Sluggish economy, sicker patients

It's not just the economy that's sick. According to healthcare professionals at several local urgent care clinics, Clark County's high unemployment rate is fostering a trend of healthcare procrastination.

Many colds and coughs can turn into something more serious, like bronchitis or pneumonia. But, if money is tight – or nonexistent – patients are often reluctant to visit a doctor's office.

"Many of our patients are in a desperate situation, and should have been looked at a month ago," stated Dean Barrus, owner of two Urgent Medical Centers, one at the corner of Fourth Plain Boulevard and Vancouver Mall Drive, the other in Salmon Creek.

Anna Axlund, office manager for the Fisher's Landing Urgent and Family Care Clinic, reported the same pattern, with fewer people coming in for coughs and colds – but more coming in for hospital stay follow-up treatment.

Making Care Affordable   

Barrus said his clinic tries to mitigate patients' healthcare expenses by offering a discounted cash rate and establishing a payment system for those who need it. But, he added, it's a juggling act to meet the needs of the poor but still be able to pay his own bills.

Efficiency in delivering care, in billing and in processing patients and data, said Barrus, is the key to this juggling act. Raelene Jarvis, clinical manager for Memorial Urgent Clinic on Main Street in Vancouver, also stated that efficiency is critical for a successful business.

"We're looking at our processes from A to Z, to determine which steps are vital, and which are redundant," Jarvis said, adding that not only does efficiency help keep costs down, but it also gives the patients what they really want: to come in, see the doctor and go home.

Washougal-based Columbia Gorge Medical Center, owned by nurse practitioner Sarah Russell, has another approach to making healthcare affordable for those who do not have insurance.

Russell, who bought the clinic from Urgent and Family Care owner Ron King last February, has instituted a Patient Assistance Program, which connects local nonprofits, businesses and churches with patients who need help in paying for healthcare.

"It looks a little different for each organization who participates," Russell said. "Some make a fixed donation each month, others commit to helping a set number of patients every year."

Patient Volume Still Growing

Waiting rooms at urgent care clinics across the county are busy. Axlund reported that her clinic treats 45 to 55 patients a day, with walk-ins experiencing an average wait-time of 20 to 45 minutes. Russell said that last year, she saw five to 10 patients per day – a number that has climbed this year to 18 to 24 per day.

Barrus said that his patient volume has grown about 10 percent over 2008, with 6 to 7 percent of that increase being made up of Medicare and DSHS patients. To accommodate this growth, Barrus' Fourth Plain clinic moved to a new location at the end of August, doubling their square footage to 10,000 square feet.

The new clinic, built by TEAM Construction, offers a digital X-ray system and a full complement of testing equipment for occupational medicine. Barrus has added one additional care provider and is currently interviewing for another open position.

Axlund stated that although her clinic reduced hours of operation due to the recession, they have added new staff to keep up with patient demand. Currently, the clinic employs two receptionists, two office managers, two medical assistants and three care providers. Russell added a second front desk person in September as well.

With the exception of Memorial, which makes no appointments, most clinics take a mixture of walk-ins and appointments for a mixture of urgent care and traditional family care.

Axlund said her group preferred appointments for those patients who wanted to establish a primary care relationship, but that for urgent health matters, walk-ins were always welcome. Russell stated that the great majority of her patients were scheduled, with only four to five walk-ins per day.

Flu Still a Threat

Urgent care professionals see a lot of flu patients, both the normal seasonal flu and the H1N1 flu. Although media coverage of H1N1 has dropped off considerably compared to a couple months ago, Jarvis cautioned that people shouldn't give up taking precautions against infection, such as washing one's hands. "All models, and our experience in the Southern Hemisphere, predict a second wave of H1N1," she said.

Barrus concurred, stating that his clinic had been "jam packed" on various days with flu patients, and that "we're not through it yet."

With Clark County's unemployment rate hovering around 13.7 percent, that could mean urgent care clinics may continue to see patients later, as well as sicker.