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Orthopedic prompt-care clinics can add to your practice coverage, income
After-hours care uses existing facilities and can become an integral part of an orthopedic practice.
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We are pleased to present this roundtable to our readers. Prompt-care clinics will be a new concept for many of you. Our objective: to offer a new idea along with some pragmatic suggestions for incorporating it into your practice if you choose to do so. We also hope to provide enough information to allow you to tailor the concept to your own operations, or to follow up in more detail. I have selected the panelists because they are individuals with some practical experience in this new ancillary service. (For more insight into my thinking on this topic, please see my editorial ).
Douglas W. Jackson, MD
Moderator
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Douglas W. Jackson, MD: What is a “quick clinic?”
Cary B. Edgar, JD, and Hilary Hellman, ACS: A “quick clinic” is one of the terms for a walk-in clinic located in a supermarket, drug store or “big box” chain store that provides treatment for strep throat, ear infections, common allergies and similar non-serious conditions.
Jackson: How do they differ from “prompt care?”
Edgar and Hellman: In contrast, an orthopedic prompt care clinic (OPCC) is typically incorporated into an orthopedic physician’s office and offers prompt care for fractures, dislocations, strains, sprains and similar injuries.
A well-qualified physician’s assistant (PA) provides much of the primary care with physician backup.
As compared to a “quick clinic,” an OPCC provides much more skilled and specialized care.
Jackson: Are OPCCs successful? How do they relate to the traditional orthopedic clinic or office?
Edgar and Hellman: OPCCs are not widespread, so it is difficult to judge their success to date. However, a number of OPCCs around the country have done well and are regarded as an integral part of the orthopedic practice.
Jackson: What are the facility/space requirements?
Edgar and Hellman: In terms of equipment, an OPCC needs access to X-ray, casting space and equipment, and at least one private exam room. If an OPCC is added to an orthopedic practice by initially extending office hours (eg, 9 p.m. on weekdays and 9 a.m. to 2 p.m. on Saturdays), no additional space or equipment is necessary assuming X-ray facilities are onsite.
If an orthopedic group wishes to provide OPCC services throughout the weekdays (eg, 8 a.m. to 9 p.m.), it should dedicate separate space to the OPCC that includes a small waiting area, front desk, cast room and equipment, X-ray room and private exam room. These facilities will require from 1,500 to 2,000 square feet that is ideally located adjacent to the physician’s office or surgery center.
Jackson: What type of personnel are required? What are their qualifications?
Edgar and Hellman: An OPCC clinic is typically staffed with a PA, X-ray tech and receptionist/aide. The PA should have the qualifications discussed below. The receptionist should be able to work on his or her own at the OPCC front desk and should be able to provide unskilled assistance to the PA with patients.
Jackson: What special compliance issues exist at the federal, state and local levels?
Edgar and Hellman: If the OPCC is simply an extension of the physician practice, no additional federal, state or local license should be necessary. However, many states require urgent care clinics to be licensed or have special regulations. Therefore, you should check your state and local laws to determine whether your OPCC clinic may be classified as an urgent care clinic and, if so, what the ramifications may be.
Jackson: What are the marketing techniques used in getting started?
Edgar and Hellman: Many OPCC patients are referred from primary care physicians, especially pediatricians. Your marketing techniques may include a one-page letter to your current referral sources notifying them that you are adding OPCC services. This letter should include an explanation of the conditions that will be treated, hours, direct phone number and other basic information.
Jackson: What are the basic finance/reimbursement issues?
Edgar and Hellman: The financial model for OPCC is very simple. Many of the services are covered by insurance and will be paid per your fee schedule with the insurer. For patients paying cash, you can base a fee schedule on prevailing, yet affordable, rates in your community. Expenses primarily consist of staff compensation, additional equipment (if necessary), space/utility costs and supplies.
Jackson: What are the qualifications of the individual who is screening and assisting in treating the patients?
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Thomas A. Frosini, RPA-C: At Greater Rochester Orthopaedics, PAs perform the initial screening and treatment. The PA must be licensed in the state where he/she is practicing and have the appropriate type of malpractice coverage. In addition, it is required that the PA have at least 3 to 5 years of experience in orthopedic care.
Jackson: How are the medical legal aspects covered and problems prevented?
