A physical urgent care with 4-5 medical assistants, a board-certified physician, an x-ray tech, an x-ray suite, POC testing, ADA parking, and access has an average gross revenue per urgent care patient of $115.
The numbers will vary a bit based on the location and the billing practices of the clinicians but this average is startling.
I recommend watching Dr. Eric Bricker on Youtube if you want to understand how the healthcare system works in the US. I learn something new every day.
Negotiating insurance contracts and getting paid by them is a full-time job. It’s why many urgent cares have such high overheads; they need dedicated billing and contract negotiation staff.
Once you agree to take Medicare or Medicaid it will also be tougher to charge cash. I won’t get into that here but those in the know will know.
Hiring medical assistants, front office staff, and x-ray techs are time and energy-consuming.
I have several friends who own their own practices and it’s rare to not have a lawsuit from a previous employee. Almost always there is a payout – a settlement.
The law is on the side of the employee which protects them from scrupulous employers. Navigating the rules and regulations of your state requires regular input from an attorney.
The more staff there is the more complicated staffing gets. You’ll still want staff for your fee-for-service urgent care but it’s going to be fewer people.
Charging Cash for Visits
I work for a large urgent care group in Southern California and a cash visit costs $105. That’s quite a good price considering the overhead needed to get an average gross revenue per urgent care patient of $115.
The patient often has a $50-$75 copay. Then there is the billing and wait time, the denials, and audits.
A cash-based or fee-for-service urgent care requires far less overhead. In return, you are taking on less risk and performing fewer administrative tasks as an owner.
Avoiding High Acuity Visits
When it comes to insurance contracts, the way to earn more is to bill for higher acuity visits. In 2021 the billing rules changed but the premise is the same – higher acuity = higher payout.
As an urgent care doctor, I prefer to avoid a high acuity visit. In our current healthcare model, extra risk is not rewarded appropriately.
Maybe in the ER and definitely in the inpatient setting taking on more risk pays off financially.
EMR and Documentation
Most of what I input into an EMR is for billing. It has little to do with the actual health of the patient.
“35 year old male presents with mild cold & flu symptoms consistent with influenza. Pulse of 90 and temperature of 101. Lungs clear to auscultation. He can manage conservatively at home and return if not better.”
The above is all I would have to write to protect myself. Sure, you likely will write more but not because you have to.
Average Gross Revenue Per Urgent Care Patient
If the average gross revenue per patient is $115 the profit will be less than $40. Often, as low as $30.
The alternative model is to do away with the x-ray and not carry too many medications or vaccines and instead charge cash for all services.
A single visit can cost $100. That’s easy to afford for most individuals since their urgent care use will be less than a few times per year.
If you want to get creative, offer membership to the urgent care for larger families. It’s a steady revenue for you and most of the time you’ll just reassure the family.
At $100 per patient, my revenue per patient is fixed. No middleman to worry about. No collections to deal with. And my net profit per patient is higher.
A medication injection such as an antibiotic or steroids or pain medication can be $25. There would still be enough room for profit in this.
I am generally not a fan of intravenous fluids since I use them rarely so they wouldn’t be a big profit point for me.
I am a fan of selling prescriptions and supplements directly to patients. I wouldn’t want to profit from it – it would be mostly at-cost.
The reason is convenience. I know I will give out nitrofurantoin, fosfomycin, cephalexin, oseltamivir, and prednisone.
I can also sell magnesium supplements, slippery elm, essential oils, or whatever you personally believe that your patient might benefit from.
From a Word catheter to draining and packing a thigh abscess, a $100 flat rate for procedures will make your life simple.
The reason I recommend charging for this is to get the buy-in from the patient and to offset the extra time and cost associated.
Simple lacerations often require staples and a 4.0 non-absorbable suture. A bit of lidocaine and a cheap laceration tray.
I often bring patients back in for wound checks and other rechecks. That’s a $100 visit.
But if they want to follow-up with me virtually I can offer them a $50 visit. Since I consider this high-acuity I think the $50 is still a great price.
For initial virtual consults, the price should be no less than $75. Again, it’s the buy-in from the patient and taking on the risk.
The Big Box Urgent Care
My current employer has 20+ insurance contracts. I have to know which patient I can give what to and which lab I can order for which insurance company. It’s all very complicated and gives me a headache.
2 ladies at the front desk are running insurance checks and collecting copays.
6 medical assistants in the back have to get vitals and room the patient and fish out vaccines and set up procedure trays for me.
Alternatively, in my cash-based urgent care model, the patient can make the payment using a QR code and check themselves in.
They will be roomed by one of 2 medical assistants and vitals will be done by me only if I need them or want them.