In Practice Urgent Care

[FulfilledDeer]

Hi everyone,

I'm not very versed in pediatrics practices (I'm an M-1) but I had a thought I was hoping people with more exposure than me could comment on. A couple of weekends ago I was in the Peds ED at my school and every single case I saw seemed to be something that could have been handled at their primary care location, but it was night/the weekend. So, assuming you have someone willing to take the job, what is the feasibility of staffing a private practice overnight for urgent care? There's a big part of me that says it has a lot of benefits over an ED visit, for practically everyone involved, but I don't know if I'm just missing something.

Not that I'm necessarily interested in practicing this, but it seems like a really good niche that I've never heard of.

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[Vita]

Hi everyone,

I'm not very versed in pediatrics practices (I'm an M-1) but I had a thought I was hoping people with more exposure than me could comment on. A couple of weekends ago I was in the Peds ED at my school and every single case I saw seemed to be something that could have been handled at their primary care location, but it was night/the weekend. So, assuming you have someone willing to take the job, what is the feasibility of staffing a private practice overnight for urgent care? There's a big part of me that says it has a lot of benefits over an ED visit, for practically everyone involved, but I don't know if I'm just missing something.

Not that I'm necessarily interested in practicing this, but it seems like a really good niche that I've never heard of.

Do you mean an urgent care only for Pediatric patients? In my part of the country, Urgent care places are popping up everywhere to prevent overuse of the ER. Most of these places are like the general ED - aimed at all patients of all ages. However, when I was interviewing, several of the residency programs spoke of Pediatric specific urgent care. I know some places allow residents to moonlight at these urgent care facilities overnight in their third year.

 

[FulfilledDeer]

Do you mean an urgent care only for Pediatric patients? In my part of the country, Urgent care places are popping up everywhere to prevent overuse of the ER. Most of these places are like the general ED - aimed at all patients of all ages. However, when I was interviewing, several of the residency programs spoke of Pediatric specific urgent care. I know some places allow residents to moonlight at these urgent care facilities overnight in their third year.

So....not exactly. When I say urgent care I'm mostly referring to the severity and type of cases not "Urgent Care" the freestanding building. Like I come up to Dr. Vita (with private practice) and say "I'll be here in your building from 8 pm - 6 am to take care of anything that is urgent, but not an emergency that comes up in those times, or if there's leftover urgent cases that couldn't be fit in during the day".

Even though it's a similar idea, the problem with "Urgent Care" is they're not usually 24 hrs, you don't have your records/people have grown to trust/familiar place, and the exorbitant fees they charge.

 

[Slade]

It sounds like a great idea, except for a few issues. The problem is visits would probably be very irregular - ie 5 visits one night, none another, 40 the next. You would probably still need a nurse to help out (for those 40-patient nights). You would get reimbursed at normal Pediatrician office visit rates, so I'm not sure this would be profitable (or even net zero) for the practice.

 

[DoctwoB]

It sounds like a great idea, except for a few issues. The problem is visits would probably be very irregular - ie 5 visits one night, none another, 40 the next. You would probably still need a nurse to help out (for those 40-patient nights). You would get reimbursed at normal Pediatrician office visit rates, so I'm not sure this would be profitable (or even net zero) for the practice.

True, but as an urgent care center you can likely charge higher copays or even refuse insurance entirely due to reduced competition for urgent care services compared to general ED service. An extra $20 per visit is still a lot cheaper then going to the ER.

 

[Socrates25]

True, but as an urgent care center you can likely charge higher copays or even refuse insurance entirely due to reduced competition for urgent care services compared to general ED service. An extra $20 per visit is still a lot cheaper then going to the ER.

Depends on the payor mix and how many Medicaid patients are in the area. Many states have Medicaid co-pays for the ER of $0. This virtually guarantees that Medicaid patients will use the ER as their primary care doctor. Hell in some states the Medicaid co-pay is HIGHER for the PCP than it is for the ER!

 

[Socrates25]

Hi everyone,

I'm not very versed in pediatrics practices (I'm an M-1) but I had a thought I was hoping people with more exposure than me could comment on. A couple of weekends ago I was in the Peds ED at my school and every single case I saw seemed to be something that could have been handled at their primary care location, but it was night/the weekend. So, assuming you have someone willing to take the job, what is the feasibility of staffing a private practice overnight for urgent care? There's a big part of me that says it has a lot of benefits over an ED visit, for practically everyone involved, but I don't know if I'm just missing something.

Not that I'm necessarily interested in practicing this, but it seems like a really good niche that I've never heard of.

You're not missing anything -- this is definitely a big area for potential growth and a good practice opportunity. We have several pediatric-only late night urgent care centers in the area.

Caveats:

1. It has to be in a big city area. There arent enough patients to keep this kind of practice sustainable in a mid-size city or smaller unless you treat both kids and adults.

2. It will be difficult to find nursing/office staff willing to work late nights. You'll probably have to pay them more than you would if they were working a day job.

 

[Socrates25]

It sounds like a great idea, except for a few issues. The problem is visits would probably be very irregular - ie 5 visits one night, none another, 40 the next. You would probably still need a nurse to help out (for those 40-patient nights). You would get reimbursed at normal Pediatrician office visit rates, so I'm not sure this would be profitable (or even net zero) for the practice.

You can plan for that -- daytime pediatric practices are exposed to the same time variance of patients. Sometimes I'll see 30 patients a day in the wintertime but in the summer it is usually 12-15.

You can plan your way around that because it will be seasonal-based. You can hire temp workers during the busy winter months to help out.

 

[FulfilledDeer]

You're not missing anything -- this is definitely a big area for potential growth and a good practice opportunity. We have several pediatric-only late night urgent care centers in the area.

Caveats:

1. It has to be in a big city area. There arent enough patients to keep this kind of practice sustainable in a mid-size city or smaller unless you treat both kids and adults.

2. It will be difficult to find nursing/office staff willing to work late nights. You'll probably have to pay them more than you would if they were working a day job.

Thanks for responding everyone!

Socrates, are you saying in #1 that this most likely wouldn't work in a single practice environment, or more that the practice would have to be in a bigger city? I'm specifically not thinking about a stand alone urgent care center but more as part of an existing practice. From the patient side, even taking money out of the situation, I would rather go to my child's pediatricians office (especially because of the implied trust) and further down that list would be the ED. I would probably rank urgent care below that.

 

[nogolfinsnow]

I think I get what you're saying; basically you go to Dr. X and say "I'll staff your clinic from 6pm-8am, and your patient panel can come here instead of going to the ED or the local U.C. clinic." It might work depending on the clinic you picked. I train at a free-standing Children's hospital that gets around 40,000 ED visits per year, a huge chunk of which are primary care complaints. Our ED even has a triage system that shunts the less acute kids to an area staffed by general pediatricians instead of ED docs. It's busiest between 6pm and midnight, and doesn't stay open all night because business usually drops off around 1-2am, even in the winter. The majority of kids have public insurance ($0 ER copay), and come b/c that's when the parents get off work or when the working parent who has the 1 car gets home. The kids with private insurance I think are often able to get into their clinics during the day. So maybe if you could figure out which clinics had lots of kids going to the ED in the evenings, you could get on to run an "evening urgent care clinic" so that clinic could get paid instead of the hospital. Interesting thought.