February 2007

New options in health care

Urgent care and retail clinics on Route 228 offer alternatives to visiting the emergency room

Sunday, February 18, 2007

By David Guo, Pittsburgh Post-Gazette

In November, a health clinic opened in the Eckerd pharmacy on Route 228 in Seven Fields, offering an on-site medical expert, night and weekend hours, and flat-fee pricing. The Take Care Health Center retail clinics strive to be easy, affordable and convenient.
"It's an idea that just makes sense," its Web site touts. One month later, a MedExpress urgent care center opened just down the road in Adams. Its ads boast services that in some ways are similar to those at the Take Care Health Center but, in other ways, are more like those offered in an emergency room.

The MedExpress trademark: "Great Care. Fast." Then there's the old standby nearby at Route 228 and Route 19 that cost-conscious consumers both love and hate. Once a freestanding emergency clinic run by St. Francis Hospital, the emergency room is now part of
UPMC Passavant Cranberry.

According to Gov. Ed Rendell's Prescription for Pennsylvania, cost and extended-hour convenience should be as much a part of the health-care equation as quality. All three factors come into play at the Route 228 trio -- the emergency room, the retail clinic and the urgent care center.

Here's a look at each.

UPMC Passavant Cranberry
As the portal to a full-service hospital, the emergency room at UPMC Passavant Cranberry stands ready to handle anything and everything at any time. Everyone agrees, however, that it's best if minor incidents get treated in lower-cost settings. And when they don't? Expect one of those bills that most patients can't decipher beyond the column marked insurance co-payment. A kitchen knife accident Dec. 22, for instance, sent a Cranberry man in for rebandaging, a finger splint and first-aid ointment. Sutures should have been used but were not because the wound was more than a day old and at higher risk for infection.

The provider's charge, which typically is what the uninsured pay, was $489.70. The insurance co-payment was $75, $60 more than for an office visit.

Was there a better choice?

The first call had gone to Take Care Health Center, which informed the patient that its staff didn't suture wounds. The UPMC emergency room advised the patient to go to an urgent care facility, but no one was sure where one might be. The MedExpress had opened just a week or so earlier.

The emergency room that holiday weekend afternoon was empty and the staff -- triage nurse, physician's assistant, attending nurse, physician -- was quick, friendly and professional. But as Mr. Rendell sees it, they might have handled the injury differently.
Under his Prescription for Pennsylvania, Mr. Rendell wants emergency rooms to divert routine suturing -- he has used a dog-bites-man example -- to a nurse practitioner, who would be outside the high-priced emergency room setting.

"At this early stage, I don't think it is appropriate to comment on details of the governor's plan," said Frank Raczkiewicz, acting director of the UPMC News Bureau. "We do applaud his efforts to expand access to high-quality health care to all Pennsylvanians."

In the meantime, he said, work has begun on a $9 million expansion of the UPMC Passavant Cranberry emergency room that will triple its size and incorporate a children's emergency department. The project is expected to be completed in summer 2008.

Take Care Health Center

The Seven Fields Eckerd drugstore stocks so many kinds of cough syrups, pain pills and first-aid rubs that it's enough to give anyone a headache, let alone someone who already has one.

Here's a healthier view: All those choices can empower the customer, just like Take Care Health hopes to empower drug store customers to become drug store patients. On a winter morning custom-made for a frosty slip or head cold, Amy Jackson, of Mars,
smiled but shied away from a handshake. Instead, her open palm muzzled her mouth as she warned, "I shouldn't even be near you."
A stuffed-up nose and wicked-red sore throat have sent her to the Take Care Health Center located by the pharmacy. She thought about going to her doctor but gauged her chances at getting an appointment at slim to none.

Within 15 minutes, she was in and out of one of the two exam rooms. Nurse practitioner Paula Somerville swabbed her throat and gave her a prescription for a sinus spray.

"I just feel relieved that I don't have strep," Mrs. Jackson said, happy to pay the $20 co-payment. If she had chosen to pay out-of-pocket or didn't have insurance, the fee would have been $59 -- still a bargain, she figured.

"It saved gas, saved time, I didn't wait in a waiting room. It couldn't have been much easier. I just think it's an idea whose time has come."

Words like those are sweet indeed to Peter Miller, a former Johnson & Johnson executive who's co-founder and chief executive officer of the Take Care Health Systems chain. The company, based in Conshohocken, Montgomery County, operates about three dozen retail clinics in Pennsylvania, Illinois and Missouri. Seven Fields is the firm's ninth in Pennsylvania, all in partnership with Eckerd.
Take Care Health limits the scope of service to basic ailments. Typical fees for those paying cash or the uninsured are $59 to $75. The key to making the business model work is to staff the clinics with nurse practitioners. They're certified health professionals whose advocates include Mr. Rendell.

