Successful Integration of a Dermatology Walk-In-Clinic
To meet the immediate needs of patient, one practice initiated "walk-in" service hours with great success. Here's how the initiative took shape.
By Doug Reid

The impact of the current economic slowdown on healthcare services has been immediate for cosmetic procedures and reportedly is now hitting the clinical setting via a "trickle down" effect. Many practices are therefore looking for a strategy to increase revenues while maintaining a focus on quality care and patient satisfaction.

One area of opportunity is to meet the "immediate" or "expanded hours" needs of patients. Many patients with long work hours have a need for expanded hours from a local medical/cosmetic practice to meet their medical and cosmetic needs. Historically, most general or cosmetic dermatology practices find it hard to "fit in" patients who need immediate or same-day care.

ONE PHYSICIAN'S JOURNEY
After reading an article in the Journal of the American Academy of Dermatology regarding the long wait times for patients to have a suspicious or changing mole evaluated, Dale Westrom, MD, a California-based dermatologist, decided to test the idea of a walk-in clinic. Heading into the project, Dr. Westrom identified three primary objectives for his walk-in clinic:

1. To meet the medical requirements of patients in need of same-day care.
2. To meet the needs of referring providers and urgent care facilities.
3. To meet the needs of patients whose work/travel schedule prohibited them from committing to an appointment during normal business hours.

Ahead, Dr. Westrom answers questions to describe the project as well as the results of his experiment.

Can you describe the basic scenario of this concept and how you incorporated it into practice?
We decided to allocate the last hour of our schedule each day to test the concept and to stop scheduling regular patients at 3:45 pm so that the walk-in patients could be seen starting at 4:00 pm. Typically, I would have seen six scheduled patients between 4 pm and 5 pm (two new, four established).

Did you have specific guidelines for patient care during walk-in hours?
Absolutely. We felt having guidelines in place was essential, especially at the beginning. We did understand, however, that changes might have to be made on the fly, but we wanted to have a foundation going in. Our initial guidelines were as follows:

1. No appointment was necessary, but patients were asked to call first to confirm that a clinic would be held that day.
2. Patients were seen on a first-come, first-registered, first-serve basis.
3. HMO patients were required to have a valid referral on file (no retroactive referrals).
4. Patients were informed over the phone, and again in writing at the office, that the walk-in visits were strictly for limited, single skin problems (i.e., a changing mole, painful rash, etc.). Chronic problems, second opinions on complex skin diseases, surgeries (other than simple biopsies or incision/drainage), and cosmetic procedures were to be put on the regular schedule.
5. Check-in, check-out, and billing were to be handled by experienced staff members.

What did you envision your initial staffing requirements would be?
Frankly, we were not sure what to expect, because nothing like this had ever been done in this office or any other office that I have known. We have five providers in our office (four dermatologists and one nurse practitioner), and three of the dermatologists participate in the clinic. Because we do have a great demand for appointments, I assumed that we would have at least six to eight drop-in patients per day for the first week.

We anticipated that, for the one-hour period, we would need two front office personnel and two back office personnel dedicated to the walk-in clinic provider. Office staff assignments were as follows:

• Front office staff member 1: Register and check out patients
• Front office staff member 2: Register and handle billing responsibilities
• Back office staff member 1: Room patients; clean and reset patient rooms
• Back office staff member 2: Stay with physician; assist with biopsies, lab slips, samples, etc.

How did you determine appropriate compensation for office personnel who participated in this test offering?
We identified a couple of methods to compensate our staff. The first was to pay regular wages and stagger the start time for individuals who will be responsible for the walk-in hours of work. The second option was to pay overtime to those responsible for the walk-in hours.

What were the results of your initial "walk-in" offering?
This has been one of the most satisfying professional experiences of my career. It has just been so much fun! I have enjoyed every minute of this undertaking, even though I was a bit nervous initially. It has been challenging, exciting, invigorating, and extremely rewarding, both professionally and economically—although that wasn't the original intent.

What kind of patient numbers did you see?
Judging from all the wonderful comments and cards we have received from patients, the concept has been very well received. The average number of patients we saw on a normal walk-in clinic day was 14, with the most patients seen within a 70-minute period being 27.

Perhaps the most important number, however, is the average number of new patients acquired from this program each day: six.

What happens if you get too many patients during a session?
On most days, all walk-in patients are seen by 5 pm. It is very important to start on time and to stick to the protocol in order to do that. Furthermore, the more rooms available, the faster it goes, especially if there is more than one dermatologist available. On the rare occasion when more time is required to see every patient, I take a moment to visit the patients in the waiting room, reassure them that we will see everyone, and let them all know we appreciate their patience. They seem very appreciative that the doctor is the one who is updating them on how long the wait will last.

In no case has any patient had to wait more than 30 minutes. Furthermore, the patients are well aware that there is limited time for an exam, and they often apologize for taking up our precious time. The cooperation of the patients has been one of the most surprising and satisfying aspects of the clinic.

What would you say are the primary benefits to patients?
There are many benefits to patients. I would say the most obvious are:

• Referrals from primary care physicians do not have to wait weeks to receive care for bothersome or serious skin conditions.
• Individuals with unpredictable schedules (flight attendants, construction workers, health care personnel) can come in when it is convenient for them.
• Kids don't miss as much school, and typically adults require less time off from work.
• Visiting relatives or patients who are just traveling through the area can gain access to specialty care rather than having to rely on emergency room advice from someone with limited dermatology training.
• For many, the peace of mind that a pigmented lesion is benign is well worth the visit.

What are the benefits of the new offering to your practice?
Benefits to the practice include:

• A strong sense of professional satisfaction for all members of the team.
• A reduction of staff pressure to squeeze patients into the regular schedule.
• You can see disease states that you normally do not see.
• Introducing new patients to the practice is a practice-building opportunity—even with those patients from other dermatology practices where they could not be seen in a timely manner.
• The walk-in clinic allows for early intervention for diseases that require it.
• The clinic provides a mechanism for handling "emergency" or same-day patients without extending the length of the practice day.

Looking back, what would you say are the keys to successful startup of a walk-in clinic?
The first piece of advice I would give is to treat this undertaking as you would any other strategic move. It takes a strong, unified commitment and careful planning. Don't rush into it. Flexibility is also required; things will change, and you and your staff will have to adapt. I've provided a list of six keys for success in the table above.

Do you have any final thoughts or words of advice?
I'd just like to emphasize that our patients love the walk-in clinic. It definitely is meeting a need and helping us grow during a challenging time. Establishing the walk-in clinic is probably the most satisfying thing I have ever done professionally.

Editor's note: If you have questions or would like more information about implementing a walk-in clinic in your area, contact Dr. Westrom at 707 579-4239, e-mail www.drwestrom@msn.com. In addition, you can contact Doug Reid, Allergan Practice Consultant, at 916-719-3067; e-mail reid_doug@allergan.com.