48
Presenting a live 90minute webinar with interactive Q&A U C C K L lC id i Urgent Care Centers: Key LegalConsiderations Complying With Corporate Practice of Medicine Laws, State Licensure Requirements, EMTALA Mandates and Reimbursement Laws T d ’ f l f 1pm Eastern | 12pm Central | 11am Mountain | 10am Pacific WEDNESDAY, OCTOBER 24, 2012 T odays faculty features: Matthew R. Burnstein, Partner, Waller Lansden Dortch & Davis, Nashville, Tenn. Kim Harvey Looney, Partner, Waller Lansden Dortch & Davis, Nashville, Tenn. Lesli A. Love, Waller Lansden Dortch & Davis, Nashville, Tenn. Lesli A. Love, Waller Lansden Dortch & Davis, Nashville, Tenn. Jon M. Sundock, General Counsel and Chief Administrative Officer, CareSpot Express Healthcare, Brentwood, Tenn. The audio portion of the conference may be accessed via the telephone or by using your computer's speakers. Please refer to the instructions emailed to registrants for additional information. If you have any questions, please contact Customer Service at 1-800-926-7926 ext. 10.

Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

  • Upload
    others

  • View
    2

  • Download
    0

Embed Size (px)

Citation preview

Page 1: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Presenting a live 90‐minute webinar with interactive Q&A

U  C  C  K  L l C id i  Urgent Care Centers: Key Legal Considerations Complying With Corporate Practice of Medicine Laws, State Licensure Requirements, EMTALA Mandates and Reimbursement Laws

T d ’ f l f

1pm Eastern | 12pm Central | 11am Mountain | 10am Pacific

WEDNESDAY, OCTOBER 24, 2012

Today’s faculty features:

Matthew R. Burnstein, Partner, Waller Lansden Dortch & Davis, Nashville, Tenn.

Kim Harvey Looney, Partner, Waller Lansden Dortch & Davis, Nashville, Tenn.

Lesli A. Love, Waller Lansden Dortch & Davis, Nashville, Tenn.Lesli A. Love, Waller Lansden Dortch & Davis, Nashville, Tenn.

Jon M. Sundock, General Counsel and Chief Administrative Officer, CareSpot Express Healthcare, Brentwood, Tenn.

The audio portion of the conference may be accessed via the telephone or by using your computer's speakers. Please refer to the instructions emailed to registrants for additional information. If you have any questions, please contact Customer Service at 1-800-926-7926 ext. 10.

Page 2: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Tips for Optimal Quality

S d Q litSound QualityIf you are listening via your computer speakers, please note that the quality of your sound will vary depending on the speed and quality of your internet connection.

If the sound quality is not satisfactory and you are listening via your computer speakers, you may listen via the phone: dial 1-866-370-2805 and enter your PIN when prompted Otherwise please send us a chat or e mail when prompted. Otherwise, please send us a chat or e-mail [email protected] immediately so we can address the problem.

If you dialed in and have any difficulties during the call, press *0 for assistance.

Viewing QualityTo maximize your screen, press the F11 key on your keyboard. To exit full screen, press the F11 key againpress the F11 key again.

Page 3: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Continuing Education Credits FOR LIVE EVENT ONLY

For CLE purposes, please let us know how many people are listening at your location by completing each of the following steps:

• In the chat box, type (1) your company name and (2) the number of attendees at your locationattendees at your location

• Click the word balloon button to send

Page 4: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Urgent Care Centers: Urgent Care Centers: Key Legal Considerations

J S d k

y g4

J o n S u n d o c kj o n s u n d o c k @ c a r e s p o t . c o m

M a t t h e w R . B u r n s t e i nM a t t h e w R . B u r n s t e i nm a t t . b u r n s t e i n @ w a l l e r l a w . c o m

K i m H a r v e y L o o n e yk i m . l o o n e y @ w a l l e r l a w . c o m

L e s l i A . L o v el l i l @ l l ll e s l i . l o v e @ w a l l e r l a w . c o m

Page 5: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Why the Proliferation of Urgent Care Centers?

● Growth spurt began in mid-1990s and has continued

5

p g 99o 2008-2009: added 330 new urgent care centers o 2010-2011: added 304 new urgent care centers

● Why the continued growth?o Acceptance by the publico Acceptance by the publico Lack of access to primary care (no access or delayed access)o Overcrowding in Emergency Departments (ED)o Long wait times at other providers (EDs especially)o Convenience of longer hours and walk-inso Emphasis on high quality carep g q y

Page 6: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Current State of Urgent Care Centers

● Approximately 600 new urgent care centers added

6

● Approximately 600 new urgent care centers added in 2011

● Approximately 9 200 urgent care centers exist ● Approximately 9,200 urgent care centers exist todayo An increase of 1 200 in just three yearso An increase of 1,200 in just three years

● 150 million patient visits to urgent care centers each year in the U Seach year in the U.S.

