Pediatric urgent care clinic survives first year

Pediatric urgent care clinic survives first year

By Charles Rathmann, of SBT

While parents with howling sick or hurt children often cool their heels in the waiting rooms of hospital emergency rooms on weekends, a clinic on Milwaukee’s west side is quietly serving children in need of after-hours medical care – at much lower costs to patients and insurers.
Kids Urgent Care, a service offered by pediatricians Dr. Noemi Prieto and Dr. Gary Nordyke at Southeastern Pediatrics & Adolescents Clinic, has made it through its first year at the corner of 86th Street and Capitol Drive.
The clinic is open until 6 p.m. on Saturdays and Sundays.
As the number of patient visits increases to the point where the urgent care function begins to break even, Prieto looks forward to extending hours further.
Two years ago, a liquor store stood on the site where Prieto and Nordyke built a 13,000-square-foot clinic with the help of a $1.13 million loan from the Milwaukee Economic Development Corp.
"People ask, ‘Why did you invest a million in that corner? I tell them we are who we are because our patients made us," Prieto said. "The urgent care function came up when we kept hearing and seeing so many patients being taken to the emergency room unnecessarily."
Adding the weekend hours for urgent care was not without risk. At least one other team of respected local physicians had gone the urgent care route and hit the wall after being open a few months beyond Prieto’s current benchmark.
Prieto said she would like to add to the evening and weekend hours, but until the practice sees the requisite volume of urgent care patients during existing hours, she is taking a wait-and-see approach.
Although the clinic serves patients from as far away as River Hills, Menomonee Falls and Germantown, she recognizes that the clinic’s foundation is the northwest side of the city of Milwaukee.
Prieto accepts every type of public and private payer insurance, and she estimates that about half of her caseload consists of government-based insurance. Hospital-owned clinics typically require their physicians to steer clear of government insurance patients receiving Medicare or Medicaid, or the hospitals financially penalize physicians if their public payer caseloads eclipse certain percentages.
"We do take care of anything and anyone that walks in our door," Prieto said. "From our office, I had grown and gotten all my experience. I wanted to give something back."
Giving too much too soon can lead to business failure, so Prieto is counting on a go-slow approach to keep the practice from overextending itself with urgent care. Unlike appointment-based practice, which yields a relatively predictable return per physician hour, urgent care volume can run hot to cold.
"We started out staring at a lot of ceiling tiles," Prieto said. "We are still on our way there. It is nice to tell you we saw 35 patients in a day, vs. three patients in a day like we used to. We would like to see that number go up so we can expand the urgent care function to the weekdays."
However, a smart approach to distribution and an aggressive stance in acquiring other practices could help her enterprise from meeting the fate of the Harambee Medical Center, which closed its doors about four years ago. The Harambee clinic was a venture of physicians Wayman Parker, Eugene Pruitt and John Silkey.
Covenant Health Care System helped with grant writing and renovation of the facility at 2373 Dr. Martin King Jr. Dr.
According to Silkey, Prieto is doing a few things differently than the Harambee trio did.
"I think she is going about it the right way," Silkey said. "She is not duplicating equipment or space in order to provide the urgent care. The other thing is that if you expect to be successful, you need a busy private care practice, because a lot of what you are going to see in your urgent care will be your own patients."
Silkey said his was the only practice located at the urgent care clinic, which limited the volume of patients prone to use the urgent care function.
"My private practice was there," Silkey said. "But we duplicated rooms. I had five exam rooms for my private practice during the day, and then we had an additional four rooms for urgent care, which brought the initial number of rooms to nine. It was a waste of money, because we had to get a much bigger place. Everything we did there we could have been done in half the space, and that would cost less as far as overhead."
The practice also did not generate revenue from the entirety of the 6,000-square-foot building, according to Silkey.
"We had the upstairs and the downstairs we were paying rent on – but never did anything with the downstairs," Silkey said. "It needed renovation before it could be leased out. It never became income-generating. … Noemi, she is using the property well, so it will generate income."
Prieto also is taking a different approach to generating volume for her urgent care clinic.
Seven physicians and 10 physician assistants are associated with her clinics, building relationships that can feed the urgent care center. Prieto has taken an aggressive approach, purchasing or opening three other clinics in the metro area and building relationships and awareness among pediatricians.
"It started with just a practice here on Capitol," Prieto said. "Then, 10 years ago we opened a second location in Franklin. From there, I opened up a third location in South Milwaukee about five years ago. Two years ago, the Teamsters clinic on Bluemound asked us to do pediatrics. Then, 14 months ago, another senior pediatrician call me. He was ready to retire."
Prieto’s clinic bought out the practice of Dr. Anthony Coe, who operated a clinic north of 35th Street and Wisconsin Avenue in Milwaukee.
"The numbers are the power," Prieto said. "That is why I did what I did six or seven years ago when I saw the Aurora and Covenants buying everybody left and right. I only wish more of the pediatricians would feed (the urgent care center), vs. continuing to feed the monsters even more."

Emergency room or urgent care clinic?
Just the check-in process at a hospital emergency room can cost $50, and the whole visit for even a simple malady can run into thousands of dollars. By contrast, an entire urgent care visit can cost as little as $50.
Of course, while walk-in clinics should be an attractive option for those concerned about containing health care costs, some situations require the resources an emergency room provides.
According to Dr. Noemi Prieto, who operates an urgent care clinic for children at 85th St. and Capitol Drive, some pediatric problems cannot be handled at a walk-in clinic.
"Any parent that sees a child that is listless, nonresponsive, any difficulties breathing, persistent vomiting and diarrhea – those must go to an emergency room," Prieto said. "An asthma attack, once the parents have done their basics at home, should go to an emergency room. Ingestions – putting things in their mouth like children always do – have to go to an emergency room. I just had a little boy here who had stuffed a couple of pearls in his ear. We sent him to the emergency room."
Dr. Tom Luetzow, president of American College of Emergency Physicians’ Wisconsin Chapter, said parents can have difficulty deciding whether an emergency room or an urgent care clinic is the best option.
"It is so person-dependent," said Luetzow, who, until recently, served in the emergency room at Waukesha Memorial, but now is practicing at a Lake Mills clinic that offers an urgent care function. "Some people do, some people don’t. And sometimes you don’t know. When does chest pain become heartburn and when is it a heart attack?"

April 18, 2003 Small Business Times, Milwaukee

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