Bypassing Emergency Rooms for More Immediate Care

All across New York City and the United States a new kind of medical care is changing how people go to the doctor. It is the urgent care facility. These walk-in without an appointment medical offices now number in the thousands across the United States. The urgent care facility, its supporters say, is neither a hospital emergency room nor your family doctor office.

Yet its success has disturbed some and delighted others. And, from a business point of view, it poses a big challenge to those doctors who have thought of going out on their own and starting an urgent care facility.

The Business Hurdles of Urgent Care

The successful urgent care facility doctor/entrepreneur must constantly improve the service and know how to battle insurance companies reluctant to pay.

That’s the view of Dr. Nabil Salib, who has been building an urgent care facility called MYDOC in Forest Hills, a neighborhood in Queens County, which is one of the five counties of New York City. He is part of a medical revolution that has been going on for the last decade (See Notes “I Need Medical Help Now”).

Urgent care facilities, which have been growing at a fast pace, offer medical services that patients can’t always get quickly from their doctors or emergency rooms. But Dr. Salib says the economics of this relatively new medical service can be daunting.

“The insurance companies are stiffing us. They are not giving us what we ask for and they are making their reimbursement hard,” Dr. Salib says. “This is not a cash business. I rely 100 percent on insurance reimbursements and that is the limiting factor of my business.”

But doctor/entrepreneurs aiming to build a successful business must be in it for the long run, he says, because there are no quick profits.

How to Succeed—Offer Something Faster

A key element of making this relatively new model work, Dr. Salib adds, is keeping patients happy, providing them with a better option.

“There are a lot of patients who don’t want to go to an emergency room,” Dr. Salib says. Others, he adds, can’t get quick doctor appointments.

The sole owner of the urgent care facility, Dr. Salib wants patients taken care of quickly. “The average waiting time here is about 15 minutes or less on a busy day.” He says he wants that number to go down.

The American College of Emergency Physicians said most emergency rooms are “operating at or over capacity.” Another study cited by Urgent Care Association (UCA) says the emergency room average wait time is four hours.

How Can You Fail?

The biggest impediment to making this urgent care concept work?

One constantly needs to improve equipment and staff, Dr. Salib says.

He wouldn’t rule out an equity partner so he could expand but thinks carefully about it.

“My hesitation about expansion,” adds Dr. Salib, “is being able to replicate and sustain the same quality of medical care.”

Before expanding, there are services that Dr. Salib would like to add to his Queens Blvd. office. He wants patients to be comfortable.

“When people are waiting, they should be told that we will see them quickly. It is important that they not be left alone, wondering when they will be seen,” Dr. Salib says. He wants to emphasize this point by someday hiring a client hostess. This person would serve refreshments and reassure people waiting that the doctor will see them soon.

Putting Money Back into Business

MYDOC is making a small profit on a low seven figure annual revenue, he says, but most of that is ploughed back into the business. The money is reinvested “so we can clear the rooms a lot faster. We are hiring top notch providers and staff.”

Urgent care centers do not care for life (or limb) threatening situations, but will stabilize patients while securing emergency transport, according to UCA. But their growth has led to criticism from some traditional providers (See Notes “An Urgent Care Debate”).

Dr. Salib says he is providing emergency room services ranging from EKG, X-rays, IV fluids, blood and other drug tests, among other services. He says his job is to supplement, not replace, the efforts of emergency rooms and primary care physicians.

“Actually, primary care physicians can’t do many things we do. We do many mini-surgical procedures,” he says. The typical patient has an upper respiratory problem or a laceration or strained or fractured joints.

Can Doctors Also Be Entrepreneurs?

Dr. Salib says starting an urgent care facility isn’t for most doctors.

“It’s a big risk, especially in New York.” He says it takes some $500,000 in startup money. “As a doctor, you’re giving up a regular salary and benefits. That’s something a lot of doctors are not prepared to do.”

Why risk half a million dollars?

“When you work in a hospital, you’re in a strict system,” says Dr. Salib, “that forbids you from being creative. Here there is room for creativity and growth. My only regret I have is that I didn’t do this sooner.”

 

NOTES:

The Rationale of Urgent Care Centers: I Need Medical Help Now

Why do increasing numbers of people go to urgent care facilities?

There are several reasons: My doctor is on vacation or is overbooked and can’t give someone an appointment today.

What should the patient who wants help now do?

For millions of Americans, the answer is a visit to a facility around the corner or down the block; one that keeps long hours and is often open on holidays. These are times when an overworked family doctor may not be available because there aren’t enough general practitioners to go around.

The doctor shortage over the past few decades, say supporters of the urgent care model, has created an industry of no-appointment medical services that started small some 40 years and now is exploding.

Urgent Care centers are an $18 billion industry. Some 8,125 centers around the United States keep long hours. The urgent care industry has a projected annual growth of some six percent, or about 400-500 a year, according to

Urgent Care Association (UCA), a trade group.

“Urgent care medicine has experienced meteoric growth across our country with convenience, high quality, an ability to significantly lower the cost of care and enhance access and entry to health care,” according to a UCA White Paper.

Some form of the urgent care center goes back to the 1970s, says UCA. The concept of no appointment, walk-in, medical care has become very popular over the last 15 years. One reason, UCA says, is price. An average hospital emergency room visit price is $1354 compared to $150 for an urgent care center, UCA says. However, their rapid growth has created some controversy.

An Urgent Care Debate

Urgent care facilities have longtime critics who question the quality of their care.

Indeed, some of these walk-in centers, says an official of a leading medical organization, are not meeting emergency care standards.

“This has been a continuing concern of ours,” says Robert Mills, a spokesman for the American Medical Association (AMA). He added that some urgent care facilities are “not in the public interest.”

Still, the AMA, in a statement, noted patients value the convenience of urgent care centers and retail health clinics because they have late hours and offer pricing at the point of care.

“However, there is concern that some of these facilities may not communicate adequately with primary care physicians about services delivered, thereby potentially undermining the physician-patient relationship,” according to the AMA.

The AMA spokesman said that after a patient receives care in an urgent care center or retail clinic, “there should be follow-up communication with a patient’s primary care provider, or usual source of care, to avoid fragmenting patient care.”

AMA officials argue urgent care centers should have “a full range of emergency services.”
Urgent Care Association (UCA), in a statement, says members are supplementing the efforts of often overtaxed hospital emergency rooms and primary care physicians.

“Urgent care provides a wide scope of services for non-emergency, situations,” UCA said. The group, founded in November 2004 by a group of doctors, said members can provide effective care for “non-life-threatening episodic events, such as sprains, broken bones, flu, colds and other common illnesses.”

UCA said it is not trying to replace primary care physicians or emergency rooms.

“Urgent care is ideal,” it said in a statement, “for episodic, non-emergency events, and should not be considered a replacement for ongoing primary care.”