Frosini: In addition to the PA, each patient is assigned to an attending orthopedist who is responsible for supervising the care provided by the PA.
Additionally, all X-rays taken and read after hours by a PA are reviewed the following morning by the assigned orthopedists and notes are co-signed by an attending/supervising orthopedist.
The on-call orthopedist becomes the PA supervisor when an orthopedist is not in the office. You also need to be sure you have the appropriate malpractice coverage, allowing the PA the flexibility of attending to patients without requiring onsite physician supervision.
Jackson: What is the compensation range for the orthopedic PA?
Frosini: It would range from $65,000 to $85,000 yearly, plus bonus. However, experience and location may play a role in that figure.
Jackson: How hard is it to find a qualified individual?
Frosini: It can be difficult to recruit a qualified orthopedic PA who is comfortable working in this type of semi-autonomous environment. The PA should have 3 to 5 years experience providing orthopedic care.
I have learned that the quality of the PA’s role has a direct and significant influence on the pool of qualified candidates.
Be sure that he or she are experienced in and can perform each of the required job tasks (eg, is the PA experienced in casting and reducing and can he or she actually apply the required cast for treatment?). I recommend performing a preemployment skills assessment.
Jackson: What types of individuals or services are needed for starting a clinic?
Albert Campagna: At greater Rochester Orthopaedics, we started our after-hours “urgent care or prompt care” program with: 1 part-time PA with approximately 3 years orthopedic experience; a part-time X-ray tech; and a part-time receptionist. We offered these services as an extension of our daytime services. However, appointments were not scheduled prior the start of “after hours.” The after hours were reserved for patients referred by their primary provider for urgent or emerging orthopedic conditions. Our marketing was geared entirely towards primary care physicians.
Jackson: What volume of patients is necessary for the clinic to be financially successful?
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Campagna: In our case, we looked at the incremental cost of operating each 3-hour prompt care session. We determined that it would only take an average of three referrals per evening to cover the incremental cost of offering this service. It took about 6 months to achieve this level consistently.
However after 3 years, the after-hours prompt care referrals averaged 10 to 12 per 3-hour session. In the past 2 years, the demand grew so high, that we currently operate prompt care hours Monday through Friday, 8:30 a.m. — 9 p.m. and Saturday from 9 a.m. — 2 p.m. We have dedicated a 1,700 square foot area, with X-ray and casting capability to our urgent care services.
Staffing includes a full-time PA, a full-time radiological technologist and a full-time receptionist.
Jackson: How do these clinics interact with the local emergency room? (ie, referrals each way)?
Campagna: The only interaction we have with the emergency department (ED) is for orthopedic follow-up when our orthopedists are on ED call. Otherwise, most of our nonphysician interaction is with freestanding urgent care centers. These centers do not typically provide casting services or follow-up care. Therefore, they provide the initial assessment and, providing that the patient does not have an established relationship with an orthopedist, refer to our prompt care for follow-up and management.
Jackson: What compensation range is necessary for an administrator? Is it a full-time position?
Campagna: It our case, there is no additional compensation to the practice manager. The prompt care program is seamlessly integrated with the office. However, in our area, I think it would be $60,000 to $80,000 yearly. This would also depend on the scope of the operation, which would also determine whether the administrator would be full- or part-time.
For more information:
- Albert Campagna is with Greater Rochester Orthopaedics PC, 30 Hagen Dr., Suite 220, Rochester, NY 14625-2658. He can be reached at 585-295-5314, or acampagna@gro-md.com.
- Cary B. Edgar is with Ancillary Care Solutions, LLC, 6900 E. Camelback Rd., Suite 850, Scottsdale, AZ 85251. He can be reached at 480-481-1561, or cedgar@acare.us.
- Thomas A. Frosini, RPA-C, is with Greater Rochester Orthopaedics PC, 30 Hagen Dr., Suite 220, Rochester, NY 14625-2658. He can be reached at 585-295-5314, or tafrosini@gro-md.com.
- Hilary Hellman, ACS, is with Ancillary Care Solutions, LLC, 6900 E. Camelback Rd., Suite 850, Scottsdale, Ariz. 85251. She can be reached at 480-824-1562, or hhellman@acare.us.