Urgent Care Centers

Attached an excellent and very interesting article written by John Dorschner highlighting the proliferation of Urgent Care centers within the Baptist Health system in South Florida.
The proponents of urgent care centers emphasize the improved access and reduced costs of care versus ER care.
One UM Family Medicine faculty teacher is being quoted too:

``The residents now going out on their own -- two or three are going to work for urgent care companies and five or so are going to larger, already established practices,'' Roberts said. ``That's just the way things are.''

I beg to differ and passionately disagree with the opinions stated.
Why? Because Urgent Care may be " cheaper" compared to emergency room visits BUT it does contribute to the fragmentation of care, the absence of care coordination and will further reduce urgently needed cash flow in primary care clinics.
Unfortunately, insurance companies seem to like the concept too. Therefore, urgent care and walk-in clinics are popping up all over Miami even in my neighborhood.
Do they provide better care ? Absolutely not!! For care coordination and continuity of care they "refer" the tough cases to family doctors because they Urgent care docs want to deliver quick fixes and have no time for history taking gibberish.
I am afraid that in search for the easy and quick buck family medicine residents will prefer those urgent care clinics.
So what can we do? Join the urgent care bandwagon? No!! We must focus on the development of collaborate practice models, develop medical homes and contract with employer groups demonstrating better and more cost-effective care.
Otherwise, we will contribute to the steady increase in healthcare costs and the fragmentation of healthcare deliver.
That's NOT just the way things are!
Looking forward to your comments.
Yours
Bernd

Posted on Fri, Jul. 02, 2010

Baptist Health makes urgent care push

BY JOHN DORSCHNER
jdorschner@MiamiHerald.com

With primary care increasingly hard to access, Baptist Health South Florida keeps expanding its urgent care centers in Miami-Dade and Broward -- and offending the chief executive of the huge Memorial Healthcare System in the process.

Urgent care -- providing faster, simpler treatment than hospital emergency rooms -- has proven to be a successful model for the prosperous Baptist system, even while smaller urgent care shops in South Florida have slid into bankruptcy.

``They're doing very well,'' said Patricia Rosello, chief executive of Baptist Out-Patient Services.

Indeed they are. Baptist Out-Patient, which includes diagnostic and imaging services, earned $52.3 million on $142.7 million in patient revenue in fiscal 2009, according to audited statements. That's a 36 percent rate of return -- and 40 percent of the $131.3 million in net income earned by the entire system, which has five hospitals.

Baptist is not alone in seeing a huge need for primary care. Many chain pharmacies stores in South Florida -- including Walgreens and CVS -- now have walk-in clinics, usually staffed by nurse practitioners who can dispense simple prescriptions for such things as antibiotics.

Aventura Medical Center, an HCA facility, is taking a slightly different tack, opening a primary care clinic in Miami Lakes operated by physicians it employs. It keeps regular doctor's hours -- daytime, Monday through Friday.

The hospital is looking cautiously at widening the service. ``We will expand geographically only as it makes strategic sense and will continue to build physician practices in communities where there is a need for primary care,'' said Aventura spokeswoman Robyn Kane.

LONGER HOURS

Baptist Medical Plazas offer broader services and longer hours -- generally 11 a.m. to 11 p.m. daily, with board-certified physicians always on duty, generally with X-rays and other tests available because the centers include outpatient diagnostic and imaging services.

Baptist now has 13 centers, with more on the way. It entered Broward last year, in Coral Springs. Its latest, opened in May, is in Davie, at Griffin Road and University Drive -- an area dominated by Memorial, the prosperous government healthcare system that dominates South Broward.

Memorial has focused on its hospitals, having only one urgent care center, in Pembroke Pines. Still, Memorial Chief Executive Frank Sacco was not happy to see Baptist's advertising in Davie: ``You'll find compassionate Baptist Health doctors and nurses. . . Broward, it's time to get treated better!''

Sacco sent a letter last month to Memorial staff: ``Such statements are offensive to thousands of dedicated and accomplished healthcare professionals. . . . It disappoints me to see Baptist Health South Florida disparage all of us.''

Baptist's Rosello says no attack was intended against Memorial.

The centers have been using the same line in their Miami-Dade advertising for the past three years: ``It's time to get treated better.''

Baptist surveys show that 90 percent of its urgent care patients walk out the door within two hours of entering, Rosello said. That's much better than lengthy waits that occur in most emergency rooms.

``We started the centers to decompress the emergency room,'' Rosello said. Baptist Hospital's, in particular, was often crammed with patients waiting for treatment. ``But then it became its own business,'' he said.

One reason: Most insurers discovered that pushing people toward urgent care is cheaper than ER visits. Baptist's own health plan for employees, for example, requires a $50 co-pay for urgent care versus $100 for an ER visit.

In the fall, another Baptist center will open in western Broward, at Dykes Road and Pines Boulevard, Rosello said. Next year, a Brickell facility is expected to open near the intersection of U.S. 1 and the Rickenbacker Causeway. Another six may open in the next three years, Rosello said.

TOUGH MARKET

Baptist's pineapple logo has become a recognizable symbol, even in Broward, where many South Dade residents moved after Hurricane Andrew in 1992. But many lesser-known centers have struggled in the market.

ER Urgent Care Centers had three facilities in South Florida. In 2004, when a reporter visited one of them, in Hallandale Beach, there were no patients. ``Our biggest problem is getting the public educated,'' said an executive of the firm. It filed for bankruptcy in 2008.

In Broward, Alan Roberts, a physician, operated three Sunshine Medical Centers, including one in downtown Fort Lauderdale, but ended up selling them to Concentra, a Dallas-based nationwide system that has the financial heft to market to patients and get good deals from insurers.

Another chain, Jacksonville-based Solantic, has 30 locations in the state, including four in Broward.

Roberts, who now teaches part time in the University of Miami family medicine program, said urgent care is only going to get bigger, because low reimbursement rates aren't enough for primary care doctors to open solo practices.

``The residents now going out on their own -- two or three are going to work for urgent care companies and five or so are going to larger, already established practices,'' Roberts said. ``That's just the way things are.''



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