KinderMender uses IT, child-centric focus to differentiate itself, expand

Dr. Keyvon Rafei doesn’t like being taken by surprise.

He doesn’t appreciate unexpected surges in patient volume. He doesn’t enjoy paying employees top dollar to monitor empty waiting rooms. He hates guessing which illnesses will plague his patients, which neighborhoods they live in or what they thought about their visit to KinderMender, the pediatric urgent care clinic he founded.

Rafei doesn’t like leaving things to chance — so he doesn’t.

The medical director of KinderMender Walk-in Pediatric Center, which opened its second location earlier this year in Laurel, uses a variety of tools to track everything he can about his patients and their visits. The information helps Rafei make day-to-day management decisions, such as how many physicians to have on-call at a given time.

“We use information technology as much as possible,” Rafei said. “It’s a necessary thing we do to be wise about our investment in manpower, which is very expensive, but also to be there for our patients.”

Rafei knows most patients are 5 years old or younger and live within a three- to five-mile radius of the clinic they visited (the first location opened in Columbia in July 2011). He knows peak hours on the weekdays are between 4 p.m. and 10 p.m., and that weekends are even busier, especially Saturday mornings. He knows one-third of his patients are covered by Medicaid, and that flu symptoms skyrocket the week after school starts.

But some things are still unpredictable.

For the first year and a half, the Columbia location averaged 1,000 patients a month, Rafei said. Then, in November, that number doubled.

“School was starting, it was flu season, and all of a sudden everybody got sick,” Rafei said. “And everybody who heard about us from family and friends all showed up together, which was a shock to the system. What keeps me up at night is, if that’s what happened last year, what’s going to happen this year? I know we’re going to have more than that; I don’t know how much more. That gives me a lot of stress, because I have to have enough providers to be ready for patients who may come, knowing they may not come.”

That’s why, Rafei said, collecting data is so crucial to his business growth strategy. As he eyes further expansion, he’s shoring up KinderMender’s IT capabilities, like improving upon the “bootstrap” Electronic Health Records system he said he created when he realized existing systems didn’t meet the clinic’s unique needs: there were systems that worked for urgent care and systems for pediatric care, but none that were designed to do both.

“As you grow, what worked for you with one or two [locations] starts to feel strained as you add more,” he said. “So we’ve now engaged IT professionals to take our prototype [EHR] model and make it into a more robust tool. It’s constantly evolving.”

Data-driven approach

KinderMender has five pediatric physicians and five nurse practitioners, some of whom speak Spanish, all of whom travel between locations. In addition to treating minor illnesses and injuries on a walk-in basis, they serve as some families’ primary-care pediatricians and, in fact, bill on a similar scale.

KinderMender also has radiology services on-site, as well as stockpiles of the most common pediatric medications, which providers give to patients for free as needed.

Rafei said the two clinics generate about $2.5 million in combined annual revenue. For now, the Columbia location supports the Laurel location financially, but volumes at the latter are growing, and Rafei expects numbers will even out soon.

“There’s no doubt in my mind that we’re going to expand,” he said. “This model works, and people are liking it.”

When that time comes, Rafei said his database will be invaluable.

“He’s such a data hound,” said Duane Carey, president of Impact Marketing & Public Relations LLC, a Columbia firm that recently worked with KinderMender to put all the information Rafei collects to use.

Impact revamped the clinic’s website and added data-driven features, including an interactive map that tracks the incidence of contagious diseases in the area. If Rafei notices pink eye or whooping cough is going around, he said he wants parents to know about it, too.

Another new website feature estimates wait times at both locations, and is updated in real time based on current patient volumes, Carey said.

Jake Skaggs, a Columbia resident who brings his two children to KinderMender, said he wasn’t aware of the website features, but would be interested to find out what bugs are going around in his neighborhood.

“I’d probably check out the website even I wasn’t planning on going in to KinderMender, just to see what the map was showing,” Skaggs said.

Specialized model

Among the dozens of urgent care centers in Maryland, KinderMender’s pediatric focus is uncommon. Other than Pediatric After Hours — an urgent care center in Waldorf with shorter hours of operation, and which doesn’t offer checkups or immunizations — there aren’t many other options in Maryland focusing on families with sick kids.

Some private pediatricians offer limited urgent-care hours, and some hospitals (including the nearby Howard County General Hospital) operate separate pediatric emergency rooms or have pediatric specialists on-call in the adult ER. But in most cases, going to a pediatric emergency room — or any ER — is more expensive because hospitals bill on a different scale than urgent care centers do.

A typical emergency-room visit costs $1,000 for consumers, according to national statistics, while urgent-care co-pays are usually $100 or less. Skaggs said he pays the same $25 co-pay at KinderMender as he does at his kids’ primary-care physician’s office.

The reason pediatric urgent care centers are uncommon, Rafei said, is that children make up only about 25 percent of a typical urgent care center’s patients.

“Now imagine you’re trying to run a business from that perspective,” he said. “It’s not easy to make a living on one out of four patients.”

Dr. Robert G. Graw, CEO of Righttime Medical Care, an urgent care center with multiple locations in Maryland, disagrees. Righttime treats adults and children — but it wasn’t always that way.

The company first opened in Annapolis as Nighttime Pediatrics, providing urgent care to kids between 5 p.m. and midnight. After several years, in response to growing demand for urgent care from patients of all ages, Graw decided to change the company’s name and target market to meet “the needs of the community,” he said, adding that the percentage of youth patients had nothing to do with it.

Pediatric urgent care can be profitable, Graw said; it’s just a different model than general urgent care. Caring for adults is more expensive — clinics must bring on specialists that can handle adult medical issues — but also brings in more revenue.

But, for all urgent care centers, expansion can be challenging, Graw said.

“The centers have to be exactly the same,” he said. “Only a small percentage of [urgent care] companies have more than a few sites. The quality and consistency of care gradually decrease. Everybody struggles with that.”

A tough market

There are about 9,000 urgent care centers in the country, according to the Urgent Care Association of America. That number has increased rapidly over the past several years, the association found, and growth is expected to take off even further in 2014 thanks to the Affordable Care Act, which will connect millions of individuals — many of whom don’t have primary care doctors — with health insurance.

As urgent care’s popularity continues to grow, Rafei said he hopes to take advantage of the lack of pediatric-specialized centers, but he knows expansion won’t be easy.

Before Rafei can open a third clinic, he has to find the right spot: a highly visible, easily accessible location, which meets zoning and parking requirements, in a neighborhood with enough young families to keep the center afloat, he said.

All those criteria gave him trouble when planning the second clinic, he said, setting his timetable off-balance. The Laurel clinic finally opened in March — the end of flu season.

“That’s a slow time for pediatric care; it’s a seasonal business,” Rafei said. “I was paying all this overhead without the patient volume to support it.”

Next time, he said, he’ll make sure to open in the fall, when the noses start running.