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Urgent care clinic providers add facilities

Customers are turning in increased numbers to urgent care centers, which often offer shorter wait times than hospitals. (Photo/James T. Hammond)

Customers are turning in increased numbers to urgent care centers, which often offer shorter wait times than hospitals. (Photo/James T. Hammond)

By Mike Fitts
Published Feb. 4, 2013

A driver hurrying to the emergency department of Lexington Medical Center has a new option to consider across the street. Just across Sunset Boulevard is a brand-new urgent care center with a digital sign out front advertising its waiting time, addressing a key complaint of emergency patients.

That cross-the-street rivalry is emblematic of the mounting competition in health care’s urgent care sector, with customers turning in increased numbers to the centers, seeking convenient treatment for the sprained, scratched and sick.

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In addition to new and established chains, hospital systems themselves are promoting their own alternatives to the emergency room.

Wait times are a key concern for patients needing urgent care, so it also has to be a top concern for the staff at Medcare Urgent Care’s new center, according to CEO Radwan Hallaba.

Having the sign out front also keeps the Medcare staff accountable for the service being provided, said Hallaba, a former emergency department physician. Ideally, Hallaba said, the waiting room at Medcare should be welcoming and empty.

‘A great market’
Medcare started in 2006 in Charleston and opened its West Columbia location in March. This spring it will open its third location in the Midlands, in Spring Valley. The Midlands is “a great market” for urgent care, with similarly strong demand as in Charleston, Hallaba said.

Doctors Care now has 18 Midlands locations, part of a statewide network that has grown in recent years to more than 50. Several Midlands hospital systems also are in the urgent care fray.

Urgent care centers are expanding nationally, too. Since 2008, the number of urgent care centers has increased from 8,000 to 9,300, and more urgent care centers have become in-network choices for insurers, according to the Washington Post.

Medcare took three years to choose its Sunset Boulevard site for its first location, but Hallaba declines to describe it as an aggressive choice. He sees urgent care centers as one provider along a larger continuum that includes drugstore clinics, physician offices and hospital emergency departments.

“At the end of the day, there’s enough of a population for everyone,” Hallaba said. “It’s not a zero-sum game.”

Doctors Care has been adding about four locations around the state per year, and it received about 850,000 patient visits in 2012.

This year it is devoting a lot of energy to consolidating that growth and renewing facilities, according to David Boucher, president and COO of UCI Medical Affiliates, which administers the Doctors Care locations.

“We’re going to get a whole lot better before we get a whole lot bigger,” Boucher said.

Conversion to electronic records
These improvements include rolling out electronic medical records across all Doctors Care locations this summer. The conversion to electronic records will add consistency to treatment, Boucher said. If you go to the Doctors Care at the beach, your records from a previous visit near home will be available to provide more background for your care, Boucher said.

Doctors Care also is refreshing or replacing a dozen facilities, including relocating to a new building on Hardscrabble Road. That project should be complete by the end of the year, Boucher said.

Connecting urgent care to the entire spectrum of a patient’s health needs is a key advantage touted by hospital systems as they promote their own urgent care options.

Hospitals adapt
Several major Midlands health care providers, including Palmetto Health, Lexington Medical and KershawHealth, are promoting their own urgent care centers as alternatives to emergency departments. Urgent care centers take some of the pressure off crowded emergency departments, Palmetto Health Urgent Care Nurse Manager Andy Carroll said. This frees physicians and staff members in the emergency department to care for those who need the highest level of care, Carroll said. Palmetto Health operates urgent care centers in Blythewood and Irmo.

Of course, the definition of an “emergency” can be different if it is you or your loved one, said Lexington Medical Vice President Roger Sipe. “That’s really very subjective to the patient,” Sipe said. Ultimately, patients make their decision about what level is appropriate.

Lexington Medical operates six urgent care facilities, having opened its first back in 1986. Some in outlying towns such as Batesburg-Leesville fill the role of a community hospital, Sipe said, and even have a nearby helicopter landing zone if needed. The centers see some patients consistently and will check to see if they are following instructions on caring for chronic conditions, Sipe said.

For bigger health systems, urgent care centers can provide a connection for new patients to the larger health care system’s retinue of employed physicians. Health care systems locally and nationally have been employing increasing numbers of primary care physicians and specialists. Current patients of the system can see an affiliated urgent care and see a physician who has access to their medical records, said Dr. Bill Gerard, chair of the USC Department of Emergency Medicine and director of professional services and education for Palmetto Health.

An urgent care center also is a more economical setting to treat a patient than a full emergency department, assuming the care is appropriate. A Rand Corp. study in 2010 estimated that one in five emergency department patients could be treated at an urgent care with a lower cost.

There also is an economic advantage for the system —patients at an urgent care have to demonstrate some method of payment, often by making a deposit in advance. An emergency department is required by law to treat anyone regardless of ability to pay, Gerard said.

Smaller copayment
Patients with health insurance often will choose an urgent care because of the incentive of a much smaller copayment versus an emergency department visit. Patients also appreciate the ways that urgent care centers let them know their costs upfront, several executives said.

The state’s largest insurer, BlueCross BlueShield of South Carolina, acquired Doctors Care two years ago and now operates it as a wholly owned subsidiary. The primary benefit for BlueCross BlueShield is to ensure that adequate and affordable physician care is available for its 1.5 million members, Boucher said. Doctors Care takes most major insurance plans, not just BlueCross BlueShield, Boucher added.

There may be “potential long-term benefits” to the insurer in owning the urgent care chain, said Boucher, who previously has overseen other service lines at BlueCross BlueShield. Boucher’s focus is on making sure there are enough doctors and facilities to meet local needs, which can be tested during times such as this year’s flu season.

Some patients, of course, shouldn’t be treated in an urgent care center. A hospital-affiliated urgent care center can quickly connect the patient and his medical data to the emergency department or a needed specialist, Sipe of Lexington Medical Center said.

Medcare has been reaching out to other health providers across the spectrum of care, Hallaba said. His centers can work to treat a patient who needs more care than a drugstore clinic can provide and are working to build links to emergency departments so a patient can be transferred easily when needed.

The strong growth in urgent care sector is projected to continue. The federal Affordable Care Act is expected to provide more people with insurance coverage, including a built-in incentive to use urgent care over emergency departments.

It also might create longer wait times at doctor’s offices — one of the key reasons that drivers head for the urgent care instead.