Most Frequently Asked Questions by Urgent Care Startups

Introduction

We love getting asked questions because we know the right questions will lead to the right answers. Having worked with more than 1,000 urgent care centers, we are quite familiar with the questions that get asked most. From clinic design to regulation to hiring and marketing, here are the most frequently asked questions (and answers) we get about urgent care.

Question 1

How much money do I need to start an urgent care?

When it comes to starting an urgent care practice, several factors influence startup costs for new clinics. Location and setting are primarily the main cost factors. Will your new center be leased or built from the ground up? Will you be located in the South or are you looking for the hustle and bustle of New York City or Los Angeles?

Most new clinics tend to select lease spaces as their first foray into urgent care ownership. Leasing helps lessen the expense associated with purchasing and improving the land. Urgent care operators who lease may even garner additional financial support from the leaseholder when it comes to leasehold improvements.

Additionally, initial staffing costs for your urgent care will be affected based on its location. In turn, this affects the amount of on-hand operational cash needed to hold the company over during the early months while your accounts receivable is maturing. In a nutshell, the average cost to start a new center—factoring in buildout, capital equipment, supplies, startup services, and cash-on-hand—will be in the ballpark of $1 million – $1.2 million. Again, it all depends on location, the size of the facility, and type of ownership.

Question 2

Who can own an urgent care?

The short answer is any licensed physician can own an urgent care. Many states have a restrictive Corporate Practice of Medicine (CPOM) doctrine, which can make urgent care ownership difficult and impractical. However, it is not impossible. If you are not a physician or licensed practitioner, some states do not have restrictions when it comes to ownership. For those located in states that do have a CPOM doctrine, you will be required to do a bit of research and engage with a knowledgeable healthcare attorney. Meeting with the right healthcare attorney will help you correctly set up your new business and avoid any future legal issues.

Question 3

Should I lease, build, or purchase my site?

Your primary concern should be locating and securing the best possible location for your urgent care. If this means you are leasing, so be it. In fact, the majority of urgent care operators—especially those just getting into the industry— lease. In particular markets, it is possible that situations may be more favorable to either build-to-suit or purchase the land and own the property. Nonetheless, for most operators, this tends to be the exception and not the rule.

Once more, the primary focus should be the site with unparalleled visibility, the best signage, prime anchorage, and the demographic that your clinic appeals to.

Question 4

What is necessary to begin my contracting and credentialing? How does it impact my startup?

Contracting and credentialing are some of the most critical tasks associated with the startup of your new clinic. As such, starting it as early as possible is crucial to the success of your clinic’s revenue cycle management.

Still, there are a couple of details you need to be aware of as they impact how soon you can start the contracting and credentialing process. Before contracting and credentialing can begin, you must have a Federal Tax Identification Number, a physician to contract and credential under, and a legitimate USPS address. If you are not an urgent care owner or operator, securing a physician to contract and credential under may be a stumbling block. Remember, if this person decides to leave your practice, you could be in danger of not having a valid contract in place.

Likewise, if you are leasing your site and elect to begin the contracting process before lease negotiations are finalized, there is a risk that your location could be lost should things go south. If this were to occur, there’s a chance you may have to start the contracting process over once a new location is found and secured. This could result in costly delays and much frustration.

Question 5

When it comes to opening an urgent care center, are there any specific design requirements?

Typically, no. While state and local codes may have some impact on specific design elements, they do not dictate things like the number of rooms, overall size of spaces, or placement of objects. The same goes for insurance payers or accreditation bodies. You may want to become familiar with some of their guidelines to make sure design choices are not in direct conflict with any of their demands. Any payer requirements could have an impact on reimbursement and the ability to become accredited in the future.

As a rule of thumb, it is best to assess what services you plan to offer at your clinic and then work with an experienced architect in urgent care design. An experienced builder can keep you compliant, make the most of the space, and help you stay within your available budget.

Question 6

Do I need a license to operate my urgent care?

In most states, you do not need a license to run your practice. Nevertheless, there are a couple of states that do have licensure and detailed review processes related to the operation of a healthcare facility. Arizona, New Hampshire, and Florida all have some application or submittal process.

This process includes submitting business plans, financials, and other detailed information before or during your startup to gain approval for your new business. Even though other states may have less rigorous requirements, you are still required to apply and to follow the rules when it comes to opening your new center. It is always wise to do the research on your state’s regulations before turning on the “Now Open” sign.

Question 7

What is CLIA (pronounced CLEE-ah) and how do I apply for my CLIA-waiver certificate?

