Opening an Urgent Care/Walk In Clinic

[NYYk9005]

Hey all,

I am wondering whether or not EM physicians open up their own Urgent Care/ walk in clinics, and how well they do?

I know working in the ER is mire lucrative than working in walk in clinics, but if you were to have your own clinic, how would that compare? Do EM docs stay away because they hate all the busy paperwork stuff, because they thirst for major emergencies you won't see there, or is it a financial reason?

I was hoping I could work in an ER until I "burnout", and then open my own walk in clinic which will be relatively lower on the stress meter.

Does anyone know the compensation of having your own walk in clinic vs having your own primary care place?

Thanks all!

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[Hercules]

Yes, we open up urgent cares. They do well financially if they are properly planned out and run well. You will trade one set of stressors as an ED physician for another set of stressors as a small business owner. There is not much money to be made in working in an urgent care. There is a lot of money to be made in owning a successful urgent care.

 

[DPCsoon]

Heaven help the urgent care business model the day after they outlaw giving antibiotics for viral illness...

 

[TrumpetDoc]

^Imagine the underground cash market for azithro!! 😉

 

[Hercules]

Heaven help the urgent care business model the day after they outlaw giving antibiotics for viral illness...

Taking away my steroid shot would be even worse for us probably. I think the steroid shot is actually listed somewhere in the patient Bill of Rights.

 

[deleted6669]

They do well financially if they are properly planned out and run well. There is a lot of money to be made in owning a successful urgent care.

agree. I sometimes do shifts at a local urgent care which is run almost like a free standing e.d. with many of the same services. I have access to the billing info. Charges for patients seen by me ( I am one of 4 providers) can be almost 100k/DAY (this includes xray, lab, nursing fees, medications, etc). I'm sure they aren't COLLECTING 100 k/day/provider but even if it's only 25% of that (x 4 providers) they are doing ok. there certainly is overhead for equipment, receptionists, security, etc above& beyond what the clinicians make but that is still a crap load of money. they make enough that they can buy worthless toys like VOCERA, etc which no one uses.

 

[deleted6669]

agree. me sometimes do shifts at a local urgent care which is run almost like a free standing e.d. with many of the same services. me have access to the billing info. Charges for pateints seen by me ( me are one of 4 providers) can be almost 100k/DAY (this includes xray, lab, nursing fees, medications, etc). me are sure they aren't COLLECTING 100 k/day/provider but even if it's only 25% of that (x 4 providers) they are doing ok. there certainly is overhead for equipment, receptionists, security, etc above& beyond what the clinicians make but that is still a crap load of money. they make enough that they can buy worthless toys like VOCERA, etc which no one uses.

are the changes in text all of the forums today a 4/1 joke? it's actually kind of annoying having "me do" end up places that it was not intended.

 

[Hercules]

agree. me sometimes do shifts at a local urgent care which is run almost like a free standing e.d. with many of the same services. me have access to the billing info. Charges for pateints seen by me ( me are one of 4 providers) can be almost 100k/DAY (this includes xray, lab, nursing fees, medications, etc). me are sure they aren't COLLECTING 100 k/day/provider but even if it's only 25% of that (x 4 providers) they are doing ok. there certainly is overhead for equipment, receptionists, security, etc above& beyond what the clinicians make but that is still a crap load of money. they make enough that they can buy worthless toys like VOCERA, etc which no one uses.

I don't know how many patients you're seeing or how they are calculating charges but I can tell you there is a major math breakdown sow nowhere in the numbers you're using. The national average for UC charges per patient is somewhere around $300 and the collected $$$/pt is in the $100-$130 range. If you were generating $100k in charges a day you would be seeing 333 pts/day. And with three other providers, the facility would be seeing over 1300 pts/day. If that's the case, I tip my hat.and hope you are being compensated incredibly well.

 

[deleted6669]

our "walk in the door charge" is 250 dollars. it only goes up from there. IV start: 100 dollars. each liter of fluid or IV med, 100 dollars. procedures $$$.
typical bills for folks with any kind of work up at all are several thousand dollars. as above, it is run much like a free standing E.D. and is hospital affiliated.
large medicaid population so collections are significantly less than billing.
my 100k figure is for a double shift of 16 hrs in which around 40 patients are seen for an avg cost of 2500 dollars each. as that is an avg, there are folks in the 500 dollars range( exam + strep + abx) and folks in the 5000 dollar range (complex lac repair with iv abx and xray).
not making these #s up.

