Alaska’s Growing Urgent Care Treatment Option: Not Just a “Doc in the Box”
Demand for after-hours urgent care services growing in Alaska
When a medical emergency crops up, most people’s first thoughts aren’t about convenience or cost; they’re thinking about how to get help as quickly and efficiently as possible. In many cases this means visiting an emergency room, especially if lives are in danger. However, long wait times and increasing healthcare costs have some people turning to urgent care centers for injuries that—up until recently—would have landed them in the ER.
Urgent Care Model Gaining Popularity
The decision about where to go for healthcare depends on a number of factors including the seriousness of the condition, whether the patient’s regular doctor is available, and whether the person needing care is insured. If a life is at stake, the ER is clearly the first and best choice. But what if you just need to see a doctor after hours for something minor?
Enter the urgent care center. According to health insurer Blue Cross Blue Shield, an urgent care center may be appropriate if the condition isn’t life threatening but still needs immediate attention. Along with the ability to visit a doctor after hours, in most cases urgent care patients also save time and money because urgent care centers aren’t equipped to handle the multiple, high-level traumas ERs are equipped to treat, so they carry less overhead and can therefore afford to charge lower prices. Additionally, urgent care centers don’t treat life or death cases, meaning their patients will likely never have to wait hours because an ambulance has just pulled in with a trauma case that pushed them and their cold or sprain further down the list.
According to the American Academy of Urgent Care Medicine (AAUCM), a nonprofit organization representing medical providers in the urgent care arena, the US urgent care market is booming, surpassing $15 billion in revenues in 2017. The website says that the United States could need “52,000 additional primary care physicians by 2025 to meet the country’s healthcare utilization needs.”
Meanwhile, healthcare research organization Kalorama Information reports that urgent care clinics first emerged as early as the 1970s and have grown rapidly over the past few decades as consumers seek out convenience and a way to beat rising healthcare costs. Kalorama also reports that some urgent care industry growth can be attributed to hospital systems opening their own urgent care centers. A hospital that operates its own stand-alone urgent care facility often does so to alleviate some of the pressure from overpopulation due to patients using ERs after-hours for minor injuries, such as scrapes, sprains, allergies, and minor lacerations. When hospitals are able to divert non-emergent cases to urgent care facilities, they reduce the overall waiting time, cut costs, and free up resources for traumatic injuries.
Urgent Care Options in Alaska
Along with the rest of the United States, demand for urgent care centers is growing in Alaska, with the majority of them opening in the state’s most densely populated areas, including Anchorage, the Mat-Su Valley, and Fairbanks. The typical family practice or physician collective of specialists may be able to treat or stabilize an ailment, but, for the most part, the state’s options are rural community health centers, local and regional hospitals, and urgent care facilities.
There are several urgent care centers in Fairbanks, including Steese Immediate Care, Fairbanks Urgent Care Center, and US HealthWorks Medical Group. Mat-Su, Eagle River, and Anchorage offer myriad urgent care clinics. Mat-Su Regional Medical Center has a stand-alone urgent care facility in the heart of Wasilla, while Lake Lucille Urgent Care has been serving the Mat-Su Valley for decades. Capstone Clinic remains one of the largest non-hospital, full-service medical providers in the state with multiple specialty clinics, physicians, and urgent care centers open seven days a week, offering expanded services in Anchorage with state-of-the-art communications technology. Eagle River also has an assortment of medical practices, some of which brand themselves as urgent care facilities, albeit with limited hours of operation.
Anchorage is home to the lion’s share of urgent care centers. Some are owned by a partnership of entrepreneurial physicians and investors, while others are stand-alone operations designed and managed by medical doctors. Beyond their comprehensive ERs, at this time neither Providence Alaska Medical Center nor Alaska Regional Hospital own or operate an offsite urgent care center.
First Care Medical Centers
More than thirty years ago, in 1985, two physicians launched an urgent care clinic named Merchant and Mackie Enterprises in South Anchorage. The goal of the business was to offer neighborhood emergency medical services to the community as an alternative to hospital emergency rooms. Access and affordability were the targets for patients, as well as convenience for South Anchorage residents and tourists.
In 2003, the clinic rebranded its name to “First Care Medical Center” and transferred ownership to Richard Wright and retired physician Scott Mackie. With one location, at 1301 Huffman Road, the center employs three medical doctors, two physician assistants, three advanced nurse practitioners, four nurses, three laboratory and radiology technicians, and a four-person clerical and medical billing team.