Page 7: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Current Distribution of UCCs7

Page 8: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

What Is an Urgent Care Center?

● No universal definition

8

● No universal definitiono Provide services that fall in between primary care and

emergency departmentg y p

● Urgent Care Association of America:o The delivery of ambulatory medical care outside of a o The delivery of ambulatory medical care outside of a

hospital emergency department on a walk-in basis, without a scheduled appointment.

● Generally focused on episodic, acute care rather than on long-term management of chronic illness or preventive care

Page 9: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Common Characteristics of Urgent Care

● Walk-in or unscheduled care

9

● Extended hours, including weekends and evenings

● Provide an array of services beyond primary care

● Customer service approach to providing carepp p g

● Occupational health services often provided

Page 10: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Services Provided by Urgent Care Centers

● Primary Care

10

● Onsite radiology

● Simple fractures and lacerationsp

● Intravenous hydration

● On-site lab testing● On site lab testing

● Medications– prepackaged pharmaceuticals and pain management

● Occupational Medicine and Worker’s Compensation

● Other services may include immunizations, travel medicine, y , ,and sports and school physicals

Page 11: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Future Role of Urgent Care Centers

● Primary care access problems to continue

11

● Primary care access problems to continueo A projected shortage of 45,000 primary care physicians

by 2020y

o Increased insurance coverage under PPACA will add to the shortfall already predicted

● Increased use of EDs for non-emergency careo 2008-2011: Approximately 27% of visits for non-pp y 7

emergencies

o Average wait times risen to over 4 hours

● Rising healthcare costs

Page 12: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Future Role of Urgent Care Centers

● Utilization projected to continue growing

12

● Utilization projected to continue growing● Current and future areas of growth include

o Primary care o Primary care o Non-emergent careo ACOs—urgent care centers could be an integral part of

the organization in order to reduce visits to ACO’s ED

● Advantageso Reduce healthcare costso Reduce overcrowding in EDs

I d t i d t h ltho Increased access to primary and urgent healthcare

Page 13: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Key Legal Considerations

Corporate Practice of Medicine

13

● Corporate Practice of Medicine

● State Licensure

● Accreditation

EMTALA● EMTALA

● Reimbursement

● Other Issues

Page 14: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Corporate Practice of Medicine

● The corporate practice of medicine doctrine prohibits

14

The corporate practice of medicine doctrine prohibits employment of physicians by corporations

● Purpose is to protect the integrity of medical profession by p p g y p ykeeping it separate from corporate interests

● State laws vary on the doctriney

o Strict prohibitions

o Some Limitationso Some Limitations

o No prohibitions

Page 15: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Strict Prohibition Against Corporate Practice of Medicine: Texasof Medicine: Texas

● Any corporation employing a licensed physician to treat

15

Any corporation employing a licensed physician to treat patients and receive fees for those services is unlawfully engaged in the practice of medicineE l h i i bj di i li i ● Employee-physician subject to disciplinary action or license revocation

● Narrow exceptions● Narrow exceptionso Professional corporations formed by physicianso Independent contractor relationships under certain circumstanceso Critical access hospitals if (1) only facility in community and (2)

population of 50,000 or less

● Exceptions do not include most physician-entity p p y yrelationships in Texas

Page 16: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Intermediate Prohibition Against Corporate Practice of Medicine: IllinoisPractice of Medicine: Illinois

● Permits hospital employment of physicians

16

p p y p y

● Employment by entities other than hospitals prohibited

● Illinois courts have construed the term “hospital” strictly● Illinois courts have construed the term hospital strictlyo Covered entities: hospitals or entities directly or indirectly controlled

by or under the common control of a hospital

o Entities must meet the precise terms set forth in the statute

o Illinois Supreme Court refused to recognize a non-profit health institute and voided a physician employment contract for not institute and voided a physician employment contract for not meeting the terms

Page 17: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Relaxed Prohibition Against Corporate Practice of Medicine: Indianaof Medicine: Indiana

● Permits physician employment as long as the terms of

17

relationship do not violate statutory requirements:o “Entity does not direct or control independent medical acts,

decisions or judgment of the licensed physician”decisions, or judgment of the licensed physician

● Most physician-entity employment relationships permitted as long as physician’s professional medical discretion g p y pis preserved

