A “hybrid" takes off

Facility blends ER department with urgent care facility
by Stephanie Patrick

Colds and broken bones are commonplace at E-Care Urgent Care Center. Meningitis and strokes are common, but treatable there as well.

E-care has seen it all since opening May 15 in Frisco. Owners Dr, Robert Rankins and Patrick Gibson call it the Metroplex’s only “hybrid” between a quick stop urgent care center and a traditional hospital emergency department that’s able to provide 24-hour care with specialists easily available.

“It was a really grown out of years of frustration,” said Rankins, who is trained in emergency medicine and has worked at Medical City in Dallas and North Central Medical Center in McKinney. “As I worked in ERs, literally across the country including in California and Texas, I saw the problems in all of them. That is: a totally inefficient system that is as frustrating to the doctor as it is the patient.”

And, with about 6,500 patient visits recorded so far at the 5,500-square –foot E-Care facility at 5575 Warren Pkwy., Rankins and Gibson are responding with plans to add another in Trophy Club in March.

Facilities in Plano and McKinney are expected to open in the summer.

E-Care’s revenue is estimated to reach $400,000 to $500,000 this year, rising to a projected $1.75 million to $2 million in 2004. Each facility costs between $1.5 million and $2 million to open, and expectations are there will be eight to 10 E-Care sites within five years, Rankins said.

He and Gibson, who is also trained in emergency medicine, have put all their services in one place. And, instead of a hospital stricture where different supervisor handle different departments, E-Care’s 14 employees and three doctors – all with emergency – department training – work together closely.

While care for illnesses and injuries are provided. E-Care also offers sports and employment physicals, drug screening and counseling services.

The biggest difference between E-Care and a hospital emergency department is that E-Care doesn’t receive ambulances and doesn’t admit patients for overnight stays – it closes each night at 10, Rankins said. But the facility, which is connected to Frisco Medical Center, has access it the hospital’s equipment and admits patients there if needed.

If more intensive care is necessary, patients are transferred to Presbyterian Hospital of Plano or Medical Center of Plano. Receiving ambulances in Frisco is not likely, but Rankins has had discussions with emergency services personnel in other cites about taking such patients.

E-Care’s Emergency comes as a Washington, D.C. based think tank, the center for Studying Health Systems Change, recently reported that emergency visits jumped to nearly 108 million in 2000-2001, up about 16% from 1996-1997. Privately insured patients’ use of the emergency department rose about 24% in the years tracked.

While its founders say it may ease crowding in hospital emergency departments, E-Care has its critics.

Dr. Lawrence Hum, as emergency department physician at Presbyterian Plano, said he sees little difference between what E-Care offers and what other urgent care centers provide. And, while urgent care centers are “viable options” for common colds and minor fractures, he said, they leave a heavier burden on hospitals that care for all patients regarding less of whether they can pay.

Presbyterian Plano ranked 13th on the Dallas Business Journal’s annual list of busiest hospitals, recording 40,756 emergency visits. Still, according to Hum, wait times in Presbyterian Plano can be as short as 15 minutes and usually last no more than 90 minutes.

Rankins said that in its effort to operate like and emergency department, E-Care does not turn away patients who can’t afford to pay. In contrast, many urgent care centers require payment.

Most major insures cover services at E-Care. For patients paying the bills themselves, the standard charge is $87 and more for additional services. Gibson said.

Hospitals battle back

To compete with the rise of urgent care centers, many hospitals nationwide have established their own urgent care centers.

Richardson Regional Medical Center, which treats patients in Collin and Dallas counties, recently announced plans to open one in spring 2005 as part of a $49 million expansion of its campus.

Richardson Regional recorded 26,357 emergency department visits in fiscal 2003, which ended May 31. Hospital officials project a 3% increase in fiscal 2004.

Bob Bohlmann, an Arlington-based principal with the Medical Group Management Association, said urgent care centers affiliated with hospitals and practice groups will become more common as fewer patients seek routine care from their own physicians.

He's seen many urgent care centers "amplify" their care to include more focus on retrieving foreign objects, fractures and orthopedics, but said urgent care centers should limit care to "illnesses and the walking wounded."

Meanwhile, Methodist Charlton Medical Center has addressed the situation by establishing nonurgent care units within its emergency departments. Since recently implementing the separate, fast-track unit for conditions such as sore throats and sprained ankles, the southern Dallas hospital has cut its typical wait time by 72 minutes.

Patients with minor illnesses and injuries still can expect to wait up to two hours, particularly in the busy winter months, said Sharon Harvey, vice president of nursing for Dallas-based Methodist Health System. The hospital saw its emergency visits climb from about 42,000 in 1998 to 58,959 in 2002.

The exact number of urgent care centers is difficult to measure, but 97% are staffed by full-time physicians and medical staff, according to North American Association for Ambulatory Urgent Care statistics.

One of the oldest in the Metroplex is Coppell-based CareNow, which has 14 D-FW facilities. While CareNow's physicians have treated the occasional patient with chest pains, the company markets itself as specializing in minor illnesses and injuries.

"A lot of things that can be done in the ER can be done in an urgent care facility more efficiently," said Norman Winland, CareNow vice president. The company competes with E-Care in Collin County and has a Duncanville facility near Methodist Charlton, but Winland declined to disclose patient visit statistics.

Rankins said there are urgent care centers nationwide that are leaning toward the same concept as E-Care, but he's unaware of any completely staffed with emergency medicine physicians. CareNow has a mix of family practice physicians and emergency department physicians.

The Texas Department of Health's Health Facility Licensing and Compliance Division regards E-Care as an urgent care center and, therefore, does not regulate its operations.

"Between now and the end of the year, we are probably going to see another 1,500 patients," Rankins said.

Meanwhile, a medical director has been hired to work in Trophy Club, and E-Care has signed an agreement with Trophy Club Medical Plaza to use ultrasound and other equipment if needed.

"After Trophy Club ramps up, I'm expecting to see between 40 and 50 patients a day there," Rankins said.

The facilities in Plano and McKinney are expected to be larger, freestanding sites and will house all their own equipment, he said. Medical directors for those facilities will be hired early next year.

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