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AGENDA
ISSUE
“People like the fact that they can just walk in any time... the environment is much less scary. You won’t see some guy next to you with a gunshot wound.”
Q3 2013
saw urgent care popping up everywhere, especially in Florida and Long Island. They all seem to be doing pretty well.” The group opened MDxpress in Mamaroneck in March and is already thinking about expansion. “The reception has been great. We’re seeing easily 30 patients a day, and we have a lot of repeat visits.”
One of the biggest needs everyone points to is the declining number of primary-care physicians, the traditional go-to guy or gal who takes our temperature, puts that chilly stethoscope on our chest, and cures most of what ails us—pretty much on demand. "It's very hard to find primary care doctors," says Hayworth. “Even an organiztion like ours has trouble hiring them.” While exact num- bers for Westchester aren’t available, there’s plenty of anecdotal evidence that points to a shortage of independent doctors who practice family medicine, internal medicine, general pediatrics, and OB-GYN. Have you tried to get a same-day doctor’s appointment lately?
Then there’s the problem of physician access. “Just because you have primary-care physicians practicing,” says Jean Moore, director of the Center for Health Workforce Studies at the School of Public Health at SUNY Albany, “it doesn’t mean they are available to everyone in the community.
In Westchester, you’re not likely to find geographic shortages, but, for people who don’t have insurance or are on Medicare or Medicaid, some of them don’t have much choice other than to go to the emergency room for their primary care.”
Lee, however, believes it is disingenuous to say that the rise of walk-in care is due to
a shortage of primary-care physicians, since physicians staff the urgent-care centers as well: “You’re just shifting them to another location.”
Regardless, consumers really like the con- venience of walk-in medicine. Vera Luthra, who manages Urgent Care of Westchester, says the message has been spreading since she and her husband, Jay Luthra, MD, an
ER physician in the Bronx, opened their first center nine years ago. They now have eight
in the NewYork metro area, including one
in Tarrytown, and hope to open two or three more in the very near future. “The most important message is that we are open seven days a week,” she says. “People like the fact that they can just walk in any time.” You can do that at an emergency room, too, she points out, “but the environment [at Urgent Care of Westchester] is much less scary. You won’t see some guy next to you with a gunshot wound.”
Sussman says half of CVS MinuteClinic patients come in on weekends or evenings. In addition, he says, “about half of our patients don’t have a personal physician, so we give them a list of doctors in their area who are accepting new patients.”
Urgent care is usually less expensive care, too, at least as compared to emergency- room services. As Hayworth explains, “Patients like the fact that the copay to go to urgent care is, in many cases, a lot less than for the emergency room.” Obviously, insur- ance companies also like the lower charges.
How do walk-in-care charges compare with non-emergency-care charges from a doc- tor’s office? Apples-to-apples comparisons are difficult to make, but a 2009 study by the RAND Corporation and published in the Annals of Internal Medicine looked at 2,100 patients in Minnesota with three common acute conditions (ear infections, soar throats, and urinary tract infections) as they were treated at retail clinics like CVS MinuteClinic versus at doctors’ offices, urgent-care centers, and hospital emergency rooms for the same conditions. It found retail-clinic overall costs were about 30 percent lower than urgent- care and doctors’ offices costs and 80 percent lower than emergency-room costs. What’s more, quality scores were basically identical across the board.
For WESTMED patients, there’s another advantage to urgent-care service, according to Jason Shuker, MD, managing physician for WESTMED's four ugent-care centers.
Co-locating urgent-care facilities with the group practice's full-service offices, he says, “essentially provides one-stop shopping. It’s somewhere you can go to get all your stuff taken care of in one place.” If you come to them with abdominal pain that turns out
to be appendicitis, for example, WESTMED Urgent Care will confirm it by examination, CAT scan, and lab work before contacting a surgeon—which may well be one of theirs. “In that situation, because the surgeon is already aware, the patient can avoid the emergency room completely.” Because WESTMED’s urgent-care clinics are located within their existing facilities, testing and imaging are immediately available and specialists are oftentimes found just a short walk down the hall.
That patient’s treatment will also become part of WESTMED’s electronic medical records system, an important advantage that’s unique to them and MKMG among the local urgent-care providers. Clinics that don’t have that capability typically rely
on faxes or even the patients themselves
to hand-carry treatment records to their personal doctors. It’s analog procedure in a digital world.
Which is a major problem, according to Robert Amler, MD, dean of the New York Medical College School of Health Science and Practices. “The patient, or customer, is looking at a trade-off,” he says. “They are gaining the immediacy of care but losing the continuity of knowledge about their current medications, past medical history, family and social history, and so forth.” That lack of history cuts both ways. “The doctor or nurse practitioner in the urgent-care facility has to deal with the absence of information that can be extremely important.”
Lee bluntly adds, “There is discontinuity of care. People, many times, don’t pass on information to their physicians or primary- care providers. In a healthcare environment where we’re trying to consolidate and inte- grate care, this is actually a massive disinte- gration of the communication chain.”
The effects of urgent care on the business of medicine in Westchester aren’t being felt very strongly—yet. Sole practitioner Michael Fusco, MD, says, “Even though I’m within a couple of miles of urgent-care centers, I’m bus- ier than I ever have been. Generally, the way my office works, I cover my patients, myself, 24 hours a day anyway. But I’m the excep- tion, not the rule.” He says he doesn’t hesitate
to send a patient to an emergency room or urgent-care center if they call him and he feels they need immediate assistance that he can’t provide right at that moment.
Westchester hospital emergency rooms are also busier than ever. From 2005 to 2010 (the latest year with available data from the New York State Department of Health), ER visits jumped nearly 25 percent at County hospi- tals. St. John’s Riverside Hospital Emergency Department currently sees 38,000 patients annually in a space built to serve 25,000, and its volume is continuing to grow at more than 3 percent per year. The new Flanzer Center for Emergencies and Critical Care at White Plains Hospital provides emergency and critical care for more than 48,000 patients annually.
While urgent-care centers may be reliev- ing some of that pressure, it’s probably going to get worse before it gets better when the Affordable Care Act takes full effect next year. As Fusco points out, “The Affordable Care Act is insuring millions of new people, but it doesn’t say who’s going to take care of them.”
Urgent-care providers are hoping to fill that gap, but even they know there’s more to the opportunity than meets the eye. “People
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