● Overallo Preserves purpose of corporate practice doctrine, but

o Allows maximum flexibility of physician-entity employment relationshipsrelationships

Page 18: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Comparison of State Prohibitions Against Corporate Practice of MedicineCorporate Practice of Medicine

18

Strict(Texas)

Intermediate (Illinois)

Relaxed(Indiana)

Prohibits any Prohibits any entity Prohibits any entityycorporation from employing a licensed physician

y yfrom employing physicians other than a hospital

y yfrom directing or controlling physician’s medical discretion

Very Narrow Exceptions

Narrow Exceptions Broad Exceptions

Severe restriction—vast j it f h i i

Fairly severe t i ti it

Flexible—allows a f h i imajority of physician-

entity relationships do not meet exceptions

restriction—permits physician employment, but must meet very specific requirements

range of physician-entity relationships

p q

Page 19: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Alternatives in States that Prohibit Corporate Practice of MedicinePractice of Medicine

● Physician ownership

19

● Physician ownership

● Forming a medical holding company

● Foundation model

● Friendly PC model

o Physician forms a professional corporation (PC) and provides the physicians for the center

o Non-physician owned company that opens the center contracts with the PC to provide management services

Page 20: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

State Licensure

Facility licensing varies greatly from state to state

20

Facility licensing varies greatly from state to stateo Arizona is the only state that specifically requires licensing of urgent

care centersUrgent care centers may fall under licensing requirements for o Urgent care centers may fall under licensing requirements for healthcare clinics

CLIA Certificate of WaiverN if h ff i li i l l b io Necessary if the center offers certain clinical laboratory testing

X-ray permit Pharmacy licensey Other licenses depending on state Check Department of Health or similar state agency for

li i i tlicensing requirements

Page 21: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Accreditation

● Accreditation is through the Joint Commission

21

● Accreditation is through the Joint Commission

● 2010 publication of Standards for Urgent Care

o Offered by the Joint Commission in collaboration with the Urgent Care Association of America

Page 22: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

15 Categories of Accreditation Standards

1. Environment of CareE M

10. Provision of Care, Treatment and Services

22

2. Emergency Management3. Human Resources4 Infection Prevention and

Treatment, and Services11. Performance

Improvement4. Infection Prevention and Control

5. Information

p12. Record of Care,

Treatment, and Servicesi h dManagement

6. LeadershipLif S f

13. Rights and Responsibilities of the Individual

7. Life Safety8. Medication Management9 National Patient Safety

14. Transplant Safety15. Waived Testing

9. National Patient Safety Goals

Page 23: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

EMTALA

Requires that a hospital with an ED provides a patient who

23

q p p ppresents with:

1. Medical Screening Exam (MSE); and

2. Treatment or necessary stabilization before transfer or discharge

An MSE and treatment or stabilization must be provided dl f h ’ b lregardless of the patient’s ability to pay

Regulations contain specific EMTALA requirements

Page 24: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Application of EMTALA

● Treatment obligations of EMTALA do not apply

24

● Treatment obligations of EMTALA do not apply unless the urgent care center is owned by a hospital or in a joint venture with a hospital hospital or in a joint venture with a hospital and services provided are billed as a department of the hospitalp po No obligation to treat patients who arrive at the center

Triage policy stabilize and transporto Triage policy – stabilize and transport

Page 25: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Reimbursement

● Contracting and credentialing with payors for

25

● Contracting and credentialing with payors for reimbursement is critical for financial success

Insurance companies● Insurance companies

● Government payorso Medicare

o Medicaid

o TRICARE

Page 26: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Reimbursement Through Insurance Companies

● Determine the payors from which the center will

26

● Determine the payors from which the center will accept payment

● Payors’ approved list● Payors approved listo Start early as this can be an extended process

P titi t b d ti l d ith th ● Practitioners must be credentialed with the insurance company

C h i ’ i ● Contact the insurance company’s contracting department early in the process

Page 27: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Government Payors

Medicare, Medicaid, and TRICARE

27

Medicare, Medicaid, and TRICARE

Typically lower reimbursement rates than private insurers

Patient population may require acceptance of Patient population may require acceptance of government payors

Contracting is an extended process—start earlyg p y

Usually covers services retroactive to a requested date

Must enroll in Medicare as a “Clinic/Group Practice”Must enroll in Medicare as a Clinic/Group Practice

