Primary Care Medical Associates (PCMA), serving the city’s North Side, decided to buck the trend toward consolidation of medical groups and the urge to sell to a large health system. Their strategy is gutsy, and it entailed some trial and error — but it has been working out for them and could possibly work for you too.
Robert G. Perlmuter, MD., founder of PCMA and active internist states:
“We were really losing business to urgent care and walk-in clinics. We would rarely see people with a cold or a rash or an acute ankle sprain.”
Reacting to the proliferation of walk-in clinics at retail klonopin no prescription pharmacies and urgent care centers, the practice switched the early part of the workday to walk-in service five days a week. On weekdays from 8:00 to 8:45 AM, established patients can come in without an appointment for treatment of specific acute conditions, such as cold and flu symptoms, rashes, urinary tract infections, and sprained ankles. Appointments start at 9 AM Monday-Saturday.
PCMA started the walk-in program with a physician assistant, who then left shortly thereafter. Still, the practice kept the early-morning window free of appointments, despite reservations from some of the physicians.
“A lot of my doctors don’t really like doing walk-ins,” according to Perlmuter, who says they worry about getting a late start with patients scheduled for the 9-AM hour if walk-in business is heavy.
“The younger doctors like it. I like it.” Perlmuter himself had training in urgent care at a walk-in clinic during his residency at Northwestern University Feinberg School of Medicine.
Getting More Patients to Come
But the practice knew that you can’t rely on “build it, and they will come.” During winter 2013, when traffic was lagging during the first hour of the workday, the practice sent out a mailing to all of its established patients touting the walk-in hours, hoping to reinforce the value of having a regular primary care physician. Business for minor, emergent issues picked up almost immediately. On Mondays and days after holidays, the practice gets about eight walk-ins in that 45-minute period, Perlmuter reports. Other days, it varies between two and five patients.
Perlmuter says the practice may expand walk-in hours soon, though it will continue to limit this service to patients with whom the physicians already have a relationship. He says feedback has been “excellent” from walk-in patients, many of whom express a preference for seeing their own doctors to being treated by a nurse practitioner at a convenience clinic. However, Perlmuter is unsure whether the walk-in service has added much revenue.
What PCMA is doing apparently is not common among small, independent primary care practices. The Convenient Care Association (CCA), a Philadelphia-based trade group for retail clinics, says that there are more than 1800 retail convenience clinics nationwide, and that does not even count stand-alone urgent care centers.
“We are seeing more and more health systems partnerships nd collaborations with physician practices”, CCA Executive Director Tine Hansen-Turon says. About 40% of patients seen at convenience clinics do not have a “medial home” or regular primary care physician, according to Hansen-Turton. “We are strong referral partners for physician practices who want to build their practices but also have an off-hours retail clinic partner.”
PCMA does not have a partnership with any walk-in retai clinic. “I have not heard of many practices doing their own walk-ins, except community health centers” Hansen-Turton says.
For its part, the Urgent Care ASsociation of America, based pin Naperville, Illinois, reports that there are about 9000 facilities in the US that provide urgent care. About 35% are owned by physicians or physician groups Nearly one half focus on family medicine, and 94% have at least one full-time employed physician.\\
the organization does not have any data on how many small, independent practices have added way-in hours as an alternative e to opening a full-scale urgent care clinic. However, three quarters of the nation’s urgent care centers are located in suburban areas; just 15% are in big cities.
A Bold Tactic To Remain Independent
In another move intended to offer better customer service and more personalized care, Perlmuter added a concierge option in November 2012. About 70 people now pay $1800 annually ($150 a month) for immediate access to Perlmuter by cell phone or in the office during business hours, as well as an annual physical examination. (Additional visits are billed to insurance like any other patient encounter)
Concierge members get a minimum of 30 minutes with the doctor. “It’s what you want to do for everybody if you had the time, ” Perlmuter says.
Indeed, patients do respond to convenience and quick access. The Medical Group Management ASsociateion reported last hyear that “better-performing” physician practices on average see 10% of their patients during same-day appointments or as walk-ins–twice as many as those not considered better performers.
HVING THE CONCIERGE OPTION HAS BENEFITED THE PRATICE–EVEN THOUGH PERLMUTER IS THE ONLY ONE OF THE 6 PHYSICIANS PARTICIPAITING AND THE SERVICE HAS BEEN REVENUE-NEUTRAL FOR PRIMARY CARE MEDICAL ASSOCIATES, BECAUSE THE CONCIERGE VISITS TAKE EXTRA TIME WHEN HE COULD BE SEEING A HIGHER VOLUME OF PATIENTS.
“IT ESTABLISHES LOYALTY AMONG OUR OWN PATIENTS” HE SAYS. THE UP-FRONT FEE ALSO ELIMINATES THE ADMINISTRATIVE HASSILE OF BILLING INSURANCE FOR ROUTINE VISITS AND ASSURES THAT THE PRACTE WON’T HAVE TO CHASE SMALL RECEIBABLESONCE THE PATIENT WALKS OUT THE DOOR.
PERLMUTER IS THE ONLY ONE OF THE 6 PHYSICIANS OFFERING CONCIERGE CARE, BECAUSE ALL FIVE OTHERS ARE MOTHERS OF YOUNG CHILDREN.”THEY DO NOT WANT TO BE AVAILABLE 24 HOURS /DAYH, EVERY DAY, LIKE I AM” PERLMUTER SAYS. THE OTHER PHYSICAISN HAVE EXPRESSED AN INTEREST IN CONCEIRGE SERVICE WHEN THEIR CHILDREN ARE OLDER, HE ADDES.
In May 2014 Medscape interview Michael Tetreault, Editor-in-Cheiof of Conceirge Medicine Today and the Direct Primary Care Journal, said that there were nearly 4000 physicians “who are verifiably, actively practicing conerge medicine or direct primary care across the US, with probably another 8000 practicing under the radar”
PCMA, which Perlmuter started in 1988, has long been trying to innovate and stay on top of changes in the business of medicine. “We haven’t had pagers in years” says Perlmuter.
Where do EHRs Fit In?
The practice bought its first electronic health record system im 1998 and achieved stage 1 meaningful use in 2011, the first year of the federal EHR incentive program–something few small primary care practices did. “It reduces time spent looking for charts, labs, x-ray reports and other data” Perlmuter says.
As PCMA, like so many other practices, struggles to meet stage 2 standards this year, Perlmuter says he is considering bringing in scribes to help physicians document patient encounters in the EHR. “Im beginning to think that data entry is not the purview of the doctor”. (Through the end of June,a very small number of individual physicians nationwide had attested to stage 2, according to the Centers of Medicare & Mewdicaid Services, compared with more than 235,000 who ahd achieved stage 1.
Stage 2, which started this year for those who reached stage 1 in 2011, requires that physicians offer at least one half their patient population access to their individual medical records thru a secure, online portal. Plus a minimum of 5% of patients must actually use a portal to download their records or securely communicate with their physicians– a difficult prospect known as “patient engagement”. For its part, PCMA has offered a portal since 2010.
The practice also has joined a Medicare accountable care organization (ACO) led by Pfresnece Health, a 12 hospital, Chicago-based Catholic health system. “It’s complicated out there” says Perl,utter who is Section Chief of Internal Medicine t NEWARBY PFRESNECE ST. JOSEPH HOSPITAL.
“I think that it helps to have this hybrid model to stay independent, ” Perlmuter says. “it sees like everybody is trying to take our business.