"I want to free nurse practitioners to do anything they are capable of doing," the governor said last month. Pennsylvania is "one of the most backward states when it comes to what we allow nurse practitioners to do."

Retail clinics first appeared in the Midwest about seven years ago. A 2002 amendment to the Pennsylvania nursing code made it easier for such clinics to operate because they no longer are required to have doctors on site. Nurse practitioners are adequate, as long as collaborative partnerships with physicians are in place. "Why is this happening? There's a health care crisis relative to access, especially affordable access. More than 40 percent [of people] don't have a primary care provider because it's not a very good economic place for doctors," Mr. Miller said. "One of the great solutions is nurse practitioners. They offer fabulous care."
Nurse practitioners are certified to treat even a wider range of diagnoses than Take Care Health clinics in
Pennsylvania will let them handle. Statutorily, they can order X-rays or suture wounds, for instance.

Mr. Miller said the clinics treat about 200 conditions, with the top 20 making up 60 percent of that total. While nurse practitioners are qualified to do more, he said, those services don't fit the easy-in, easy-out retail clinic model.

As president of the 6,000-strong Pennsylvania Coalition of Nurse Practitioners, Pat Schwabenbauer supports the growing role of her members. She also understands why Mr. Rendell might want them to tackle even more situations than for-profit models now
deem wise. The marketplace will decide who's right.

It's a business decision, she said, "where the convenience is a selling point. If you get into doing too much, you run into not being able to do it quickly."

MedExpress

Nobody has to tell Nick Colovos or Tom Stein what an emergency room is all about, not after the pair has logged a total of 20 years between them at Allegheny General Hospital's.

"We sutured and splintered for a living for years," Dr. Stein said. Slowly but surely, the highwire act they had loved became threadbare from all of the high-wire pressure. Their selfdiagnosis: emergency room burnout.

"We had a vision five years ago, but we were so busy with our emergency jobs," Dr. Stein said. Then, about a year ago, the AGH pair learned of four emergency room doctors in Morgantown, W.Va., who had pretty much the same dream: slower pace, more patient interaction.

The Morgantown doctors opened the first MedExpress there in 2001. Five years later, when they wanted to open one in Butler County, the chain's sixth, they knew who to contact.

"We sort of latched onto each other. It was fortuitous that it worked out that way," Dr. Stein said. "But we were going to do something like this come hell or high water."

Fliers for MedExpress were mailed out last month, though they didn't include any clip-and save specials. "No gimmicks," said Medical Director Nick Colovos, who doesn't believe that a person with an urgent medical problem needs a gimmick.

What can he offer? "You're not going to see a packed waiting room."

Kris DeMarco was up for that. Having spent the day before in front of a packed Butler County courtroom fighting sniffles, sore throat and "ears that were killing me," she wanted in and out in a hurry.

Ms. DeMarco, of Cranberry, wanted to come in sooner but put it off until she had delivered the closing argument in a trial. The day after, she was in MedExpress. A half-hour later, she was on her merry way. "They had told me to come in a couple of days sooner, but I just didn't have the time," she said. "That's another great thing about it, the hours."

Her case could have been handled at Take Care Health Center for probably the same $15 copayment, but she decided against that. "I wasn't sure who worked at Eckerd, but I imagined it wasn't a physician," she explained.

An hour later, Brett Smith, of Ellwood City, a business major at Robert Morris University, also came and went as a happy customer. His father had stopped in earlier and had recommended it when his son developed bronchitis. "I was in like in five minutes. Usually you've got to wait for the doctor forever. At this place, it was real, real quick," Mr. Smith said. He got a chest X-ray and a prescription for prednizone. Three days later, he told the doctors - - they do phone follow-ups on all patients -- his bronchitis was a lot better.

"They're fast, friendly ... next time I've got to go see a doctor, I'm going there."

About the only part of Mr. Smith's endorsement that Dr. Colovos might quibble with is the plan to blow off his primary care physician.
"Our goal is not to impact the primary care physicians and to abduct their patients from them," he said.

Neither is it to push the smaller Take Care Health Center or the larger UPMC off the Route 228 map. MedExpress's game plan is to handle the bulk of diagnoses that it says are either too complex for a retail clinic or too cost-inefficient for an emergency room.

"The truth is there's 10 percent on one end, 10 percent on the other end and we've got the 80 in the middle," Dr. Stein said.

(David Guo can be reached at dguo@post-gazette.com or 724-772-0167. )

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For more information, contact Sarah Lewis, Communications Coordinator, at: (304) 225-2500 or slewis@greatcarefast.com.

 

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