Melissa J. Holley treats patient Jessica Chiaramonte at MyCare Express in Eldersburg.
Written By Scott Braden
Whether you know them as walk-in medical clinics or urgent care centers, one thing is certain: they are experiencing rapid growth; both nationwide and in Carroll County.
Three clinics in and around Carroll County have made their debut in just as many years. The Deloitte Center for Health Solutions, an international consulting firm, predicts that the number of clinics nationwide will grow to 5,000 this year.
“We offer professional care at a more rapid rate than an emergency room,” said ExpressCare Director of Marketing and Business Development Melvin Kougl. Having opened in January 2010, ExpressCare of Westminster is the company’s fifth facility – with a sixth set to debut in Harford County.
Offering convenient, cost-effective health care on a non-appointment basis, the clinics provide an extensive range of outpatient services, including care for minor illnesses and injuries, onsite lab tests and digital X-rays, physical examinations, and the availability of many prescription drugs. Staffed with board-certified physicians, physician assistants and nurse practitioners, some also perform pregnancy testing and provide flu shots, among other services.
Are clinics prevalent in Carroll County and throughout the nation?
“Very much so,” said MyCare Express’ Director of Clinical Services Melissa J. Holley, MSN, CRNP. The Eldersburg clinic she represents first opened its doors in September 2008.
“I think with a lot of people not having insurance right now and not having access to physicians,” said Holley, “urgent care centers are up and coming, and being utilized a lot more than they have been [in the past].”
“Patient First supports a trend toward centering health care services on the patient’s needs,” said Patient First community relations manager Ian Slinkman, who represents the Patient First Neighborhood Medical Center in nearby Owings Mills, Md. “We have extended hours, 365 days a year, to make health care more accessible. We offer onsite services so patients can get everything they need in just one stop.”
“There’s been quite a rise in clinics,” Kougl said. “And there is definitely a need. Population growth throughout the country has caused quite a backup in hospital emergency rooms. Primary care physicians [PCPs] are limiting their practices to five days a week and are not open on weekends. What are the choices if you can’t get in to see your PCP, or if you get sick in the evening or on the weekend? Do you go to the emergency room or is there somewhere else you can go? We fill that niche. We can do what the emergency rooms do for people with non life-threatening injuries, but we can do it at a faster pace. You don’t have to wait six or seven hours for an X-ray.”
“[Clinics] are becoming more prevalent throughout the nation,” said Hanover Hospital Director of Marketing Lisa Duffy. Minutes away from Westminster, the South Hanover Express Care of Hanover, Pa., has seen 11,000 patients since opening in May 2009, which is why the Hanover Medical Group – the parent company of both the clinic and non-profit Hanover Hospital – is opening an Express Care in Spring Grove, Pa., at the end of June.
“I think that they provide a tremendous resource,” said Duffy. “The Express Care just seemed like a good fit for the Hanover and northern Maryland communities, because people in those areas aren’t going to drive to York [Pa.] for urgent care. We wanted to provide this service in our community.”
“Our own growth is an indication of [urgent care centers becoming more prevalent nearby and throughout the nation],” said Slinkman. “You will find other providers with varying degrees of similarity to what we do throughout Maryland and across the country. Since 1981, Patient First has grown from one location in Richmond, Va., to 26 centers throughout Virginia and Maryland. We plan to continue to grow to meet that demand.”
How do walk-in clinics recruit physicians? And are they attracting doctors who do not want to start practices of their own?
“I think there is a trend nationally where physicians – especially physicians coming out of school – want to be employed by hospitals or other healthcare organizations,” said Duffy. “Certainly, it helps reduce their cost and their overhead. Liabilities, as well, are taken into account. I think it’s interesting that we may have the opportunity to attract and recruit physicians who would be interested in working four 10-hour days. The schedules are certainly flexible when you have services [like the clinic] available.”
“And something like malpractice insurance is extremely expensive,” said MyCare Express’ Holley, “so if providers can have that cost covered for them, it offers them a different opportunity.”
“Our physicians come from numerous sources,” said Patient First’s Slinkman, “ranging from residency programs to established practices throughout the country. Work hours are predictable and flexible, compensation is comparable to private practice, and Patient First provides all the support systems the physician would otherwise have to manage themselves, such as staffing, billing, collections, referrals, training, contracting with insurers, and malpractice coverage. All of these distractions are the responsibility of Patient First, not our physicians. Patient First recruits only those physicians who are patient-focused and have the professional qualifications necessary to be credentialed by the insurance companies with whom we contract.”
All of the clinics in and around Carroll County take most health insurances. For patients who are underinsured or uninsured; a number that ExpressCare’s Kougl has seen increasing by 10 percent over the last year and a half. The family-owned and operated U.N.I. Urgent Care Center in Westminster, a pioneer in the area, reports that it offers a “low-fee direct medical access plan.”
Holley revealed that MyCare Express “offers a self-pay rate of $120, which is inclusive of any labs or X-rays done in-house.” As for ExpressCare of Westminster, Kougl said that they have “a program we are developing for self-pay patients.” And as for South Hanover Express Care, Duffy said that no patient is turned away.
“We have financial advocates who work with all of our patients,” said Duffy. “They can assist them into various programs if they need to be, and work on payment plans with them. So I think it’s very affordable either for people to come and get that level of care, and then know that if something arises from the visit they can come back in for a follow-up. We are definitely willing to work with our patients.”