Physicians must enroll in Medicare using CMS Form 8551

Page 28: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Other Issues

● Coding and Billing

28

● Coding and Billing

● Malpractice Insurance

OSHA St d d f M di l Offi● OSHA Standards for Medical Offices

● Physician Supervision Requirements

● Prescription Writing Authority

● Breath Alcohol Testingg

● Employer Drug Testing/Screening

Page 29: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Coding and Billing

● Specify reimbursement amounts and payment codes

29

● Specify reimbursement amounts and payment codes in the contract

● CMS has designated two HCPS codes for UCCso S9083—global fees; does not take into account the

treatment provided

“ dd d ” f i b f io S9088—“add on code” for reimbursement of expenses unique to UCCs

● Some managed care organizations will only reimburse Some managed care organizations will only reimburse freestanding UCCs for professional procedure codes

Page 30: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Malpractice Insurance

Malpractice risk for UCCs generally falls between

30

Malpractice risk for UCCs generally falls between that of primary care practitioners and EDs

Risk factors for UCCso Lack of long-term, well established patient relationshipso Target for drug seekerso Target for robbery if UCC stocks medicationso Discharge management—patient follow-up plano Potential for underdiagnosing patients—rely on patients

to correctly self-triage and select appropriate facility for careo c e

Page 31: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

OSHA Standards for Medical Offices

● OSHA has issued guidance on the following areas:

31

● OSHA has issued guidance on the following areas: o Bloodborne Pathogens Standard

Hazard Communication o Hazard Communication

o Ionizing Radiation

o Exit Routes o Exit Routes

o Electrical

o Reporting Occupational Injuries and Illnesses o Reporting Occupational Injuries and Illnesses

● Requirements apply to all medical offices—whether there are 2 or 200 employeesthere are 2 or 200 employees

Page 32: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Physician Supervision Requirements

● State laws vary on requirements but issues are similar

32

y q

● Certified Nurse Practitioners and Physician Assistantso Continuous and constant supervision or intermittentp

o Availability of supervising physician for consultation—generally must be at all times

o Arrangements for a substitute physician to be available

● Registered Nurses and Licensed Nurse Practitioners o Frequency and length of time that physician must be “on-site”

o Availability of supervising physician for communication and consultation—at all times

Page 33: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Prescription Writing Authority

State laws vary as do requirements for Nurse Practitioners

33

State laws vary as do requirements for Nurse Practitioners and Physician Assistants

Nurse Practitioners (TN)Must hold a certificate of fitness o Must hold a certificate of fitness

o Joint adoption of physician supervisory rules concerning controlled substances requiredCan prescribe and/or issue controlled substances listed in Schedules o Can prescribe and/or issue controlled substances listed in Schedules II, III, IV and V

Physician Assistants (TN)W i l i d d l d d d b h i i o Written protocols required—developed and agreed upon by physician and PA

o Supervising physician may delegate authority to issue prescriptions or medication orders for legend drugs and controlled substances or medication orders for legend drugs and controlled substances listed in Schedules II, III, IV, and V

Page 34: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Breath Alcohol Testing

Policy setting forth the UCC’s procedure for Breath Alcohol Testing

34

Policy setting forth the UCC s procedure for Breath Alcohol Testing Use of U.S. Department of Transportation (DOT) procedures for

modeling alcohol testing policies increasing

DOT Procedures: Initial tests for alcohol concentration:

o Approved Saliva Screening Device operated by a trained Screening Test Technician (STT); or

o Approved evidential breath testing device (EBT) operated by a pp g ( ) p ytrained Breath Alcohol Technician (BAT).

Alcohol concentration of 0.02 or greater—Second EBT test to confirm An alcohol concentration of 0 02 or greater considered a positive An alcohol concentration of 0.02 or greater considered a positive

alcohol test.

Page 35: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Employer Drug Testing & Screening

● Policies for setting forth the UCC’s procedure for

35

g pdrug testingo Employer provided forms for listing medications

o Collection procedures

o Chain of custody procedures

o Security of the collection site

o Privacy of individual

R i d i f h io Retention and transportation of the specimen

● State-approved procedures can be used as a model for drafting UCC drug testing policies and proceduresdrafting UCC drug testing policies and procedures

Page 36: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Overview of Issues

ReimbursementInsurance Companies—start process earlyMedicare enrollment required for reimbursement both the UCC and

36

Reimbursement Medicare enrollment required for reimbursement—both the UCC and physicians

State LicensureNo License Required. Except in AZ.

CLIA CertificationCLIA Certificate Of Provider-Performed Microscopy Procedures Is Required.