 

[iish]

Are you guys telling me that UG centers can make their owners in the $10+ million range?

 

[Hercules]

our "walk in the door charge" is 250 dollars. it only goes up from there. IV start: 100 dollars. each liter of fluid or IV med, 100 dollars. procedures $$$.
typical bills for folks with any kind of work up at all are several thousand dollars. as above, it is run much like a free standing E.D. and is hospital affiliated.
large medicaid population so collections are significantly less than billing.
my 100k figure is for a double shift of 16 hrs in which around 40 patients are seen for an avg cost of 2500 dollars each. as that is an avg, there are folks in the 500 dollars range( exam + strep + abx) and folks in the 5000 dollar range (complex lac repair with iv abx and xray).
not making these #s up.

Not saying you are making the numbers up but it sounds like the charges are likely significantly out of
line with the collections. You can always charge whatever you want but you're only going to get paid the contracted amount with your contracted insurers. For example, If BCBS is only paying $140 for a level 4 and another $20 for your IM decadron, you can submit a $2500 charge but you'll still only collect $160. It also sounds more like a freestanding ED than an UC if you're charging $2500/pt.

And no, no one is saying you will make $10M/yr off of owning one urgent care.

 

[deleted6669]

Yup, I'm sure collections are probably 10-20% of billing.

 

[styphon]

Taking away my steroid shot would be even worse for us probably. I think the steroid shot is actually listed somewhere in the patient Bill of Rights.

I had a patient once state "The constitution guarantees opiates for anyone who wants them"

 

[Arcan57]

Yup, I'm sure collections are probably 10-20% of billing.

It sounds (based on your numbers) like you are billing as a free-standing and collecting facility fees for the testing you're doing. That's a very different model then an UC.

 

[scummie]

I had a patient once state "The constitution guarantees opiates for anyone who wants them"

Duh, don't you know patients have the right to order anything they want?

Once had a patient request "late check out."

 

[Cerberus]

For those who own an Urgent Care, can you give me a ballpark figure of startup costs, how you funded it, and your take away income? Is it worth it? I'm looking for a way to start investing and like the idea of owning my own business (I have no intention of actually working in a UC, just considering prospects of starting one).

 

[USCDiver]

Cerberus, send me a PM

 

[Hercules]

For those who own an Urgent Care, can you give me a ballpark figure of startup costs, how you funded it, and your take away income? Is it worth it? I'm looking for a way to start investing and like the idea of owning my own business (I have no intention of actually working in a UC, just considering prospects of starting one).

Start up costs will be highly variable. Are you buying or leasing the location? Banks are more than happy to finance you. Take away income will obviously depend on how many patients you see and what your average collections are. You're going to have to work in it at some point. The typical plan for those of us who want to own but don't want to work them involves opening it up, staffing it yourself for a while, and then hiring other physicians to staff it once you have it up and running. They can be very profitable.

 

[fuegofrio17]

Forget Urgent Cares--the true opportunity is in Freestanding ERs. California will most likely pass legislation in the near future in support of independently owned FSERs (pending ACEPs new president). Prepare for the next Gold Rush...

 

[Cerberus]

Start up costs will be highly variable. Are you buying or leasing the location? Banks are more than happy to finance you. Take away income will obviously depend on how many patients you see and what your average collections are. You're going to have to work in it at some point. The typical plan for those of us who want to own but don't want to work them involves opening it up, staffing it yourself for a while, and then hiring other physicians to staff it once you have it up and running. They can be very profitable.

Did you do start yours yourself or with a group? Did you just get started with loans or did you seek out investors? How did you get started? I have been reading what I can find about the market but there is enough that I don't know from the business side, that I am considering getting an MBA.

 

[Hercules]

Did you do start yours yourself or with a group? Did you just get started with loans or did you seek out investors? How did you get started? I have been reading what I can find about the market but there is enough that I don't know from the business side, that I am considering getting an MBA.

