Walk (in) This Way

About ten 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 (my training is 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 9:00 a.m. every weekday morning. We went on to add an evening walk-in clinic from 5:30 p.m. to 7:00 p.m. every weekday evening as well as Saturday morning hours.

This turned out to be one of the smartest decisions we ever made. Here's why:

• 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 visit (99214) and takes between fifteen and twenty minutes to see. Clearly the profit margins are higher on the 5 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 5-physician practice).

• About 20 percent of our patients come in repeatedly for chronic care. They don't seem to mind either waiting for available appointments or waiting when they do come in. However, the other 80 percent only occasionally need care. They want an appointment when a problem arises -- one that fits in with their schedules as best as possible. 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 to friends from bragging about these clinics is a very good source of new patients in the practice. Plus, since most other practices are not doing this type of clinic, the patients are very dissatisfied with other practices if they do leave us.

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

• Define the quick-sick visit. Post rules for specific types of walk-in visits, 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 recheck. If patients object to these terms, then say: "Your problem is too important to be given only 5 minutes. Let us 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.

Watch both your patient satisfaction and your revenue skyrocket after implementing a walk-in clinic. An 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, Georgia. He is board certified in internal medicine and pediatrics and specializes in the care of adults, pediatrics, diabetes, high blood pressure, asthma, preventative 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 rob.lamberts@gmail.com.