“For self-pay patients,” said Patient First’s Slinkman, “payment of visit charges is expected at time of service. If, during registration, a patient expresses an inability to pay, a nurse evaluates the patient to determine if he or she is experiencing a medical emergency that requires immediate attention, in which case the patient is evaluated by the physician and appropriate care rendered.”
Are these clinics a function of the economy?
“I think they are,” said Holley. “But also, patients don’t like waiting to get into their PCP. If they are sick, they don’t want to wait until next week for the sore throat that they have today. And clinics allow them the flexibility to come in and be seen when they are sick after-hours and their PCP is not available, or on weekends when their regular doctor’s office is closed. It assists with convenience as well.”
“Regardless of the economic environment,” Slinkman said, “patients are receptive to convenient, cost-effective healthcare. This was true in 1981, when Patient First opened its first medical center, and it is true today. Our charges are about 25 percent of the cost for an emergency room visit for comparable services and are consistent with charges for visits to a traditional PCP for routine primary care. Patient First is a good value in today’s healthcare environment.”
“In a conversation that occurred this week about the new health care reform bill,” said Duffy, “the concern is if there are going to be enough PCPs around to take care of all the people who will have benefits. And how do you take care of these people? So, with [the clinic], even if you don’t have a PCP and you come in, there is only a minimal fee that you are paying to be treated and at least you are being seen by people with a good clinical background who have the appropriate expertise.”
How will the newly passed health care reform affect clinics?
“It will bring us more patients that have insurance,” said Holley.
“We are in the process of taking a really close look at how we’ll be affected by it,” said Duffy. “As more people feel comfortable with the fact that they have health insurance available to them, I’m sure that all organizations across the country would start to see an increase in the number of people coming through their doors. I think patients will take advantage of it.”
“If 32 million additional people will have health care insurance available to them,” said Kougl, “our numbers will increase dramatically.”
“Patient First supports efforts to make healthcare available to all,” said Slinkman. “An integral part of accomplishing this national goal is to figure out how to reduce the costs of health care. Patient First believes it is in a good position to help. Very few would disagree with the assertion that emergency rooms are overcrowded and used unnecessarily, leading to higher cost. Patient First is an attractive alternative for 70 percent of visits cared for in the hospital emergency room setting at 25 percent of the cost.”
Where does the new healthcare reform leave those who are on Medicare and Medicaid? Are clinics replacing doctors who no longer take Medicare and Medicaid patients?
“You are starting to see that,” said Kougl, “and with the new healthcare bill that was passed, that will become very prevalent in the next few years. Especially in 2014 when everything kicks in; you will see that happen.”
“I think it’s possible that we can see an increase [in patients],” said Duffy. “But again, no matter what their circumstances might be, whether they have Medicare and Medicaid, it’s important that they receive care. And we don’t turn people away.”
“Patient First’s objective is to provide health care to the residents of the areas in which we operate,” said Slinkman. “We do participate in Medicare, a number of managed Medicare programs, as well as in several major managed Medicaid programs.”
Although clinics look attractive on paper, do they offer a continuity of care – where all PCPs are informed and involved in the process – as opposed to fragmented care? Most of the experts we spoke to said it is very possible.
“In addition to urgent care for routine injuries and illnesses,” said Slinkman, “Patient First physicians also provide preventive and primary medical services to those patients who have chosen one of our physicians as their PCP. Continuity of care is a priority. We recommend that those patients returning for care of a chronic medical condition like high blood pressure or diabetes see the same physician each visit. While appointments are not necessary, those choosing Patient First physicians as their PCP can refer to www.patientfirst.com to see when their PCP is scheduled. Patients may also call any center for a three-day physician schedule.
“To facilitate continuity of care for patients who have a PCP in the community, we routinely forward a copy of the Patient First visit record to that physician with the patient’s permission.”
“We work to collaborate with PCPs,” said Duffy. “When a patient comes into the Express Care, the PCP’s office may be closed or the physician may be on vacation. We’re not looking to take these patients away, we’re looking to provide them with the level of care that they need at that moment in time.
“And we provide all that information back to the PCP. It gives the PCP another resource for their patients, as opposed to having to say I’m out of the office or on vacation now, so you need to go to the emergency department for that. The majority of [the PCPs] have been thrilled with the level of care that their patients have received [at the clinic], as well as the response time with the reporting.”
AREA CARE CENTERS AT A GLANCE:
- ExpressCare of Westminster
1011 Baltimore Blvd. (Rte. 140) Westminster, MD 21157; 410-848-3990
Hours: Sun.- Sat., 8 am – 9 pm - MyCare Express
1311 Londontown Blvd., Suite 130, Eldersburg, MD 21784; 410-549-7222
Hours: Mon. – Fri., 9 am – 9 pm; Sat., 10 am – 8 pm; Sun., 10 am – 6 pm - U.N.I. Urgent Care Center
Phyllis Green Professional Building
826 Washington Rd., Suite 110A Westminster, MD 21157; 410-751-7480
Hours: Mon. – Sat., 8:30 am – 8:30 pm; Sun. 8:30 am – 6 pm - Patient First Neighborhood Medical Center
10210 Reisterstown Rd., Owings Mills, MD 21117; 410-902-6776
Hours: Sun. – Sat., 8 am – 10 pm - South Hanover Express Care
Grandview Shopping Center, 140 Baltimore St., Hanover, PA 17331; 717-637-0470
Hours: Sun. – Sat., 8 am – 10 pm
