Emergency care without the wait
'We are not a 'doc in the box''
By IEVA M. AUGSTUMS / The Dallas Morning News

FRISCO – Dr. Robert Rankins hates it when people confuse his Frisco health-care center with the walk-up medical clinics so common in the Dallas area.

"We are not a 'doc in the box,' " he says. "We are so much more."

Dr. Rankins is the brains behind E-Care, a new concept in health care that is modeled after hospital's emergency rooms.

He calls E-Care an "emergent-urgent care center" that combines elements of neighborhood clinics and hospital emergency rooms. The concept is simple – to get basic emergency care without the long hospital wait.

"The only difference between us and a hospital is that we don't take ambulances, and we would have to transfer a patient to a hospital to continue their care," Dr. Rankins said. "But a hospital emergency department would have to do the same thing. It's just that the hospital is upstairs, not across the street or down the road."

The first of Dr. Rankins' four planned centers opened in May next to Frisco Medical Center. Three others – in Trophy Club, Plano and McKinney – are on the drawing board and scheduled to open by July 2004.

The demand is there. The number of U.S. emergency room visits increased 20 percent over the last decade, according to the U.S. Centers for Disease Control and Prevention. In 2001, the last year for which statistics are available, hospitals received more than 107.5 million emergency room visits, up from 89.8 million visits in 1992.

But Dr. Rankins hasn't won over many area hospital officials, who are skeptical about the level of care patients can receive at his centers.

"Yes, it's going to be competition, but by no means can it be equal to what a hospital has," said Shelley Tobey, chief nursing officer at North Central Medical Center in McKinney. "Bottom line, it's a consumer's choice where they go."

Dr. Rankins agrees. In fact, he's counting on consumer frustration with hospital emergency rooms to boost his fledgling business.

On-the-job inspiration

It's a frustration he saw first-hand in the nine years he spent working in emergency rooms from California to North Carolina, including stints at Medical City Dallas Hospital and Wilson N. Jones Medical Center in Sherman.
Dr. Rankins, 43, was on the job in Sherman when he came up with the idea of E-Care.

"I thought if I could provide the same services at a faster, cheaper or comparable cost, why not do it," said Dr. Rankins.

He found a partner in Dr. Patrick Gibson, a former colleague who was practicing in Columbia, Mo. The men pooled their money to come up with $1.5 million needed to build the first E-Care.

Dr. Rankins and Dr. Gibson are also – for the time being – the only two physicians on staff at E-Care.

"I am an emergency physician first before a businessman," Dr. Rankins said.

E-Care isn't a trauma center, Dr. Rankins said, but it can handle most medical emergencies.

"We treat everything from sniffles to chest pains, lacerations, burns and broken bones," Dr. Rankins said. "And if you have to be at a hospital rather than here, we will get you there."

Lynn Mergen, chief executive of Centennial Medical Center in Frisco, said that the difference between E-Care and hospital care is more "black and white" than Dr. Rankins describes.

"It is competition, though, if patients are going to go there for treatment instead of come to us," said Mr. Mergen, whose hospital is scheduled to open in June 2004.

Fed up with waiting

John Jones, 38, of Frisco is one patient who already prefers E-Care to hospital emergency rooms.
He said he arrived at a Plano hospital Monday complaining of excruciating pain above his stomach. Mr. Jones had his gallbladder removed three weeks ago, and his wife took him to the hospital for follow-up emergency care.

But after 2 ½ hours of waiting, the Joneses got up and left. They drove 12 miles north and Mr. Jones checked into E-Care.

"If I would have known that the wait was going to be that long there, we would have came here first," said Mr. Jones' wife, Deborah.

The Joneses' experience is typical of emergency room patients, according to the Centers for Disease Control and Prevention. Patients, on average, spend about three hours in a hospital's emergency room, and more than half spend two to six hours there.

In comparison, Dr. Rankins said his clinic handled "three belly pains, two asthmatics and one fall" in under an hour on Monday.

Each E-Care visit costs $87, with additional charges for X-rays, radiology and lab work and specialized treatments. Area hospitals charge more than double that amount for just an emergency department visit, not including any additional treatment costs.

Amanda Engler, spokeswoman for the Texas Hospital Association in Austin, said Dr. Rankins and Dr. Gibson have "found a new niche."

"Every community is going to be different," Ms. Engler said. "Some may need these centers; others may not."

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