Texas Doctors say facility can meet
emerging needs
E-Care Urgent Care fashions itself as a quicker alternative to a hospital emergency department.
by Mike Norbut

Hospitals rely on emergency departments to be a main entry point for patients, but emergency care often is viewed as a losing proposition. Two physicians in the Dallas area, however, say emergency care can be profitable if you just eliminate the red tape, and they've decided to test their theory by opening a series of free-standing centers.

Robert Rankins, MD, and Patrick Gibson, MD, have started E-Care Urgent Care Center, a type of hybrid "emergent-urgent care" facility complete with its own laboratory and x-ray technology. They opened their first facility in Frisco, north of Dallas, in May, and they're planning to open three more centers in other nearby cities in the coming year.

The doctors, who are emergency physicians by training, say their facility is equipped and runs like an emergency department, sans the hassles patients normally face when they seek immediate care.

"There's nothing we can't do," Dr. Rankins said. "The only difference is if we had to admit the patient to a doctor, we might need to transfer them."

The center does not receive ambulances, but if a patient walked in with a life-threatening emergency, the doctors said they could stabilize, then transfer. The center closes at 10 p.m. each day, but the doctors are hoping soon to expand to 24-hour care.

The facility, connected to Frisco Medical Center, a small surgical hospital with more than 80 physician owners, has access to some of the hospital's equipment, such as its CT scanner.

With all of its services under one roof and all employees answering to the physicians, E-Care can run more smoothly than a normal emergency department, Dr. Rankins said. If a patient comes in with an ankle injury, for example, the communication with the x-ray technician, who works only a few steps away, is seamless. Compare that with a hospital, where the imaging department is likely on another floor and run by workers who have different supervisors and priorities, Dr. Rankins said.

"What we've created here is a team, where we want to get the patient in and out," he said. "We have kids come in [with sports injuries] and we have them x-rayed and splinted in 30 minutes."

Dr. Rankins acknowledges some of that efficiency is due to the center being new and not busy yet. However, "we've had spurts before where we've seen eight patients in an hour, and it's flowed pretty well," he said.

"As the volume picks up, I think we'll have longer waits," he said. "But the volume would have to reach triple digits [in a day] before it would start to bog down."

Officials from the Health Facility Licensing and Compliance Division of the Texas Dept. of Health say they do not regulate anything considered to be an urgent care center. The Texas Hospital Assn., meanwhile, has not taken a position regarding niche facilities, spokeswoman Amanda Engler said. "Texas is not a [certificate of need] state," Engler said. "So you're seeing facilities pop up where you might not expect them to."

Gaining acceptance from insurers, however, has not been difficult, Dr. Gibson said. E-Care has been given a special allowance in many cases to bill for services like lab work, which normally are not offered by an urgent care center, he said.

E-Care is getting into some areas around Dallas that still do not boast much hospital coverage, and its ability to build quickly gives it an advantage over large facilities that need numerous development stages. Dr. Rankins said the doctors have financing lined up for the other three facilities, which are estimated to cost between $2 million and $2.5 million each.

"We know of ERs losing their shirts, because no one is managing business in the ER," Dr. Rankins said. "It takes the concept of oversight. There are too many people in the loop in a hospital. You need to get it down to one person."

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