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Walk-In Clinic Business Model

In my career as a Family Medicine doctor I’ve mostly worked in Primary Care clinics, Urgent Cares, and Emergency Rooms. I’ve only worked at 2 Walk-in clinics. But I have become more fascinated with this clinic model over the past few years.

If someone were to ask me to explain the difference between a Walk-in clinic and an Urgent Care I couldn’t give a really good explanation. I learned about their important differences by researching this post.

Walk-in Clinics

Walk-in Clinic is the umbrella term which encompasses all sorts of clinic models including an Urgent Care Center, Retail Clinics, a Primary Care office with walk-in slots, etc.

Recently Walgreens made the news for announcing that they will be closing 150 of their retail clinics. These were inside their Walgreen pharmacies and are/were operated by the company.

There are a ton of chain retail clinics all over the country. They are more common in places where most physicians don’t practice. And these are often staffed by NP’s or PA’s.

You may have heard of some of the common chain walk-in clinics such as MinuteClinics, Concentra, MedExpress, AFC, US Healthworks, CareNow, GoHealth, and Target Clinics.

Urgent Care Clinics

For me, an Urgent Care is unmistakable. It’s a higher acuity walk-in clinic that’s a step down from the Emergency Room. Many ED docs know the difference quite well as they later in their careers switch from the ED to the UC.

An Urgent Care generally will be able to run labs onsite, perform xrays, place casts, given IM/IV medications, and monitor patients because of their larger bed/room capacity. And that it is why UC’s have been on the rise over the past decade.

The typical Urgent Care is staffed with physicians, usually more than one. And there is a high ratio of staff to physicians so that several rooms can be run simultaneously.

UC’s will also perform many procedures such as corneal foreign body removal, joint injections, setting fractures, draining abscesses, and repairing lacerations.

Retail Clinics

A quick work about Retail Clinics. Their business structure is complex so don’t just look at what’s reported in the news to form your opinion.

Retail Clinics are sometimes owned and operated by the corporate entity in which they are located or they are owned by a separate business entity.

They aren’t always meant to be profitable. Sometimes they are just a strategy to draw more customers to the particular pharmacy chain.

Obviously the care is far below basic standards. Overtreatment with medications and overtesting is the norm in such clinics. And I say this because I’ve reviewed the data and have colleagues who work/worked in such settings.

It doesn’t mean that they are bad. Sometime access is more important than the quality of care that’s delivered.

Acuity of Care

Retail Clinics and other low-acuity Walk-in Clinics tend to see lower acuity patients. They focus on the following list of common complaints in descending order:

  1. cough/cold/flu/bronchitis
  2. sore throat
  3. rashes/acne/lice/scabies
  4. pink eye/ear pain
  5. GI issues/UTI’s
  6. STD’s

A few basic labs are done such as rapid flu, rapid strep, urine dips, etc. But there is usually no onsite lab or imaging.

An Urgent Care certainly sees a higher acuity patient population and that’s why they are often staffed with physicians. And their office visit is billed at a higher rate both to the insurance and as cash-pay.

Insurance/Cash

I have never worked at a facility which didn’t take some sort of insurance. And if the person preferred to pay cash, they would allow for that as well, of course.

Even Kaiser Permanente, which is an HMO, allows patients to register for their Urgent Care and offers a cash price of $175 for the visit.

Billing the insurance might seem more logical because the insurance company will feed you all the patients you would ever want. And you can bill to your heart’s delight.

If you are a cash-only practice then you have to find your own patients. And because the average healthcare consumer knows more about their auto insurance than their health insurance, recruiting savvy healthcare consumers is getting harder.

Volume/Capacity

An Urgent Care should have a higher volume compared to a low-acuity walk-in clinic. Patients like the fact that they have a lesser wait time than if they went to the ER. Not to mention the lower cost.

UC’s also will see all sorts of patients, from newborns to the elderly. Walk-in Clinics often have limits on the age of the patient and acuity of complaints.

So you would expect that an Urgent Care makes more money. But the UC has a much higher overhead, not to mention the billing department and uncollected fees.

Patient Satisfaction

Do lower acuity Walk-in clinics (ie Retail Clinics) save the healthcare system money? It appears that they don’t. Probably because the patient doesn’t have as much faith in the mediocre care they received and so if their symptoms continue for 3 more days they will make a follow-up appointment with their traditional medical office.

So now they’ll have sunk the cost at the walk-in clinic and will have to pay for the follow-up care. Naturally, by the time they come in for that follow-up they want the kitchen sink.

Do these Walk-in Clinics have good customer satisfaction reviews at least? No, hello no. I had no idea until I googled some clinics and inspected their reviews.

