine beauty. Plus-size model Ashley Graham made a splash in a Swimsuits for All ad that graced this year’s Sports Illustrated swimsuit edition. Readers of Vogue’s vaunted September issue did a double take at the #PlusIsEqual two-page advertising spread, later revealed to be a campaign by plus-size retailer Lane Bryant. Both built on a foundation laid by The Body Shop, which in the 1990s created Ruby, Barbie’s antithesis. Ruby’s tagline? “There are 3 billion women who don’t look like supermodels and only 8 who do.” It’s natural that advertisers would leverage body positivity to sell fashion and beauty products to the more than 100 million women in the U.S. who are considered plus size. But here’s a radical idea: Urgent care centers can leverage body positivity to create a non-judgmental environment that accommodates patients all sizes of large – and attract a loyal market segment in the process. Many plus-size women interviewed for this article echoed the sentiment of Taneesha Roberts*, who says, “If there were a fat-friendly urgent care center, I would drive two counties away if I had to when I needed one. I have been treated so badly at urgent cares that I don’t go anymore – even if it would prevent an ER trip.” Although many may cringe at “the f-word,” Marilyn Wann, activist and author of Fat!So?, says, “Fat is the term of preference in the fat community. Words like ‘obese’ and ‘overweight’ pathologize and medicalize body diversity in ways that are discriminatory and damaging to public health.” She adds, “Fat is not a bad word if we stop putting negativity into it.” Dr. Linda Bacon, author of Body Respect, points to research demonstrating that focusing on body size in a medical setting can negatively impact health. “When people’s bodies are viewed as wrong, people are less likely to come to a medical visit and less likely to trust their doctors,” she says. “Fatter people delay or avoid medical care for fear of judgment.” In contrast to the “weight loss for all” prescription most frequently offered to fat people, Bacon promotes the Health at Every Size (HAES) model. “It focuses on health outcomes rather than on weight outcomes,” she says. While many people think the two are synonymous, Bacon says that conventional wisdom about weight-related morbidity and mortality is based on tainted research. “Whenever we see that disease is more common in heavier people, we assume that fatness is to blame,” she says. But correlation is not causality, and she says there are many factors – including fat bias – that play a role in disease.
Fat bias rears its ugly head in healthcare settings even when the presenting condition is clearly unrelated to weight. Amy Montoya*, who is active in animal rescue efforts, says that her last visit to an urgent care center was to obtain treatment for a cat bite on her hand. “I got a lecture that my weight was ‘making the situation significantly worse,’” she says, “although the doctor was unable to explain how my weight was impacting a bite from 45 minutes earlier.” Eyebrow raised, she queries, “Perhaps cats only bite fat people?” Wann says that the inability to get unbiased medical treatment is a significant barrier to healthcare for fat people. “’Don’t be fat’ is not a diagnosis, nor a safe, effective treatment,” she says. “There are a lot of ways to separate out weight bias from diagnosis and treatment plans,” even for conditions that may be associated with higher weights, she says.
An Untapped Market
According to Wann, fat people often don’t have a medical home. “If their primary care doctor only wants to focus on ineffective approaches to attempting to lose weight, then a lot of fat people just don’t have a primary care physician that they can work with,” she says. This creates a void that, with a bit of effort, urgent care centers could easily fill. Word of unbiased medical care travels fast. “The fat community is very proactive about self-advocacy around our healthcare needs,” says Wann. “We create resources to help each other find the care we need and deserve.” Stef Maruch, founder of FatFriendlyDocs.com, began curating her compilation of unbiased health professionals in 1997. She says that on various fat acceptance Internet forums, “People kept posting, ‘Does anyone know a fat-friendly health professional’ in a given city. I decided to make a Web resource collecting these recommendations.” Since then, Maruch has added to the site several hundred health professionals and facilities, ranging from acupuncturists to psychotherapists, and from family practice doctors to nutritionists. She says that recommendations arrive to her in box from both patients and providers. “People seem to find out about the list through search engines, references on fat activist blogs and forums, and word-of-mouth,” she says. The trend toward cultural body positivity means membership in the fat body politic is on the rise. Wann says that the movement’s numbers are increasing, as is its access to the mainstream media. “Early adopters of fat-positive approaches to healthcare will definitely benefit from partnering with this growing community,” she says. * Name changed by request
“Fatter people delay or avoid medical care for fear of judgment.”
The first step in creating an urgent care center free of weight bias is to design a welcoming physical space. Dr. Karen Chase is both a Louisiana emergency room physician and a fat patient who has stage 3 or 4 lipedema. “The biggest barrier is having a chair to sit in,” she says. Chase was pleased when she visited a nearby urgent care center that had doublewide chairs in the waiting room. “I could actually sit down while I waited,” she says. Exam tables that have a high weight rating and that are bolted down are also critical. “I can’t safely get on a regular exam table,”
says Chase. “If I try to stand on the ledge, the table can flip up and I’m at risk of falling. That’s not acceptable.” While Chase, Wann, Maruch, and Bacon all emphasize that fat patients should only be weighed if medically necessary, and then only with consent and without commentary, they also advocate for the availability of high capacity scales. “It’s really embarrassing for a patient to be put on a scale that has a 250-pound capacity when they’re not even close to that,” Chase says. Chase went so far as to purchase, out of her own pocket, a highcapacity scale for a hospital where she worked. “It pissed me off,”
HOW TO HELP THE COMMUNITY TODAY While the fat community is proactive in addressing its healthcare needs, fat people routinely scramble to find diagnostic equipment with higher-thantypical weight capacities. The community is currently compiling a database of locations for accessible CT scanners, MRIs, and other diagnostic equipment, and would like your help. If you know of a facility that has higher-capacity equipment, email email@example.com with the facility’s name and location. Your urgent care center will be given credit for contributing to the directory.
