EagleTribune.com, North Andover, MA

April 14, 2013

Urgent care facilities crop up all over region

Urgent care facilities see regional growth boom

By John Toole

---- — Denise Survilas had a recent family health crisis.

Her son Mike, upset, called her from Woodbury School in Salem to tell her he had to get a physical right away so he could try out for the baseball team.

Within the hour, Survilas, her son and his brother Anthony were at ConvenientMD, a new urgent care center that opened last December in Windham.

ConvenientMD is on the front lines in a healthcare revolution in New Hampshire that has patients looking beyond their doctor’s office and the emergency room for treatment of less pressing health concerns.

The Survilases walked into the clinic on Indian Rock Road, a minute from Interstate 93, to find an open reception area — and no line.

“Everything’s easy here,” Denise Survilas said. “I can’t even believe it.”

For the Savilases, the price also was right. ConvenientMD, to build business, had provided vouchers to local schools for free sports checkups.

While Massachusetts has had more urgent care facilities, there, too, they are growing.

Pentucket Medical Associates moved its urgent care facility from North Andover to the Riverwalk complex in Lawrence several years ago, and recently expanded its services there.

Pentucket CEO John Sarro said the facilities fill a gap between primary care physicians and emergency rooms. Patients with noncritical problems can seek care, and avoid the long wait and expense associated with a trip to an emergency room.

“It does fill in that gap when a physician is not available, which is a lot of the time lately,” Sarro said. “With primary care physicians, there’s so much responsibility it can be overwhelming, but they do the best they can to meet the demand. When that’s not possible, we’re the safety net that catches those people.”

Pentucket expanded its Lawrence office and will add a new campus in Andover at the end of the year when a building on Lowell Street is completed.

Paul Therrien became a believer in urgent care earlier. Therrien slashed his hand while working with a wood splitter at his Windham home, five minutes from ConvenientMD. He required more than 20 stitches to close the wound.

“Dr. (Jeff) Collins took me immediately, without worrying about paperwork or anything,” Therrien recalled. “He saved my bacon on my hand.”

Urgent care facilities open around region

ConvenientMD has company in Southern New Hampshire.

Parkland Medical Center’s new facility on Stiles Road in Salem, just off Exit 2, opened recently.

Parkland Urgent Care is one of three such centers to open in the I-93 corridor in less than a year. In all, there are now four in Salem, Windham, Pelham and Londonderry.

Operating seven days from 8 a.m. to 8 p.m., patients will be able to see a doctor and receive X-ray and lab services on site. The Parkland Medical Building also will provide them a continuum of care, with access to providers such as Salem Radiology, New Hampshire Orthopaedic and the Lahey Center for Oncology.

“Truly, this is a patient-driven service and an insurance-driven service,” Parkland chief operating officer Jeff Scionti said.

Healthcare professionals agree urgent care is more convenient for patients who either don’t have a doctor or can’t wait for their own.

Franchised facilities are cropping up, too.

In Massachusetts, Doctors Express opened its first urgent care facility in Springfield in 2010, and now plans to open its 10th in the state later this year.

Last summer, a Doctors Express opened in the Eaglewood Shops plaza on Turnpike Street in North Andover.

“There’s a huge need for it,” said Rick Crews, president of Doctors Express New England. “There are fewer and fewer primary care physicians out there.”

Crews said a visit to an urgent care facility can cost as little as 20 percent of an ER visit.

“We don’t want to compete with primary care physicians. We need to communicate and coordinate with them. When (patients) come in, we say, ‘Who’s your PCP?’ Then after they’re done, we fax over copy of the visit to their primary care physician.”

The federal Centers for Disease Control and Prevention estimate about 136 million people go to emergency rooms annually, with only about one in five seen by a healthcare provider within 15 minutes. Typically, it takes an hour or longer to see a doctor.

It’s different with urgent care.

“We want them to be seen by a doctor quickly,” ConvenientMD chief executive officer Max Puyanic said. “On average, this is happening in less than five minutes.”

Crews said his company’s goal is to see and treat a patient in under an hour.

Visits usually cheaper than ER

But cost is a factor, too. Patients will pay less than they would at the emergency room through co-pays and deductibles.

Those vary, depending on insurance coverage. Providers say a patient may have a co-pay ranging from $10 to $50 in urgent care, compared to $100 for an emergency room.

The overall cost of an urgent care visit is closer to that of a doctor’s office visit and can be under $200, compared to as much as $1,000 in an emergency room.

“That already is the main advantage,” said Melissa Wu, medical director for Immediate Care of Southern New Hampshire, which opened a center in Pelham last June.

Nashua-based Southern New Hampshire Health System operates the Pelham center, as well as ones in Nashua, Hudson and Merrimack.

Manchester-based Elliot Health System was a trailblazer when it opened an urgent care center in Londonderry about five years ago. It has since opened another in Manchester.

“There’s a cluster in the southern and central part of the state,” said John Martin, who oversees licensing for the state Department of Health and Human Services. “We’ve definitely seen a number come online.”

There are about two dozen licensed urgent, immediate care or walk-in centers in New Hampshire.

Paula Minnehan, the New Hampshire Hospital Association’s vice president for finance, said there was much talk in recent years about pending development of urgent care centers around the Interstate 93 corridor.

“That is where the population is and it is convenient,” Minnehan said.

“Population density and market need are keys to all this,” said Frank McDougall, vice president of government relations for Dartmouth-Hitchcock health care system.

Puyanic sees urgent care as a necessary option for consumers.

“It is where you are going to get the highest quality care, in a friendly environment at an affordable cost,” Puyanic said.

ConvenientMD is planning a new urgent care center in Concord in what the company hopes will become a group of outlets in the state.

“We anticipate there will be a rush for urgent care and walk-in centers to open over the coming years, creating an oversupply,” Puyanic said. “ Ultimately, we expect that only the facilities that provide the highest quality of care, at the most affordable rate will survive.”

Parkland’s Scionti expects to see more.

“I believe we will because there is a demand for it by patients,” he said.

CEO Douglas Dean said Elliot Health System expected to see 6,000 to 8,000 patients annually in Londonderry. Today, about 20,000 people use the center every year.

“I would not have predicted the volume we are experiencing,” Dean said.

There is agreement that the growth in urgent care is driven by costs, crowded emergency rooms, a shortage of doctors and an aging population.

The various urgent care centers operate under different labels, but have some things in common.

They treat smaller healthcare issues — colds, earaches, cuts — not big ones like a heart attack or stroke.

“There is no ambulance drop-off,” Minnehan said.

The centers all have extended hours, including weekends.

Usually there is a doctor, but not always. Immediate Care of Southern New Hampshire typically has a nurse practitioner or physician’s assistant in Pelham.

Elliot rotates hospital emergency room physicans through its urgent care centers in Londonderry and Manchester.

Some provide X-rays and lab services, others do not. Some have affiliations with hospitals and partner providers, others do not.

So patients have to ask questions about services and costs.

Puyanic sums them up: “What will be my co-pay and the total cost of my visit? Will I be billed a facility fee? Is there a physician on site, or only a physician’s assistant or nurse practitioner? How long should I expect the visit to take?”

Urgent care didn’t get to New Hampshire in a hurry, but appears it is here to stay.

“Now that they are here,” Wu said, “patients realize this is really good.”

Staff writer Doug Moser contributed to this report.