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Filling a medical need: Growth of urgent care centers follows a national trend

December 28, 2014

Family physician Dr. Monisha Sarin talks during an interview at the Walk In Center for urgent and primary care at the Family Health Center of Worcester on Wednesday, Dec. 3, 2014. (T&G Staff/PAUL KAPTEYN)  

Noreen Johnson Smith, vice president of development and advancement at Family Health Center of Worcester, talks during an interview at Family Health's Walk In Center for urgent and primary care in Worcester earlier this month. (T&G Staff/PAUL KAPTEYN)

Urgent care centers — filling a gap between primary care doctors and hospital emergency rooms — are expanding rapidly in Central Massachusetts. Some are for-profit, some are nonprofit, but all offer expanded hours on nights and weekends to help people deal with emergencies — cuts, sprains, broken bones, flu symptoms, X-rays, some medical tests, stitches, and more — that might normally be dealt with in an emergency room, especially during off-hours.

Reliant Medical Group in Worcester opened two ReadyMED urgent-care locations in the past 18 months, at prominent retail locations in Shrewsbury and Auburn. Reliant plans to open three more in and around Worcester, company officials said.

Doctors Express, a national for-profit chain of urgent care centers, has opened 12 locations in Massachusetts since 2010, and most recently an urgent care center in Marlboro.

Family Health Center of Worcester, a nonprofit organization, operates an urgent care center in the former City Hospital property on Queen Street in Worcester. HealthAlliance Hospital announced in July that it would open an urgent care center on North Main Street in Leominster, but that plan is apparently on hold. And recently, Harrington HealthCare announced that it will open an urgent care center next year on Route 20 in Charlton.

The growth of urgent care centers here follows a national trend.

Since the early 1980s, urgent care centers have been operating in the U.S., but their growth has exploded lately. The industry now has between 4,000 and 9,000 facilities across the country, according to the Urgent Care Association of America, the industry's trade association.

Convenience and lower cost are considered as two important facts that help the urgent care centers expand.

"You make a phone call, schedule an appointment, take a day off from work and go sit in the waiting room, " said Eric Buehrens, the Chief Operating Officer of Reliant Medical Group, describing the old way of getting treated in America. "This is not the way business is being done in the 21st century."

Similar to emergency rooms, patients don't need appointments to see a doctor in urgent care centers.

"If you wake up sick in the morning and you can't get to see your doctor, you can come here and get the visit in the same day," said Noreen Johnson Smith, the vice president of development and advancement at Family Health Center of Worcester.

The average time patients spent waiting in the emergency room before being seen by a doctor was 36 minutes in Massachusetts during 2013, which ranked as the fourth longest wait time in the U.S.

The wait time is 45 minutes in the emergency room at UMass Memorial Medical Center, and 29 minutes at Saint Vincent Hospital, according to ER Wait Watcher by ProPublica, an app analyzing 2013 data collected from the federal Centers of Medicare & Medicaid Service.

The average wait time at a Doctors Express clinic is under 10 minutes, the company claimed on its website.

Focusing on medical care that requires immediate attention but is not life-threatening, "urgent care centers allow emergency rooms to serve true emergencies, and its average discharge time is under one hour," wrote Lisa Salerno, the associate vice president of health care practice at Rasky Baerlein, a Boston public relations firm, in an email.

Besides same-day visits, patients can ask for medical help anywhere through an online electronic portal MyChart offered by Reliant Medical Group.

"I think this (electronic visit) is a way that a lot of people want to deal with their medical care these days and it's something that we hope to expand in the future," said Mr. Buehrens.

Urgent care centers typically cost patients less than an emergency room visit because insurance companies charge a lower co-payment for an urgent care visit. The lower co-payment is possible because the urgent care center is likely to bill the insurance company less than the emergency room. A patient can also save money by going to the less expensive urgent care center when he exceeds his insurance policy if it has a high deductible and he becomes responsible for the full cost of the service.

For patients with Blue Cross Blue Shield Insurance, the co-pay for a visit to emergency room is $100, while the co-pay is $10 or $20 at Family Health Center. For patients with MassHealth, a publicly run state medical health plan, there is no co-pay, according to Dr. Monisha Sarin, a doctor who has been working in Family Health Care of Worcester for 12 years.

"It's an umbrella for all state-sponsored health insurance," said Dr. Sarin.

High-deductible health plans are becoming more common. Sixty-seven percent of employers offer high-deductible health plans, and 47 percent offer plans compatible with health savings accounts that can receive both employer and employee contributions according to a report from PricewaterhouseCooper's Health Research Institute in September 2014.

"As a shrewd consumer, wouldn't you choose to visit an urgent care center like ours for non-life threatening conditions?" said Bing Yeo, the managing director at Doctors Express, who was confident to say that the bill in an emergency room would be five to six times higher than the bill from Doctors Express.

As a for-profit business without funding from government, Doctors Express Urgent Care Centers have the right to pick patients. The chain does not accept all kinds of MassHealth, the state-sponsored health insurance for the poor. But it does accept Medicaid offered by Fallon Health, Neighborhood Health and Network Health, according to Mr. Yeo.

By contrast, hospitals are legally obligated to treat everyone, regardless of whether they have health insurance. Hospital emergency rooms do not require patients to pay upfront for care.

For patients without insurance, Doctors Express Urgent Care Centers charge a flat fee of $149 for a regular visit, which includes X-ray and some in-house labs.

Nationally, an urgent care center performs an average of 342 exams a week, according to the Urgent Care Association of America.

"Urgent care is a low-margin, high-volume proposition," according to a recent story on urgent care centers in The New York Times.

At $149 per visit at Doctors Express, and with the national average of 342 visits a week, "the money starts to add up," the article stated.

For Reliant Medical Group urgent care centers, the goal is to keep patients out of very expensive and inappropriate locations for receiving care.

"In particular, to keep our patients away from the emergency rooms," Mr. Buehrens said.

Dr. Sarin, at Family Health Center, recalled one patient coming with a huge bill from the emergency room.

The patient was a refugee, who was sent to an emergency room as soon as he landed in America for the first time.

"He gave me a bill, asked me 'What do I do with this bill?'" said Dr. Sarin, who originally from New Delhi, India.

Dr. Sarin gave the $3,000-plus bill to a benefit advisor at Family Health Center, who talked to the hospital and found the patient was qualified for MassHealth. The hospital, UMass Memorial Medical Center, will directly bill the state insurance, according to Dr. Sarin.

"But that was a wake-up call to see, 'Oh my God, he cost the ER three thousand dollars,'" said Dr. Sarin.

Though competing against emergency rooms with more convenience and lower-cost, the urgent care centers cooperate with emergency rooms.

"We work closely with the emergency rooms in Worcester," said Mr. Buehrens. He explained that there are certain circumstances that patients need to go to emergency rooms, though its main goal is to keep patients away from the emergency room when patients have a routine illness or injury.

As a long-time doctor in the urgent care center in Family Health Center of Worcester, Dr. Sarin said they have a very good relationship with the emergency rooms.

"We take the business they (emergency rooms) don't want," said Dr. Sarin. "The doctors at UMass Memorial know our names now."

Simeng Dai

Worcester Telegram & Gazette

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