“’Don’t be fat’ is not a diagnosis, nor a safe, effective treatment” vaginal specula available for fatter patients. Visual images have impact, and Wann encourages urgent care centers to take a critical eye to their artwork, posters, and pamphlets. “Fat people should be positively portrayed, along with people of color, people with disabilities, and people of all genders and sexualities,” she says. Along with artwork that depicts “role models of healthy fat people,” Bacon says that waiting room reading material should be scrutinized. “There should be magazine options that don’t have fat-shaming messages,” she says. she says. “They were sending people out to the cattle weighing station to be weighed.” Wann says that larger wheelchairs, exam gowns, and drape material go a long way toward making fat patients feel welcome. The National Institutes of Health recommends installing a split toilet seat and providing specimen collectors with handles, and having large adult blood pressure cuffs, thigh cuffs, extra long needles, and large
Bacon emphasizes carefully evaluating whether or not to weigh a patient prior to rooming. “If the patient presents with a broken finger or a virus, weighing them isn’t necessary,” she says. When medically necessary, she advises, “Recognize that, in this culture, it’s very loaded to step on that scale and see that number.”
Staff can make it easier on the patient by having them stand on the scale backwards. “Reassure them that you understand it can be uncomfortable and that you don’t see their weight as a marker of their character or health,” Bacon says. When a staff member treats the scale as a judgment-free zone, they create a safer environment for the patient. If the patient asks not to be weighed, Maruch says, “The request should be honored and taken into account automatically on future visits.” Wann says that having the proper size gown and necessary equipment in the room prior to the patient’s arrival communicates that the person belongs. “Putting a patient in a room and then gathering the equipment and supplies you need to accommodate their size is a form of weight bias,” she says.
Bacon, who trains healthcare professionals in HAES, says that she encourages providers to take a weight-neutral approach when
MARKETING TO THE FAT COMMUNITY Activist and author Marilyn Wann believes that urgent care centers are a natural fit for fat patients who don’t have a medical home. “Urgent care centers can affordably tweak their practices to be both welcoming to and effective for fat patients,” she says. Once an urgent care center’s physical and attitudinal barriers to bias-free care have been surmounted, Wann advises that owners and operators get the word out to the fat community by:
1. Doing outreach in your area and online. Be on the lookout for social events (often advertised as BBW gatherings), plus-size clothing swaps, fat swim clubs, plus-size dance troupes, and so forth. Facebook has myriad fat communities, some of which are location-specific and some of which are not. Wann warns, though, that urgent care centers should “Be prepared, and know that advertising a weight loss program will not get a positive response.”
2. Obtaining a listing on FatFriendlyDocs.com. FatFriendlyDocs.com is the go-to resource for fat community members seeking unbiased healthcare. According to Founder Stef Maruch, “I would be delighted to list facilities like urgent care centers.” Criteria for inclusion can be found on the site, but Maruch says that the minimum benchmark “is that a health professional does not push weight loss on their patient if the patient says they don’t want to pursue that option.” Maruch accepts self-referrals. Send an email to firstname.lastname@example.org with the subject line, “FFP Submission.” In the body of the email, include the urgent care center’s name, city, state, and URL.
3. Joining the Association for Size Diversity and Health. ASDAH (www.sizediversityandhealth.org) maintains a searchable database of healthcare professionals who are members and Health at Every Size experts that is accessed by the fat community members in search of providers.
FOR MORE INFORMATION Body Respect: Linda Bacon, Ph.D. and Lucy Aphramor, Ph.D. are the authors of Body Respect: What Conventional Health Books Leave Out, Get Wrong, or Just Plain Fail to Understand about Weight (2014, BenBella Books, ISBN 978-1940363196). Intended for healthcare professionals, Body Respect is built upon peer-reviewed research and is grounded in the notion that health is intertwined with social justice and that healthcare must be steeped in compassion.
