Broken bones, concussions, an asthma attack, debilitating migraines—these conditions often mean a trip to the emergency room. Once in the door, it’s time to brace for a long wait as more acutely ill or injured patients get treated first. Next comes the big bill.
But the Twin Cities health care landscape has evolved lately, making room for a new model of ambulatory care. When people are too sick for urgent care but probably not ill enough to be admitted to a hospital, they can turn to one of several urgency centers across the metro area. Since the first urgency center opened in 2010, more health care providers have adopted this intermediate style of care.
It’s become a popular model because urgency centers are an efficient, low-cost way to provide high-quality care for high-need patients, says Kurt Belk, an emergency medicine physician and medical director of Minnetonka-based Urgency Room, which operates three Twin Cities urgency centers.
“We’re there to fill the gap between what urgent care can’t do and what hospitals don’t do well, which is take care of the walking wounded—the folks who have to wait hours to be evaluated for knee pain, a fracture or a bad laceration,” Belk says. “We provide that experience for the 70 percent of patients who go home from the ER, and we do it in an average of 77 minutes from door to discharge.”
Belk’s practice group, Emergency Physicians Professional Association (EPPA), opened its Woodbury Urgency Room in 2010. Already running emergency care at five area hospitals, EPPA physicians wanted more control over operations and the flexibility to be more innovative. The company added locations in Eagan in 2012 and Vadnais Heights this year.
There are now about a half-dozen urgency centers open for business, with at least one more underway. North Memorial Medical Center will open its new Minnetonka Medical Center this coming fall, which will include an urgency center. It will be North Memorial’s second; it opened an urgency center at the Blaine Medical Center this spring with Multicare Associates.
J. Kevin Croston, chief medical officer of North Memorial and president of ambulatory and provider services, views Minnetonka Medical Center as a vehicle for redesigning health care delivery. It’s a one-stop site where people can go for comprehensive medical care, 12 hours a day, 365 days a year. In addition to urgency care, it also will house a primary care clinic, same-day surgery center, specialty medical care like orthopedics and urology, laboratory testing, imaging and wellness services.
“Our philosophy is that you can get 98 percent of the care you need right at this center,” says Croston. “I’m excited about the whole building. It’s a chance for us to redefine health care and look at things differently. We’re trying to create a new care model that’s patient-friendly, heavy on technology to make sure they get a good experience, and more concierge-oriented.”
The concierge mentality starts by offering accessible emergency care close to home. Then there are the details, like doing away with those too-revealing gowns favored by hospitals or designing smaller waiting rooms so that patients get into exam rooms quickly, Croston says. North Memorial aims to take the pain out of health care billing, too. Its Minnetonka Medical Center patients will get one invoice instead of separate bills from the facility, the providers and the lab.
To amp up customer service, the Urgency Room reduces wait times by allowing patients to preregister from home. After filling out their personal data, insurance information and time of arrival, they receive an estimated wait time. If their wait is longer than normal, they can leave and run a few errands, then come back when the staff is ready. Patients generally wait no more than 30 minutes, Belk says.
These shorter waits are possible because the most serious emergency cases head directly to the hospital, often by ambulance, which urgency centers don’t accept. This means physicians aren’t diverted by trauma cases or life-threatening emergencies, as happens at hospital ERs, Belk says. In addition, urgency center doctors don’t get bogged down by patients with concerns like strep throat, flu or bladder infections, which can be treated easily in urgent care. If an urgency care patient needs to be admitted for more extensive care, an ambulance can transport them to the hospital of their choice.
Another benefit of urgency centers: Care tends to be less expensive than at ERs because they don’t operate around the clock. This reduces overhead costs and middle-of-the-night downtimes, Belk says. Doctors can see patients faster, too, because they don’t have to follow some of the operational procedures a hospital does. And urgency centers are less expensive for patients, who avoid hospital ER facility fees.
But the lower cost doesn’t mean low-quality care. Urgency centers are staffed by board-certified emergency room physicians, many of whom also work in hospital ERs. They also have much of the same technology that doctors use in the hospital, such as CAT scans or MRIs. “Patients really like the model. The ramp-up in Blaine has been spectacular,” says Croston. “Patients understand that they can come in and get cared for in a timely way, and the bill is cheaper. Why not do it?”
Part of the challenge for urgency centers is communicating their market niche. Generally, they can handle anything an emergency room takes on in cases where patients aren’t going to be admitted for a hospital stay. That might include chest pain, kidney stones, eye injuries, blood clots, dehydration, pneumonia and pediatric care like high fevers. At the Blaine Medical Center, a triage staffer directs patients to either urgent care or the urgency center, based on their symptoms.
Both Croston and Belk say they think patients will get acquainted with the concept when they visit comprehensive care buildings like the planned Minnetonka Medical Center or the Helene Houle Medical Center in Vadnais Heights, which opened in August. Designs for both facilities incorporated urgency centers and other health care services.
In Minnetonka, the 65,000-square-foot building on the rise near highways 7 and 101 is conceived as a comprehensive resource for patients. In addition to urgency and primary care, it aims to attract patients for wellness services such as physical therapy, men’s health and sports medicine. North Memorial is still working out the details about the specific programs it will offer there, but generally it plans to integrate the services with patients’ overall care, Croston says.
The Urgency Room’s Vadnais Heights location has a similar one-stop-shop structure with Allina. The building, near Interstate 35E and County Road E, houses an Allina primary care clinic and specialists such as podiatrists and ear, nose and throat doctors. It also has dental services, physical therapy and the urgency center. “It’s more of a medical destination,” says Belk. “Its success is incredible—volumes are outpacing Eagan and Woodbury. I think now that there are a bunch of these [urgency centers], so people think they must be good. It fills a niche.”
On top of taking care of emergency patients more efficiently and less expensively, urgency centers also expand health care choices in underserved areas. Two Twelve Medical Center, a freestanding ER in Chaska, opened in partnership with Ridge- view Medical Center in Waconia. Before, residents of the fast-growing southwest metro didn’t have many options for emergency care, notes Sandra Potthoff, associate professor of health care administration at the University of Minnesota.
Often, providers are motivated by more than altruism. “In some places they are being used to get into someone else’s market where they might not have had a foothold,” Potthoff says. “They might say to patients, ‘This is more serious,’ and send them to their hospital or facility as a feeder to try to increase volumes in their parent health system.”
Urgency centers might be a cost-effective way for providers to offer community-based emergency care without having to build a new hospital, Potthoff says. Generally, though, she is skeptical that they will reduce health care costs. It depends on whether patient volumes cover urgency centers’ sizable fixed-cost investments.
Health care providers and observers still are trying to determine how urgency centers fit into the macro Minnesota health care market. The jury’s out on whether the Minnesota Hospital Association (MHA) and its members think urgency centers are a welcome addition or a thorn in their sides, says Wendy Burt, MHA vice president of communications and public relations.
“Health care delivery continues to change, and this is an example of meeting people where they are,” says Burt. “I think there is a question of whether it duplicates capacity. They don’t have the same requirements as an emergency room, such as treating anyone who comes in regardless of their ability to pay. In a time when we’re trying to hold down the total cost of care, the question is, does it help do that?”
For now, urgency centers aren’t at the top of hospitals’ concerns, as they focus on watching the MNsure rollout and the expansion of Medicaid. Burt adds, “Right now, there are more questions than answers.”