The Walk-in Clinics and Urgent Cares in Texas, for example, had an average 2/5 stars. Ouch.

RediClinic

Well, there was a big exception which repeated in many cities. A Retail Clinic chain owned by Rite Aid Pharmacy which is called RediClinic has off-the-hook reviews.

The only way you can get such reviews is to provide very good customer service and proactively chase down each review. It’s time consuming and expensive but it definitely has a high return on investment.

Because they only treat a handful of issues, it’s easier to master the art of saying no, when needed. And with a solid PR firm to manage your online reviews, you will corner the market.

Virtual Care

So what about the onslaught of telemedicine, that certainly must be cutting into the profit margin of these Walk-in Clinics. Maybe not.

I think that the Telemedicine consumer is very different from the consumer who chooses an Urgent Care or a lower acuity Walk-in Clinic. At least for now. Maybe 10 years from now things will be different.

Virtual care is often cheaper and definitely more convenient in terms of access. But patients still feel a lot pushback when requesting specific medications or when it comes to their insurance reimbursement.

The Walk-in Clinic as a Business Model

I worked at a small Walk-in Clinic in West Los Angeles which was open from 5 pm until 10 pm. The clinic was owned by a Primary Care group but another group rented the space from them for the Walk-in Clinic.

We had movie stars coming in for their opioid refills and moms bringing in their kids with a tiny scratch on their arm. The work was very easy and the pay was great.

We charged $100 for a cash visit. And we would dispense medications out of the office for an extra profit.

1. Urgent Cares Are Complicated

I also worked at an Urgent Care in the Valley north of Los Angeles where I would see 80-100 patients on my own in 14 hours with a staff of 7 MA’s. We had lacerations, fractures, MI’s, pneumonias, PE’s, and I even had a case of Cauda Equina.

The owner of that Urgent Care had an back-office staff of 10 running the workman’s comp side and billing side of the business. Sure, they made very good money but it was a behemoth of a business.

We charged $150 for a cash visit in the UC.

2. Common Complaints are Common

Even in that crazy ass Urgent Care most of the complaints were GI and URI. Some UTI’s and aches and pains.

Sure, because we had a solid billing department it made sense for us to utilize our xray machine for cough and trauma patients. But I also recall a LOT of negative xray films. Good for us, not great for the patient.

In the Walk-in Clinic we did simple laceration repairs and charged $150 on top of the office visit fee. So in total the person would pay $250.

In the Urgent Care a laceration would set you back at minimum $400, if you paid cash.

3. Higher Risk

At the Urgent Care I diagnosed cancers, lung abscesses, PE’s, sepsis, and had a patient who tried to commit suicide with the pain meds I prescribed him.

We had several deaths from certain things we missed even though they weren’t cases for which patients could have sued. But it was still heartbreaking.

The Walk-in Clinic had no major bad outcomes. We’d turn patients away regularly when their complaint was more complicated than what we wanted to deal with.

The worst thing that happened to me there is that I set a patient’s arm on fire because I used the cautery tool after I had sprayed Ethyl Chloride on their arm. And we still charged him to treat the redness from the burn. ?

4. Dispensing Medications

In a very busy Urgent Care dispensing medications can backfire. You’ll need an extra staff to document and handle the medications. And the doctor has to spend time educating the patient on side effects etc.

But in the Walk-in Clinic we’d sell a packet of Z-pack for $35 which only cost us $5. We’d sell 10 pills of tramadol for $20 and it only cost us $2.

5. Lab Tests

We had a STAT machine at the Urgent Care but the values were often borderline and we needed a staff member calibrating the machine and run the samples.

At the Walk-in Clinic we did simple samples such the ones I mentioned above. These POC tests are cheap and simple to administer. And they offered us a decent profit margin as well.

6. Office Space

The Urgent Care had 7 exam rooms and I’d jump from room to room. We had a hand washing station in each room and a pelvic table in each.

Because of the high acuity, it only took a GI outbreak in the community for all of the rooms to be occupied. This meant that many patients had to wait a long time or be diverted to the ER.

The Walk-in Clinic didn’t offer IV’s and we didn’t monitor patients for more than 15 minutes. With only 3 exam rooms and a ‘lab station’ we could easily churn through 10 patient per hour.

7. Staffing

The Walk-in Clinic operated with 2 doctors on busy days and always 2 staff members. It was an MA and a front office person.

The Urgent Care had a score of employees and it needed an office manager who earned $125k/year just to make sure the place would run smoothly.

The Walk-in Clinic had a roster of 4 doctors and the Urgent Care had 10 doctors.

