Starting a Primary Care Walk-In Clinic at an Academic Health Center Heather Holmstrom, M.D. David Serlin, M.D. University of Michigan Department of Family Medicine

Disclosures None to Report for any of the presenters

Objectives Learn the benefits of providing walk-in service to your patients Consider different staffing models Identify and implement measures to improve the quality of care provided

26,000 faculty, staff, students, trainees, & volunteers 3 hospitals with 990 beds, 45,000 stays annually 40 outpatient locations, 120 clinics, 1.9 million outpatient visits annually Research – $453 million annually Department of Family Medicine: 6 Clinics, 90+ Faculty, 75,000+ patients 26,000 faculty, staff, students, trainees, & volunteers 3 hospitals with 990 beds, 45,000 stays annually 40 outpatient locations, 120 clinics, 1.9 million outpatient visits annually Research – $453 million annually Affiliations – AAVA, ACOs, state-wide collaboratives, others Family Medicine: 6 Clinics, 90+ Faculty

Current State University of Michigan Health System had no ambulatory urgent/walk-in access Ambulatory sites did have various early evening and Saturday morning same day/scheduled appointments. Many patients using ED or outside urgent care clinics, leading to duplication of services, overtesting, and overtreatment Significant measured patient and physician dissatisfaction Health System had no plans to add services

Clinic Design Decisions Walk-In vs. Urgent Care Model Location and Hours of operation How to staff (providers and staff) Marketing ACLS certified, required to see any patient that comes in.

Walk-In vs. Urgent Care Model Regulatory requirements of Urgent Care are burdensome Goal to provide enhanced care for OUR patients

Location and Hours of Operation Central clinic location chosen to draw patients from all 6 sites Close proximity to radiology and lab services Pilot to start on Saturdays to increase non-traditional hours Overlap with AM clinic to take advantage of home site clinic staff

How to Staff Volume Dependent 2 Providers Most cost effective 1 physician and 1 Advanced Practice Provider (APP) 1 Medical assistant per provider 2 clerical staff(check in/check out/phones) 1 Nursing professional (LPN, RN) Cost, skillset, utilization

Marketing Posters in exam rooms Cards and small signs at checkout EMR portal message blast prior to opening Providers and staff at all sites educated and reminded On call faculty and residents paged with reminder on Friday night/Saturday morning Staff Nurse email reminder Friday afternoon Planned for a relatively soft opening given not sure of the demand.

Marketing Effectiveness Note, Not able to continue the AVS messaging Other includes Family members, and ????

Family Medicine Walk-In Clinic Opened January 3, 2015 Patient volume per shift ranged from 20-45 patients Noted a large rush at the beginning with tapering by the end of the afternoon

Who Came and From How Far?

Patient Satisfaction

Patient Satisfaction

Patient Satisfaction

Decreased ED and Outside Urgent Care Utilization Patients

Quality Metrics Shared EMR and PCP group allows performance of preventive and disease based services where applicable Immunizations Flu, Pneumonia, HPV, TDAP Management of chronic disease DM, HTN Screening services Cervical, colorectal, and breast cancer

Services Provided 7/4/15 – 11/12/15 CRC 10/34 Chlamydia 2/12 Pap 15/43 Flu Shot 40/232 HPV Vaccine 7/40 DM foot 7/9 DPOA 1/10

Business Case Clinic Financial Model vs. Dept. Model Limitations on academic health center revenues (no pathology or radiology)

Clinic Financial Performance January - June 2015 Revenue $113,192 Expense $114,123 Net Loss $931 Total visits 815

Department Financial Performance January – March, 2015 Revenue $25,476 Expense $22,000 Net Profit $3,476

Adjustments to Improve Clinic Financials Hire dedicated staff to reduce overtime 1 physician + 1 APP more economical Evaluate whether RN/LPN necessary and ultimately cut hours to 11-3 Adjust MA staffing to cover busier hours Reduced physician hours from 11-6 to 11-5 due to low utilization in the later afternoon

Future Considerations Expand service to Sundays, and consider weekday evenings Expand service to other primary care patients (Internal Medicine, Pediatrics, Med-Peds) Increase emphasis on quality metrics

Questions?