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How Urgent Care Can Complement Medical Group Services

Thursday, July 6, 2017   (0 Comments)
Posted by: HealthLeaders Media
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Consider the six guidelines one system used to execute its plan to improve population health by strategically deploying urgent care facilities

Wellmont Health System, with seven hospitals and two medical groups serving a 23-county service area in Northeast Tennessee and Southwest Virginia, has its work cut out in caring for one of the least-healthy populations in the United States. Not only is the region in the nation's lowest 25th percentile in the incidence of chronic lung disease, obesity, stroke, diabetes, and hypertension, but the population also suffers from high rates of opioid dependence and neonatal abstinence syndrome. As part of its effort to improve the health of its patients through access to care, Wellmont set a goal to place an urgent care center within 30 minutes of every patient across its region. To date, the system has opened 12 urgent care centers, with 70% of them adjacent to a Wellmont Medical Associates (WMA) primary care office. WMA's leadership team has learned some critical lessons throughout its endeavor:

1.Use a common medical record throughout the system. "One patient, one record," is a must, according to Stephen Combs, MD, the health system's CMO. "It's really nice to be able to see if someone is overdue for an annual physical and help set that up. This positions our urgent cares as complementary to and not exclusive from primary care. Using one record also saves money by not having to repeat tests.

2.Adhere to standardized protocols. "No matter where you are in the country, it is important to have standardized patient care protocols," says Combs. "That goes along with our quality review, our interaction, and it's very satisfying for our urgent care providers."

3.Facilitate regular communication. The system's oversight process includes quality case reviews by the urgent care CMO and physician director of the emergency department, seasonal hot topic meetings to standardize and educate all urgent care providers and staff, and monthly calls with providers to disseminate education and go over trends. The trend review in particular has helped providers be on the lookout for serious conditions they may have otherwise missed, says Karen Williams, MBA, MPH, MGCHA, CHES, NHA, vice president and COO of WMA.

4.Don't steal patients from independent physicians. "If somebody does not have a PCP and we think they need more care, then a nurse makes them an appointment with one of our primary care offices while they're there," says Williams. "If they do have a PCP and we really think they need to go back there—even if it's one of the independent practices, we help them get an appointment with their physician so they can get the care they need."

5.Don't prescribe opioids, except in the case of an acute injury. All of the urgent care centers display signage explaining that they don't prescribe opioids, and providers receive scripting about how to respond to patients' pain. "If you come in with a bone sticking out, we'll prescribe you no more than three days' worth of pain medication," says Williams.

6.Don't overextend your employees. To ensure work-life balance for employees and keep turnover low, WMA found it critical to stick to a provider schedule of seven days on, seven days off. That said, the employees have been very adaptable to the cyclical nature of urgent care, says David Brash, FACHE, WMA's president and CEO. "We have also hired some float personnel, both providers and staff, when we see a spike in volume at a particular location. We've been able to manage through that without losing the focus on 55-minute turnaround time, and the satisfaction levels have not suffered during those periods of higher activity," he says.

Debra Beaulieu is the Senior Physicians Editor for HealthLeaders Media.


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