8. Expansion Potential

A big-ass Urgent Care like that couldn’t be easily replicated, at least not in close proximity of that neighborhood.

But a Walk-in Clinic is often limited by space and volume and staff. It’s otherwise not complex. That is why there are a lot more Retail Clinic chains than Urgent Care chains.

9. Resale Value

As far as the potential future resale value, a simple Walk-in Clinic and Urgent Care likely will have a higher value than a Primary Care Clinic. Most patients will leave once the main PC physician exits the practice.

But the Walk-in and Urgent Care become healthcare access points in the community. Other businesses know to refer people there and even Emergency Rooms will nudget their patients towards them.

The Urgent Care likely will sell for a lot more in the future because it has a higher income potential. But it also required a lot more effort and time to build up.

10. Volatility

A large Urgent Care is resource hungry and will be hit hard if there are major legal changes in healthcare or insurance products. They take patients away from private Emergency Rooms and hospitals and can be problematic in that sense.

Regardless of any major changes, there will always be patients who will need Walk-in access.

And it’s easier for the Walk-in Clinic to change their business model if they need to. They can add botox or weight loss remedies or sell other healthcare products to boost their profits if needed.

11. Signage

The Walk-in Clinics that I’ve known have often been off the beaten path. They had minimal signage.

But an Urgent Care needs to be more accessible and more visible. Think a bigger parking lot and on a street corner.

I suppose this simply adds to the overhead of the business but also means that a lease is tougher to negotiate in the future.

12. Income Potential

This is a hard one to gauge. The max income potential of course will be higher for the Urgent Care than the Walk-in Clinic. But that comes at an obvious cost.

The busy UC was probably taking home $1.5 million with gross sales of closer to $4m. The owner was still working 3 full days in the UC. He had owned it for 27 years and likely been profitable for along time.

The Walk-in Clinic was probably pocketing $150,000/year. But the owner worked maybe 1 day a week there. And it took her 6 months to start it and be profitable.

13. Access

As an Urgent Care you have to provide decent access to patients. That takes staffing costs even higher because either you’ll have to provide overtime or have more staff to manage.

Our UC was open 7 days a week from 8 am – 10 pm.

The Walk-in clinic was open 6 days a week from 5 pm – 10 pm.

14. Clinical Staffing

You can’t easily staff an UC with just any doctor. And it’s even harder to bring in PA’s and NP’s. Not because Advanced Practice Clinicians are incapable of working in an Urgent Care but because most will prefer to work for larger medical groups and prefer less independent roles.

If you can find a solid APC then it’s fair and acceptable to have them work beside you in the Walk-in Clinic or have them staff it solo.

But the busy UC will have a harder time getting away with an APC for many reasons. The least of which is the high acuity which needs to be handled delicately without overutilization of testing/resources.

Physician-run Walk-in Clinic

The model that I would propose would be a lot acuity walk-in clinic, sometimes referred to as Same-day Clinics. It would be run by 1 physician and 2 MA’s.

The physician should be associated with that clinic. That’s what makes such a clinic stand out from other less capable Walk-in Clinics.

Treatable Complaints

This would allow the doc to see all of the common ailments and even farm out their overflow to a telemedicine PA/NP or MD/DO.

  • coughs/colds
  • rashes
  • UTI’s
  • STD’s/pelvic exams
  • GI issues
  • headaches/pain
  • med refills

Procedures and Labs

As far as any extra billing, it can be done for the following:

  • medication dispensing
  • stat labs
  • small procedures
  • immunizations
  • FB removal
  • in-office injections

Streamlining the Practice

If the majority of patients leave paying something extra for the added procedures or dispensed meds, then the cost should be built into the office price. Then the service can be advertised as “all-inclusive”.

If only 25% of patients end up needing something extra then as much as possible should be removed from the list. This will decrease the complexity of the clinic and allow more patients to be seen.

Seasonality

I would expect quite a bit of seasonality with such a clinic; very busy in the cold and flu season and dead during the summer. But aesthetics and sports physicals and DMV physicals can be added in for extra income if needed.

Expanding

A proven business model in healthcare is expandable. We know that because many have done so. Many physicians own more than one practice and many companies own more than one Retail Clinic.

Extra staffing should ideally still be done with an MD/DO but the right PA or NP could easily be the face of the second and third sites.

Marketing/PR

A Retail Clinic or low-acuity Walk-in Clinic is not a necessity. It’s often a convenience. That is why a shitty Urgent Care or ER can get away with ignoring their online reviews.

But managing the online appearance of the Walk-in Clinic is very important. A good marketer or PR company can be contracted affordably to handle the social media and customer service part of the business.

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