Training Bacon and Aphramor also conduct Health at Every Size (HAES) training workshops for those in the healthcare field. “HAES starts from respecting people as they are in the body that they are in, instead of viewing theirs as a body we need to change,” Bacon says. Find more information at www.thebodypolitic.biz/training/
Webinars: The Association for Size Diversity and Health offers HAES curriculum and webinars. Visit the “HAES Approach” section of www.sizediversityandhealth.org working with fatter patients. “Think about what kind of advice you would give someone in a thinner body,” she says. Using the example of joint pain, Bacon says, “If proper stretching and strengthening helps thin people with joint problems, that would work just as effectively in a fatter person.” Acknowledging the challenges inherent in having a fat body is also critical for delivering quality care to fat patients. When encouraging a patient to exercise more, Bacon says, “Recognize that going to a gym would not be a pleasant experience because of fat shaming. You have to support them in a world that doesn’t support fatter people exercising.” When it comes to engaging the patient in a discussion about weight loss, Wann advises treading carefully. “Providers should not offer or push weight loss treatment,” she says, “especially if that’s not the reason for the visit, and especially if people don’t want to hear about it.” Wann and Bacon both challenge the idea that weight loss can be sustained. “Weight loss triggers compensatory responses in the body, and the weight is regained,” Bacon says. “It’s time to throw out the idea that eating less and exercising more is an effective health practice.” All the same, Bacon acknowledges that many healthcare professionals have an entrenched belief that being fat is unhealthy and that permanent weight loss is possible. “There are very high levels of weight stigma among people who go into this field,” she says. “The levels are higher in healthcare professionals than in the general population.” UrgentCareMagazine.com
IDENTIFYING WEIGHT BIAS Researcher and author Dr. Linda Bacon says that most people in our society have a bias against fat people – even when they consciously try not to discriminate. “People aren’t always aware of the judgment that might be in their eyes when they see a fatter person,” she says. Project Implicit (https://implicit.harvard.edu/implicit/) offers the Weight Implicit Associations test, which can help identify unconscious biases against fat people. “When you’re aware of your bias, you can watch for it and protect against it,” Bacon says.
Yet even if medical staff members believe that fatter patients have greater health risks, Bacon says that telling the patient that there’s something wrong with their body isn’t helpful. “Think about what it must be like to go through life hearing the message that your body is a sign of failure,” she says. “If you don’t like yourself, it’s hard to take care of yourself.” She says that fat patients anticipate getting a weight loss lecture, which is why they delay or avoid receiving medical care. Wann says that most fat people have tried many different weight loss treatments without success. “If you focus on a patient’s weight, you will probably never see that patient again,” she says. “It’s not because we’re sensitive about the subject. It’s not because you’ll hurt our feelings. It’s because we know better.”
Clinics in Hiding?
Emergency room physician Chase and a handful of other fat patients interviewed for this story related positive, unbiased experiences at urgent care centers. Edna Yang*, a school librarian, said, “The urgent care center near my house has treated my strep throat, cellulitis, a UTI, and migraines without ever mentioning my weight.” Yet Yang asked that we not contact the center for comment. “I don’t want them to stop treating me so well,” she said. Yang’s concerns might not be misplaced. Three urgent care centers recommended by fat patients were contacted multiple times for comment, and none returned calls. While body positivity may be surfacing in the collective consciousness, unconscious bias could be depriving urgent care centers of a significant revenue stream. “Urgent cares could corner the market in their area by publicizing that larger patients can get care without shaming,” Chase says. “It would be a goldmine.” ■
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The Big Picture INVEST IN A DIGITAL X-RAY SYSTEM THAT’S A GOOD FIT BY CHERYL MCCARRON
rgent care facilities address an important need in the healthcare market by providing daytime and after-hours care for ill or injured patients with non-life-threatening conditions. X-ray systems – along with other diagnostic technologies – are a vital tool for physicians to assess a patient’s condition in order to determine the appropriate treatment. An urgent care facility typically has only one X-ray room, so it needs to be highly productive to reduce wait times and handle peak volumes that occur at random intervals. Digital radiography (DR) is the technology of choice because it provides high-quality imaging of all areas of the body and makes images available in as little as five seconds. Choosing a DR supplier and an X-ray system requires careful evaluation. Urgent care clinics need a supplier that has established a reputation for providing reliable, high-quality DR systems as well as excellent service and support. MD Buyline (and other organizations) poll hundreds of users to create rankings of imaging systems for topics including performance, reliability, service, and support. Their report can be a valuable tool because it involves user input and is created by a company whose success depends upon its independence from any vendor. Once several systems have been selected for evaluation, it’s time to visit facilities that have these systems in place and talk to
users. Prior to making these visits, the X-ray imaging team should make a list of the most common – and most challenging – types of exams they perform and rate each system for its ability to provide both quality and productivity for these studies. Most urgent care centers need an X-ray system with both a wall stand and table to capture the wide range of exams that may be required. These systems can have either one detector that moves between the table and wall stand or two detectors. While it’s faster and more convenient to have two detectors, this also involves additional cost. Another important element is the X-ray tube. A floor-mounted tube can both lower costs and speed installation time, and is appropriate for many urgent care centers. A ceiling-mounted tube requires bolting the tube mounting system to structural steel supports in the ceiling. While this is more expensive, it enables greater flexibility because the tube can be moved away from the table to image patients who may be in wheelchairs or who cannot be easily moved onto the table. As with any major purchase, the key investment is the time spent researching options, determining must-have features, and talking with others who use the systems under consideration. The right DR system can streamline urgent care center operations while supporting the bottom line. ■
Cheryl McCarron is Carestream’s regional business manager of X-ray Solutions
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