CLIA stands for Clinical Laboratory Improvement Amendments. It is where federal regulatory standards were enacted for all clinical laboratory testing on humans. For most healthcare facilities, there are three levels of testing: Waived (simple), Moderate (difficult), and Certified (complex).

The majority of urgent care centers typically perform point-of-care, rapid, and CLIA-waived tests—rapid strep, rapid influenza, and urine dipsticks. To perform these tests, your urgent care will have to obtain a CLIA-waiver certificate.

Obtaining a CLIA-waiver certificate is easily accomplished by going online, downloading a CLIA 116 form, completing it in its entirety and then submitting it to the appropriate state agency (often the State Division of Laboratory Services). A note of caution: some states have their own forms and applications that are required in addition to the CLIA 116 form. It is your responsibility to check with the state to see what, if any, additional requirements must be met to comply. Additionally, there may be an on-site inspection of your facility—even for a waiver application. Here is a list of state survey agency contacts.

Question 8

If I want to be CLIA Moderate, are there any advantages or disadvantages?

Clinic by clinic, there will be pros and cons to applying for a CLIA Moderate certificate. For most urgent care centers, a moderate certificate enables urgent care centers to perform more tests, such as CBCs, BNPs, H&H, or CK-MB.

One downside is it also requires a much higher level of oversight and preparation. You have to identify a Lab Director (with certification from an accrediting body like COLA) and a Lab Consultant (trained and sometimes individually licensed to perform tests, quality assurance programs, documentation, inspections, and more).

If you are considering adding tests that fall into the CLIA Moderate realm, you should be sure the cost to implement and maintain such a program will justify the return on investment.

On the upside, you may be the only provider in the area to offer these services, which in turn means patient satisfaction could vastly improve. From a competition standpoint, you will set your urgent care apart from the others by having a lab that can go above and beyond.

Question 9

Is it ever too soon to begin building my website?

No. In fact, getting your website created and published is in your best interest. Why? Because it typically takes Google an extended amount of time to recognize new websites. Also, don’t worry if your website is not in its final, perfect form. That is what optimization is all about. It is a process of evolution—always changing, improving, and adding to make it better. The trick is to get the design done and add content as you go. From there, you can refine and pick out what you think makes your website more attractive to the clients you will be serving.

Don’t forget: social media is important as well.

Use it strategically to promote awareness to potential patients. Posting pictures of your facility while it is under construction will help generate interest and bring excitement to your community.

Question 10

Without resorting to a recruiting firm, where can I find practitioners to work in my urgent care?

Finding practitioners without resorting to a recruiting firm is always one of the biggest dilemmas associated with starting and operating an urgent care. Whether you are an urgent care owner or operator, finding reliable, qualified practitioners in many markets can be difficult and often seem impossible. Using a recruiter has its perks, but it can be expensive.

Moreover, it does not guarantee that the results will be long term or favorable. The idea is that time, and proper planning will help in the search. First, tap into any professional associations that you have access to. Many have job placement services, postings, or boards. You never know when someone will be looking for a change.

Along those same lines, don’t be bashful about tapping into the social networks you use. Don’t feel like you have to post to Facebook—but get the word out. Friends, family, and colleagues are typically more than willing to help spread the word. Shoot, you never know who has a family member or a friend of a friend who is relocating or fed up with their hospital position. It is an opportunity they may be waiting for.

Lastly, if mid-levels are an option, there are much easier ways to get in touch with PAs and NPs through professional associations and mail campaigns (commercially available lists). Doing this will cost you a few dollars, but when you look at the long-term impact, it could be a wise investment as you are looking for staff for future positions.

Conclusion

Finding practitioners without resorting to a recruiting firm is always one of the biggest dilemmas associated with starting and operating an urgent care. Whether you are an urgent care owner or operator, finding reliable, qualified practitioners in many markets can be difficult and often seem impossible. Using a recruiter has its perks, but it can be expensive.

Moreover, it does not guarantee that the results will be long term or favorable. The idea is that time, and proper planning will help in the search. First, tap into any professional associations that you have access to. Many have job placement services, postings, or boards. You never know when someone will be looking for a change.

Along those same lines, don’t be bashful about tapping into the social networks you use. Don’t feel like you have to post to Facebook—but get the word out. Friends, family, and colleagues are typically more than willing to help spread the word. Shoot, you never know who has a family member or a friend of a friend who is relocating or fed up with their hospital position. It is an opportunity they may be waiting for.

Lastly, if mid-levels are an option, there are much easier ways to get in touch with PAs and NPs through professional associations and mail campaigns (commercially available lists). Doing this will cost you a few dollars, but when you look at the long-term impact, it could be a wise investment as you are looking for staff for future positions.

Still have startup questions?