Urgent Care Centers Popping Up at Brisk Rate

March 09--Susan Maldonado doesn't have time to spend all day in a crowded doctor's office or emergency room.

She works full-time and goes to school full-time, so her time is at a premium. But the Bridgeport resident is sick, and has been for a while, with symptoms that include a high fever.

Looking for some relief, she went to the new Doctor's Express Urgent Care clinic on Boston Avenue in Bridgeport, which opened March 3.

For many residents, urgent care clinics provide a lower-cost, more accessible alternative to doctors' offices and hospital emergency rooms. They're typically opener longer hours than most doctors' offices, and are open on weekends.

Maldonado said that kind of convenience is part of why she picked the Boston Avenue clinic. It's also a two-minute drive from her home and she found the atmosphere of the office, which sits in a strip mall near the Boston Avenue Burger King, a more pleasant environment than most doctors' offices.

"It's not crowded," Maldonado said. "The people aren't rude. It's nice."

It seems that others share her interest in convenient health care, as urgent care centers have been popping up at a brisk rate in recent years. According to the American Academy of Urgent Care, the number of these walk-in, stand-alone urgent care facilities has increased from 8,000 to 9,300 within the past five years, and about 50 to 100 new clinics open every year.

These clinics provide a variety of medical services, from treating colds and the flu, to setting broken bones to conducting school- or employer-mandated physicals. Some say the clinics are needed in today's health care landscape, as they help keep uninsured and underinsured people from seeking costly care in the emergency room.

"The hospitals are full of people who don't really need (emergency room) care," said Yvonne Lederer, market director for the Doctor's Express Bridgeport sites.

A 2009 RAND Corp. study backs up her statement, showing that anywhere from 14 to 27 percent of emergency department visits could be handled by urgent care centers or retail clinics (such as CVS MinuteClinics), saving up to $4.4 billion a year in health costs.

Doctor's Express, which has more than 140 locations in 26 states, is one of several urgent care chains in Connecticut. In addition to the Boston Avenue site, three more Doctor's Express offices are expected to open in Greater Bridgeport in the near future. All four will be managed by Dr. Steven Heffer, a former emergency room physician from Greenwich Hospital. Heffer said he lives Fairfield and liked the idea of working in his community and was interested in the urgent care model.

"In the emergency room, you see a patient once, and that's the end of it," Heffer said. Urgent care centers, however, become part of the fabric of the communities they serve.

Other urgent care chains in the state include 203 Urgent Care, which began in 2009 and now has six clinics throughout the state, including spots in Norwalk, Orange and West Haven.

Dr. Jasdeep "J.D." Sidana, chief executive officer of 203 Urgent Care, said when the company opened its first site in Orange in 2009, there were only two other clinics nearby -- one in Milford and one in Stratford.

Today, Sidana said, he counts 12 urgent care centers in the towns surrounding the Orange clinic. He said the rise of urgent care facilities is part of a major cultural change in how health care is delivered.

"There's been a paradigm shift in how we deliver health care, and it's still shifting," Sidana said.

Angela Mattie, chairwoman of the department of health care management at Quinnipiac University, agreed. She said the country is in the grips of a physician shortage that often makes it difficult for people to get an appointment quickly.

The shortage is expected to get worse in the coming years, with the federal healthcare legislation known as the Affordable Care Act expected to provide health coverage to millions of uninsured Americans this year. According to the Association of American Medical Colleges, the country could have a shortage of nearly 92,000 physicians by 2020 -- a number that is expected to grow to nearly 131,000 by 2025.

Given that landscape, Mattie said, the idea of the neighborhood physician is disappearing and people are seeking medical care from whoever will see them the fastest. That's a large reason why many people who can't get in to see a doctor -- either because the physician is busy, or because they simply can't afford it -- end up in the emergency room.

"(Urgent care) provides an alternative for when you have a cold and need to see someone right away," Mattie said.

Urgent care centers typically accept most insurance plans and some, including Doctor's Express, offer special rates for the uninsured and underinsured. Depending on where the patient goes and what insurance they have, urgent care visits are either close to or slightly more expensive than a trip to a primary care physician.

Either way, the clinics charge significantly less than emergency rooms.

There are two major hospitals near the Boston Avenue clinic -- Bridgeport Hospital and St. Vincent's Medical Center, both of which run their own walk-in clinics. However, Heffer and Lederer said, they don't see themselves as competition to the hospitals, but as a partner.

"There's more than enough space for an urgent care clinic in the area to fill the family need," Lederer said.

At least one hospital official shares Lederer's feeling that the relationship between clinics and hospitals is symbiotic and not parasitic.

Urgent care centers prevent unnecessary emergency room visits, which helps keep hospital costs down, said Joseph Bisson, vice president of business development for Yale New Haven Health System, a chain of hospitals that include Greenwich and Bridgeport hospitals.

"I think, from our perspective, this has a positive impact," Bisson said. "It's filling the need in the marketplace."

There are drawbacks to the urgent care model, including the loss of a certain continuity of care, Mattie said. If patients get the bulk of their care from a rotating series of urgent care doctors, they lose the benefit of forming a relationship with a doctor who knows them and their medical history, she said.

"Our parents had a (primary care) physician that they saw for their entire lives," Mattie said. "And there's something to be said for that model of care. But we don't live in that society anymore."

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