In Case of (Non) Emergency

Business NH Magazine, Apr 01, 2007 by Cohen, Erika

Anyone who's been in an emergency room knows about long waits. A heart attack patient is seen far faster than that cut finger that needs a stitch.

Hoping to separate the true emergencies from those simply requiring urgent care, NH hospitals are increasingly opening walk-in clinics to better serve patients with urgent, but not lifethreatening, problems. Those can include flu, ear aches, sprains and even back-to-school screenings.

Nationally, there are 12,000 to 17,000 urgent care centers, with new ones opening weekly to meet the growing demand for hospital emergency department services, according to the Urgent Care Association of America. Of those, 26.5 percent are owned by hospitals.

This summer, Elliot Health System will become the latest to open an urgent care center (near Exit 4 off Interstate 93 in Londonderry). Concord Hospital opened its urgent care center in 2004. LRGHealthcare in the Lakes Region was well ahead of the curve, having opened urgent care centers at its hospitals in Laconia and Franklin more than a decade ago.

The reason for opening the urgent care centers seems universal: Achieving efficiency for both the hospital and patients. "The hospital wants to run efficiently and be profitable," says Dr. Michael Lynch, president of Concord Emergency Medical Associates, which staffs the Concord Hospital emergency room and urgent care clinic. He says "quality was being hampered by volume."

At Concord Hospital's emergency room, patients with the flu or a bad sprain might wait hours to be seen, while the hospital's urgent care center generally sees people in an hour or less. For patients, long waits are frustrating. For hospitals, it means lost revenue because some patients leave before they are seen, Lynch says. The urgent care clinics have long hours, opening seven days a week, including weekend evenings for those attached to hospitals.

An Unmet Need

So why are emergency rooms so packed? A 2002 survey by the Centers for Disease Control and Prevention found that half of all emergency room visits are not true emergencies, and insurers and health care providers say that number is rising.

The emergency room at Elliot Hospital in Manchester sees about 50,000 patients a year, or about 4,000 a month. An increasing number of them are not emergency cases.

Doug Dean, the president and CEO of Elliot, says that is partly due to a growing number of people who are uninsured or underinsured and use the emergency room like a doctor's office. And that, he says, is not efficient. Since most hospital costs are fixed, treating two gunshot victims or 10 people with urgent issues such as sprains and lacerations has a similar cost. Segregating urgent cases, Dean says, will make hospitals efficient.

In the Concord area, Lynch says a shortage of primary care doctors means more people don't have a primary care physician or can't get an appointment on short notice.

In the Lakes Region, LRGHealthcare's emergency rooms and urgent care clinics in Franklin and Laconia are seeing more traffic as a result of population growth and increased summer tourism.

Elliot officials hope the new clinic will not only meet current demands, but also attract new clientele-namely the 17,000 people who live in NH, but were admitted last year to Massachusetts hospitals according to an Elliot study. When Dean saw those numbers, he took it as a challenge to convince patients to choose Eilliot instead. Bringing all these patients to Elliot is worthclose to S300 mil lion in care. "Our reading of that was people have a sense that they could be accessing better care in Massachusetts than New Hampshire and I just think our hospital needs to do a better job developmg that relationship with people." To help meet that goal, the new center will also house primary care doctors, rehabilitation and other routine services.

Unlike in Manchester and Concord, the urgent care centers at Lakes Region General Hospital in Laconia and Franklin Regional Hospital are adjacent to the emergency rooms. During the hospital intake process, or triage, nurses decide whether patients should be sent to the emergency room or the urgent care center, called Fast Track. Prior to 2004, patients chose where to go. For the hospital, that means more efficient patient flow, says Dr. Paul Racicot, director of emergency medicine for LRGHealthcare. Racicot says it's important given that emergency and urgent care visits have steadily risen 8 to 10 percent in recent years.

Wentworth-Douglass Hospital in Dover has Express Care, the urgent care section of the emergency room that treats people with minor bums, flu and other non-emergency issues.

Other hospitals say they are meeting patient demand without urgent care centers. Dartmouth-Hitchcock Medical Center in Lebanon and its affiliated hospitals do not have urgent care centers. Instead, individual specialty offices save a few spots each day for urgent cases, says hospital spokesman Jason Aldous.

Reducing the Bottom Line

Emergency room directors are hopeful hospitals will realize additional savings in future years as insurance companies recognize the role urgent care centers play in providing quick, cheaper care. In NH, that change is starting to happen. LRGHealthcare charges less for Fast Track than traditional emergency room services. Charges aside, NH hospitals will be forced to adapt as overcrowding grows. That is not a problem now, says Michael Hill, president of the NH Hospital Association, but he sees that changing in coming years.