I started mine up with 4 other partners in my EM group. Had offers from investors (hospital) but there is really no benefit to you whatsoever in having investors who can't pull shifts and staff it. It's a mistake-- money is easy to come by but your time will be in short supply. Banks are more than happy to loan the $1M-3M you need as long as you have a tight business plan and you won't have given away any of the ownership.

I got started by doing a lot of research and listening to a lot of lectures. UCAOA had a good start up lecture series. Then pick your location. You do not need an MBA to do any of this. I've kicked around picking one up but haven't been able to justify the cost or time so far (though I would love to hear from others on here who did go ahead and pursue their MBA). An MBA can be helpful to open certain career doors but owning an urgent care isn't one of them.

 

[Restart13]

I started mine up with 4 other partners in my EM group. Had offers from investors (hospital) but there is really no benefit to you whatsoever in having investors who can't pull shifts and staff it. It's a mistake-- money is easy to come by but your time will be in short supply. Banks are more than happy to loan the $1M-3M you need as long as you have a tight business plan and you won't have given away any of the ownership.

I got started by doing a lot of research and listening to a lot of lectures. UCAOA had a good start up lecture series. Then pick your location. You do not need an MBA to do any of this. I've kicked around picking one up but haven't been able to justify the cost or time so far (though I would love to hear from others on here who did go ahead and pursue their MBA). An MBA can be helpful to open certain career doors but owning an urgent care isn't one of them.

I think that's awesome that you went out and did that. I know I have an entrepreneurial itch, and owning/being a partner in an urgent care is something I'd definitely look into in the future.

Just one question about location; Are you opening one up in rural areas without any other urgent cars nearby? Or are you openly competing against other existing urgent cares? I live in a major metropolitan area and I imagine that the supply of urgent cares probably meets the demand already (as I would guess in most major cities/suburbs). I guess an alternative is to buy into a group owning an urgent care and go from there.

 

[MDROBIN001]

I work at an urgent care clinic. I brought my 1 year old son as a pt, who had a bad cough. He has Blue Grass BlueShield insurance.. I gave him abx and Dex IM shots.. the bill was over $500 for that visit.. the insurance paid most of it except for $65..

 

[Hercules]

I work at an urgent care clinic. I brought my 1 year old son as a pt, who had a bad cough. He has Blue Grass BlueShield insurance.. I gave him abx and Dex IM shots.. the bill was over $500 for that visit.. the insurance paid most of it except for $65..

Sometimes the EOBs can be a bit misleading. Their charges may have been over $500 but I assure you that your insurance did not pay $400+ for that visit. There is a large portion written off as a result of the UC's contract with your insurance company.

 

[Hercules]

I think that's awesome that you went out and did that. I know I have an entrepreneurial itch, and owning/being a partner in an urgent care is something I'd definitely look into in the future.

Just one question about location; Are you opening one up in rural areas without any other urgent cars nearby? Or are you openly competing against other existing urgent cares? I live in a major metropolitan area and I imagine that the supply of urgent cares probably meets the demand already (as I would guess in most major cities/suburbs). I guess an alternative is to buy into a group owning an urgent care and go from there.

There are 3 other UCs in our suburban catchment area.

Buying in will likely not be a good option because there's no real reason to let someone buy in once you're already successful with little risk of failing. I if I were to offer someone a buy-in it would be at a double digit EBITDA multiple.

 

[MDROBIN001]

Hercules, I believe the owner of the clinic told me something similar to what you were saying , and I believe that's true for almost all the health insurance..I've also heard that Medicare won't pay not even half of the visits charges

 

[USCDiver]

At the Urgent Care I own, we offer a Cash Pay "discount" to our uninsured patients that is similar to our contracted insurance reimbursements if they pay the whole thing before they leave. Otherwise they get a bill for the whole $500 or whatever visit.

 

[BAM!]

Forget Urgent Cares--the true opportunity is in Freestanding ERs. California will most likely pass legislation in the near future in support of independently owned FSERs (pending ACEPs new president). Prepare for the next Gold Rush...

where have you heard this?

 

[MDROBIN001]

At the Urgent Care I own, we offer a Cash Pay "discount" to our uninsured patients that is similar to our contracted insurance reimbursements if they pay the whole thing before they leave. Otherwise they get a bill for the whole $500 or whatever visit.

I do the same with the urgent care I own.. although 2 IM shots and one X-ray is included