1. 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

2. Disclosures
None to Report for any of the presenters

3. 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

4. 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

5. 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

6. 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.

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

8. 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

9. 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

10. 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 reminder Friday afternoon
Planned for a relatively soft opening given not sure of the demand.

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

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

13. Who Came and From How Far?

14. Patient Satisfaction

15. Patient Satisfaction

16. Patient Satisfaction

17. Decreased ED and Outside Urgent Care Utilization
Patients

18. 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

19. 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

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

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

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

23. 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

24. 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

25. Questions?