Urgently filling a niche

In 1978, Dr. Robert Thornton and two colleagues came up with a novel idea – a clinic where people could walk in with minor illnesses or injuries, and get treated without an appointment – the first urgent care clinic in Washington state.

Today, Clark County is host to at least a dozen such clinics. According to Ron King, who owns two Urgent and Family Care clinics, the role of urgent care clinics is two-fold: offer immediate care to patients, and enable hospital emergency rooms to concentrate on treating acute illnesses and trauma.

 

Growth driven by many factors

Why the burgeoning number of urgency care clinics in Clark County? One reason is the declining number of family practitioners. According to the American Academy of Family Physicians, in 2007, only eight percent of U.S. medical school graduates chose to become family physicians, only half the number that made the same choice in the early 1990’s.  

“Doctors are becoming more scarce,” said Raelene Jarvis, clinical manager for the Memorial Urgent Care Clinic on Main Street in Vancouver. “This is leaving patients without access to care,” a gap which urgent care clinics try to fill.

Lower reimbursement rates and rising malpractice insurance costs contribute to the dearth of family doctors. For example, Dean Barrus, owner of Urgent Medical Centers on Fourth Plain Boulevard and in Salmon Creek, stated that over the last three years, reimbursement levels have dropped 30 percent. Across the nation, the cost of family practice malpractice insurance has more than doubled in the last five years.

There’s also a cultural impetus behind the prevalence of urgent care clinics.

“We’re a ‘get it now’ generation,” said Jan Loomis, clinic manager for the Lacamas Medical Group in Camas.

Cost is also a factor. King stated that a clinic visit cost about one-fifth of an ER visit, with an average wait time of only 20 minutes, versus about four hours at the ER.

And of course, the 20 percent increase in Clark County’s population since 2000 means urgent care clinics get busier every year. At the Family Care and Urgent Medical Clinics started by Thornton, Le Ann Bigoni, director of operations, said, “After 30 years, we are impressed with the large number of new patients we see every month.”

 

A new spin

When you talk about urgent care clinics, there are actually two types. The “pure” urgent care clinic takes only walk-ins – no appointments. A classic example is the Memorial Urgent Care Clinic on Main Street in Vancouver, which is open 24 hours a day, and is what Jarvis called “ER Lite.”

But an “open access model” has been developing in Clark County over the last five years.

“You’re seeing many family practices offering urgent care, and some urgent care clinics offering follow-up,” said Scott Jonason, owner of the Lacamas Medical Group, which caters to both urgent care patients and family practice.

Several local clinics follow this model, including the Lacamas Medical Group.

“We have the best of both worlds,” said Jonason, who enjoys the variety of the urgent care work, but also values the long-term doctor-patient relationships that family practice offers.

Some clinics have also found niches where they excel. For example, one of Barrus’ physicians specializes in occupational medicine. Barrus said that many businesses contract with his clinic to perform injured worker exams and answer questions for both the business owner and the patient.

“Businesses value that,” said Barrus.

The Memorial clinic has found a different niche – high-tech language interpretation. The clinic, which is part of the Southwest Washington Medical Center system, has access to the hospital’s telephone interpreter, allowing immediate communication with a non-English-speaking injured person. Also, the clinic has a video language relay, which enables clinic staff to quickly communicate with deaf patients via a two-way video conferencing system.  

 

Meeting the challenges

Urgent care clinics face some of the same challenges encountered by appointment-only offices, such as declining Medicare/Medicaid reimbursements and the climbing costs of insurance.

“Fewer and fewer facilities are willing to see Medicare patients due to lower reimbursement levels,” said Barrus. “Urgent care facilities offer a way for these folks to be seen.”

However, as King points out, urgent care clinics have to cover their costs, too, and that means “seeing volume,” which can push up wait times.

Jonason reported that an “astounding” 15 percent of his patients are private pay. These patients suffer sticker shock, he said, when they get their bill, and call the clinic with questions.

“We do a lot of education with patients with respect to out-of-pocket expenses and other policy verbiage,” said Loomis.

One way King mitigates the effect of rising insurance costs for clients is to be cognizant of patients’ pay source, and to keep costs down where possible, including handing out sample medicines and offering free follow-up visits for the same condition.  

Another common problem for all medical facilities are government regulations, such as the HIPPA privacy rules, which Bigoni said “make the practice of medicine more difficult,” especially when trying to interface with a patient’s primary caregiver.

But urgent care clinics face some unique challenges, as well – not the least of which is scheduling.

“Walk-in traffic tends to be random,” said Bigoni, with illnesses predominating in the winter, and injured workers and lacerations common in the summer.

King schedules about half his available staff hours as appointments, and does not schedule appointments for two hours before the clinic closes in order to “catch up” with walk-ins. More appointments can be scheduled in the summertime, as urgent care clinics tend to be less busy then.

People’s interpretation of “urgent care” can also sometimes present a problem.

“People think ‘urgent care’ means walk in, walk out,” said Jarvis. “That doesn’t always happen.”

This is especially true, said King, in open-access clinics, where “patient” can take on a double meaning as the clinic tries to balance “first come first served” with the clinical needs of patients, appointments and availability of staff.

How urgent is the future?    

With close to a dozen urgent care clinics in Clark County, is the market getting saturated? King admits it is a good question, and said that customer service was going to be a big differentiator in the coming months.

Many clinics are becoming more digital, to provide better answers more quickly. For example, on-site labs and x-ray equipment mean patients don’t have to wait weeks for results. Bigoni said their clinics were updating and remodeling, and were in the preliminary stages of electronic records. Similarly, Jarvis said they had instituted bedside registration in the exam room, digital radiography and scanning patient records into a paperless system.

Many urgent care clinics are also looking at expanding. King is in the process of hiring a part-time physician’s assistant, and the clinic is expected to outgrow its current Washougal site in about a year. Loomis reported that they added a fourth full-time provider just last fall, while Bigoni indicated that they were looking into opening a new clinic near 192nd Street.

 

RETAIL CLINICS COULD OFFER COMPETITION

 

Urgent care clinics have a new competitor: “retail clinics” (also called “convenient care clinics, or CCCs) in pharmacy chains and retail outlets. These clinics can treat minor, non-acute illnesses such as strep throat, and prescribe medications.

Currently, there are no retail clinics located in Vancouver, according to the website, www.healthcare311.com, which helps search for such clinics. But, it’s only a matter of time. In 2007, there were between 400 to 500 such clinics located in such places as QFC and Walgreens stores, and airports. According to the American Medical News, plans call for having 1,500 retail clinics up and running by the end of 2008, and conservative estimates project more than 2,100 clinics in operation by 2010.

“I think we’ll be seeing more retail clinics,” said Scott Jonason, owner of the Lacamas Medical Group. “They’re another option for consumers.”

Jonason admitted that retail clinics were unpopular with some medical providers, due to concerns over conflict of interest and quality of care. To compete with retail clinics, he said, urgent care clinics must simply offer a higher level of care. Plus, he said, as more clinics – both urgent care and more traditional doctor offices – move toward the open access model, taking both appointment and walk-in patients, there would be less need for retail clinics.

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