How to Open a New Urgent Care Center

April 28, 2016
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According to the American Academy of Urgent Care Medicine (AACUM), the number of urgent care centers in this country has increased 14 percent to 9,300 centers since 2008. And the results of a 2013 benchmark survey from The Urgent Care Association of America (UCAA) in which 83 percent of urgent care centers experienced growth, suggests these facilities aren’t just open to the public, they’re thriving.

According to the American Academy of Urgent Care Medicine (AACUM), the number of urgent care centers in this country has increased 14 percent to 9,300 centers since 2008. And the results of a 2013 benchmark survey from The Urgent Care Association of America (UCAA) in which 83 percent of urgent care centers experienced growth, suggests these facilities aren’t just open to the public, they’re thriving.

The fragmented urgent care market is drawing significant attention from providers and investors, with many planning on opening urgent care facilities in the next few years. In fact, according to Chad Pinnell, managing director of health care solutions at JLL, a commercial real estate services firm in Columbus, Ohio, “Clinics and related health facilities account for up to 40 percent of all new retail real estate transactions in some markets.”

As with any business model, considerable planning must go into opening one of these clinics. And, because of their unique service offerings, special considerations must be given before opening an urgent care center.

1. Determine the Structure of Ownership

Before any other decisions are made, the structure of ownership must be determined. Some states do not allow the corporate practice of medicine. This is to protect the integrity of medicine by keep it separate from the monetary interests of corporations and prohibits corporations from employing physicians.

In the state of New York, for instance, it’s a felony for an unlicensed individual to practice medicine (thankfully) and yet a corporation may not hold licenses to practice medicine. Ergo, in the state of New York, an urgent care center owned by a corporation may not employ physicians at the clinic. Alternatively, in Florida, a corporation, LLC or partnership may own an urgent care center and employ physicians at the facility.

It’s often a physician who decides to open a clinic, but when this is not the case, it’s important to understand whether or not the state where the clinic will be opened allows the corporate practice of medicine. Having said this, there are legal avenues that allow non-physicians to own and operate an urgent care center in a state that does not allow corporate practice. For instance, forming a medical holding company or a “friendly PC” model. This second model is where a physician(s) form a professional corporation (PC) under the state’s corporation laws. Non-physician owned companies can then contract with PCs. The PCs staff the center and the corporation provides management services.

2. State Licensure

Each state requires different licensing for healthcare facilities. Currently, Arizona is the only state that requires the licensure of urgent care clinics. Other states like Florida, that licenses healthcare clinics, may find that urgent care centers fall under this definition. As more urgent care centers open, more states will likely enact specific licensure requirements (replete with fees), so it’s best to check with the Department of Health in your state to determine your specific requirements.

Beyond state licenses, urgent care centers will require a CLIA certificate (or CLIA Certificate of Waiver) if it is going to offer clinical lab tests. There will also need to be an X-ray permit. Your state’s Department of Health or similar agency should be able to provide relevant information regarding the types of licenses and permits your clinic may require.

3. The Emergency Medical Treatment and Labor Act (EMTALA)

While urgent care centers are generally thought of as the place to go when you don’t need an emergency room, the fact is many will provide what some would consider emergency care – setting those broken bones for instance. Because of this, you may be wondering whether your new center must comply with the requirements of EMTALA.

The short answer is no. Under EMTALA, hospitals with dedicated ER departments must provide certain services to patients regardless of their ability to pay. Unless an urgent care center is owned in whole or part by a hospital, it is not subject to EMTALA and typically will not have to treat patients who cannot pay.

4. Reimbursement Considerations

Of course one of the biggest considerations of opening an urgent care center is to vet and contract payors for reimbursement. An urgent care facility can only be monetarily viable when it accepts reimbursements from insurance companies.

Be forewarned – getting your clinic on a payor’s approved list can be a lengthy process, so one of the first things you should do when planning to open an urgent care center is to contact the contracting departments of the insurance companies as well as government payors like Medicare, Medicaid, and TRICARE (for military benefits) and get the ball rolling.

5. Consider the Technology You’ll Deploy

Besides receiving quality care, one of the biggest concerns (AKA demands) your patients will have is continuity of care. Your urgent care center should be able to share information with patients’ primary care physicians regarding any treatment that was received in your facility. An EHR solution can make this incredibly easy.

Many out of the box systems were designed for hospital or physician office settings, so look for a solution that takes the unique needs of an urgent care practice in mind. You’ll want a solution that:

  • Expedites patient check-ins to ensure a smooth workflow
  • Charts multiple conditions at the same time
  • Integrates with X-rays and EKGs and other diagnostic equipment
  • Receives and analyzes lab tests
  • Automates referral systems
  • Is cloud-based so the technology is always up-to-date
  • Is certified by an ONC-authorized testing and Certification Body (ONC-ATCB)
  • Comes with ICD-CPT codes specific to urgent care
  • Comes with worker’s compensation templates and reports

While selecting the right EHR system for your urgent care center can seem like a daunting task, it will eventually save your clinic time, frustration and money. CureMD offers customized EHR solutions that may be tailored to the fast-paced and dynamic environment of an urgent care center. Contact CureMD today and let us help you provide your patience with the utmost care.

 

Opening an urgent care clinic will no doubt come with its own challenges as well as its own rewards. By considering these five steps, you’ll be well on your way to opening a local center that is economically viable.