Other Licenses X-Ray Licensure Pharmacy Licensure and OthersOther Licenses X-Ray Licensure, Pharmacy Licensure, and OthersOSHA Standards for Medical Offices

OSHA Standards Applicable

Physician Supervision Certified Nurse Practitioners and Physician AssistantsRegistered Nurses and Licensed Nurse Practitioners

Requirements

Prescription Writing Authority

Nurse Practitioners v. Physician AssistantWritten protocol requirements

Alcohol policies based on DOT increasing

Alcohol and Drug Screening

Alcohol policies based on DOT increasingDrug policies based on state-approved standards if available

Page 37: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Key Business Considerations

● Location management and services

37

● Location, management, and services

● Issues in buying or selling an Urgent Care Center

● Partnering with hospitals and investors

Page 38: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Location

● Volume key to financial success

38

● Volume key to financial success

o One study showed that a population of 20,000 to 30,000 was needed to sustain a UCCwas needed to sustain a UCC

● Currently, UCCs are concentrated in urban areas (distribution map on next slide)(distribution map on next slide)

● Convenience for patients

● Free-standing v. Hospital associated

Page 39: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Management of UCCs

● How will the UCC be managed?39

o Physician managed

o Management companyo Management company

● Customer service oriented management improves fi i l f UCCfinancial success of UCCs

● Leadership with a healthcare background is key

Page 40: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Services Provided

● Target population

40

● Target populationo Know the community’s demographic in order to tailor

services to community’s needsy

● Specialty v. Generalo For example some UCCs focus specifically on pediatric o For example, some UCCs focus specifically on pediatric

care

● One stop shop● One stop shopo All services within the UCC or nearby referral locations

Goes back to the convenience factoro Goes back to the convenience factor

Page 41: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Buying or Selling an Urgent Care Center

● Buying an existing Urgent Care Center

41

● Buying an existing Urgent Care Centero Location

o Competitionp

o Reputation

o Property—leased or owned

● Valuation

● Due Diligence g

● Non-Disclosure Agreements

● Employment & Non-Compete Agreements● Employment & Non Compete Agreements

Page 42: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Buying or Selling an Urgent Care Center (continued)

● Governing and Ownership Agreements

42

● Governing and Ownership Agreementso Voting

o Officers

o Compensation

o Decisionmaking—Management and Control

● Retirement

● Sale of Ownership Interestp

● Tax Considerations

Page 43: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Partnering with Hospitals and Investors

● Possible Ownership Models

43

● Possible Ownership Modelso Physician or group of physicians – 50%

o Hospital – 27.9%p 7 9

o Corporation - 13.5%

o Non-physician individual – 7.6%

o Franchise – 1.0%

● With the wide range of services offered and extended service hours, integration is key to the successful growth of an urgent care center

Page 44: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Different Integration Models

● Group Practice Model

44

● Group Practice Model

● Physician-Hospital Organization

● Management Company Model

● Accountable Care Organization● Accountable Care Organization

Page 45: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Group Practice Model

Multiple physicians practicing under one form of entity at

45

one location Multi-specialty group practices advantageous for UCCs

S pe g o p Model Supergroup Modelo A new practice entity formed by and among existing group practiceso Owned by individual physician members or existing group practiceso Higher volume of patients typically

Advantageso Increased revenueo Increased revenueo Greater input and control over range of care and treatment

Criticismo Concerns over abusive arrangements and overutilization

Page 46: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Physician-Hospital Organization

● Provides healthcare services through a network of

46

● Provides healthcare services through a network of collaborating physicians and hospitals

● Characteristics● Characteristicso Clinical and economic efficiency and effectiveness are

central to the designcentral to the design

o Provides a wide range of services

Goal is seamless integration that great reduces or o Goal is seamless integration that great reduces or eliminates referrals to entities outside the system

Page 47: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Management Company Model

● Provides the facilities office space equipment non-

47

● Provides the facilities, office space, equipment, nonphysician personnel, and non-professional services to an existing practice or other healthcare services provider

● Must be commercially reasonable and reflect fair market value payment for the goods and services

● Physician’s return on investment is limited to a reasonable return

● Must ensure the joint venture is a management company and not a healthcare provider

Page 48: Urgent Care Centers: Key LlLegal Cid iConsiderationsmedia.straffordpub.com/products/urgent-care-centers-key...2012/10/24  · Presenting a live 90‐minute webinar with interactive

Accountable Care Organization

● Entity willing to become accountable for the quality, cost

48

Entity willing to become accountable for the quality, cost and overall care of Medicare FFS beneficiaries assigned to it

● Expected to meet specific organizational and quality p p g q yperformance standards

● If standards met, eligible to receive cost sharings, g g

● UCCs can be an important intermediary in any ACO

I d i b d i ED i it h i o Increased savings by reducing ED visits when primary care physicians are unavailable

o Increased continuity of carey