1. Does anyone have a job description for an urgent care medical director?
2. Should we install x-ray in a new urgent care center?
3. How can I set up an urgent care with non-physician owners?
4. What is the appropriate compensation for an urgent care physician?

Spectrum Health: Excellence in Urgent Care

Dr. Bryant Pierce builds a team to bring quality 24-hour urgent care services to Grand Rapids, Michigan. What can you learn from their experience?

In 1998, Dr. Bryant Pierce faced the biggest challenge of his life—moving from director of a hospital ED to medical director of an urgent care network. Two medical centers in Grand Rapids, Michigan were merging to form Spectrum Health, a system with 8 urgent care centers (including some dedicated to Occupational Medicine) and annual losses totaling about $4-5 million. The new hospital system was no longer buying the idea that urgent care was a “great loss leader” for hospitals. They hired a crackerjack administrative director, Lois Temple. She named Dr. Pierce to the position of medical director. Together they would either stop the financial hemorrhage or the system would divest itself of its urgent care centers.

They took action immediately. They moved billing out of the hospital department and formed an urgent care billing department—with seven people exclusively devoted to urgent care billing and collections. Each of the eight centers had been functioning independently each with a separate medical director, collecting a medical director stipend. This had created the inevitable lack of standardization between centers. For example, some centers removed warts, others did not. Dr. Pierce took the position of medical director for all clinics and eliminated the medical director positions at each clinic. The move was unpopular, but to his credit not a single physician left over the loss of income and status. They analyzed their financial situation and found that stocking and selling durable medical equipment did not pay for itself. Solution: no more DME.

With his background in the ED, Dr. Pierce has focused on bringing the standards and procedures of the urgent care centers as close as possible to ED standards. Over the years, he has made the following changes:

• Most full-time hires have been Board Certified ED physicians.
• He began a system of “Mock Code” training for the centers, to allow more comfort in handling the occasional critical patient.
• He made the transfer process from urgent care center to ED as streamlined as possible. Even though they are under no obligation to do so, the Spectrum centers even fill out EMTALA forms that are normally reserved for transfers from one ED to another ED.
• Triage rooms were set up or built in each center, and all patients with acute injuries or illness now have immediate triage. These are staffed with registered nurses or medical assistants who have verified triage skills. This improved the complaints and problems associated with using receptionists to triage patients.
• Dr. Pierce continues to work some shifts in the ED to maintain the connection between the two related services.
• They went to 24/7 coverage in their busiest urgent care center seven years ago. He estimates that this additional service is about “break-even” financially. This 24/7 service allows occupational medicine clients access to the system of Occupational Services at Spectrum Health, and avoids the pitfalls of ED treatment of occupational patients. It has also decreased the overtime that they previously incurred, when they officially closed at 11:30 PM, but they often found high volume or complicated patients keeping staff on site until past 1:00 AM.
• In July of 2003, the hospital moved another center to 24/7 service. This change might have been strategically directed to get the neighborhood looking to Spectrum for 24/7 services. The new night shift has been very successful and even saw 26 patients in one busy night.
• Recognizing the substantial practice experience of his physicians and Physician Assistants, Dr. Pierce has marketed them to local doctors and the community as “Specialists in Urgent Care.”
• Urgent Care functions as an official and separate department of the hospital’s medical staff.
• In the Spectrum ED waiting rooms, fliers promoting the urgent care centers are prominently displayed.
• A new dress code was implemented to increase the professional appearance of staff.

They, also, surveyed their community to see what barriers might be limiting community usage of the urgent care centers. What they found was somewhat surprising-- even in this town, home to one of the first urgent care centers in the USA, community members were unaware of the availability and benefits of urgent care services. Thus, Spectrum initiated a major program to educate the community about the high-standards and convenience of their unique urgent care system.

Spectrum Health serves Grand Rapids, Michigan with five quality urgent care centers, with two urgent care centers open 24-hours per day. Dr. Pierce and his team can be proud of the system that they have created, offering the residents of Grand Rapids the finest combination of quality, service, access and cost savings.