“Our emergency services range from treating severe allergies and flu-season problems to addressing recreation and work-related injuries,” says Vanessa Rodriquez, the center’s director of finance and administration. “[These] services are comprehensive, including diagnosis and treatment of animal and insect bites, minor fractures and contusions, infections, lacerations, and burns, as well as minor surgical procedures like stitches and wound stabilization.”
Rodriguez notes the center also specializes in work-related injuries such as emergency healthcare services including foreign-body removals, fracture and injury care, burn treatment, and needle-stick injury response.
Rodriquez also believes there is a definite opportunity to expand urgent care services in Alaska communities. “Being that we are more than just an urgent care clinic, we can take advantage of the growing healthcare industry and meet the needs of our city and state through a broadened menu of health services,” she says. “We find that our patients appreciate convenience, same-day service, and fast, affordable emergency healthcare. Add in-house lab and x-ray support, with immediate results for review, and injured, sick patients receive state-of-the-art treatment.”
First Care’s medical staff is available 7 a.m. to 11 p.m., seven days a week, with no appointment necessary.
“A Communal, Know-Your-Doctor, Healthcare Ecosystem”
Quick access to quality medical care and practitioners make all the difference to a patient and make for a winning business model in urgent care, according to Dr. Layne Crowe, the founder of Urgent Care Medical Clinic (UCMC). Crowe opened his first treatment center in 1998 at Boniface Parkway and Northern Lights Boulevard in East Anchorage. As a former flight surgeon in the US Navy, and still serving in the Navy Reserve, Crowe’s focus is accessibility and comprehensive urgent care. When he conceived of the idea for UCMC, it was because he saw a need for neighborhood health services and saw an opportunity to deploy an alternative for patients.
UCMC has two clinics since a second facility opened in Southwest Anchorage in 2002 at Dimond Boulevard and Jewel Lake Road. Both clinics are open seven days a week and provide access to four doctors, two nurse practitioners, and seven medical assistants.
“Our focus has always been to offer a convenient, friendly, professional medical option to an emergency room,” says Laura Bailey, UCMC’s office manager. “If you consider the spectrum of medical treatment, there’s lots of room for niche urgent services in neighborhoods across the larger cities, beyond hospitals. Urgent care clinics benefit both the patient and employees. The patient gets close, quick, less expensive care. Employees get a job, salary, and benefits, and they often live in the same neighborhood so it evolves into a very communal, know-your-doctor healthcare ecosystem.”
UCMC treats minor emergency and urgent situations ranging from basic lacerations that require stitches or tissue adhesives to run-of-the-mill sprains and strains. The centers’ staff members diagnose broken bones and splint them. The East Anchorage facility provides basic radiologic x-ray services for arms, legs, hands, and feet. Other treatments offered include sudden illness, severe cold and flu, worker injuries, and bites and burns, among many other services.
“The advantage of the urgent care model is we can save a patient significant time, money, and resources with a simplified treatment process,” says Clinic Physician Dr. Laura Johnston. Johnston says there is an obvious and absolute necessity for full-service hospitals and ERs, and her clinics work to complement higher-level emergency services.
“We work as a team with emergency rooms. If a mom brings her daughter in with a laceration that needs stitching, we’re fully capable of [that] treatment. If a medical problem is beyond our aptitude, we don’t hesitate to transfer the patient to an emergency room and have done so via ambulance for events such as a heart attack or major injury. Both urgent care and emergency room paradigms are needed and useful,” she adds.
For the team at UCMC, the bottom line is quality patient care at a reasonable price. To that end, they also offer routine health physicals, school and employment physicals (such as CDL exams), and vaccinations.
What About Communities Without an Urgent Care Center?
While urgent care and emergency center options make business and practical sense in Alaska’s populated regions, there remain many rural regions where a “doc-in-a-box” isn’t financially viable. Alaska’s enormity, in concert with transportation and weather considerations, make exigent medical services complex.
Absent access to a smaller, 24/7 privatized medical clinic, it’s up to local boroughs, cities, villages, and nonprofit Alaska Native organizations to consolidate their efforts to offer healthcare alternatives.
In the Bethel region, the Yukon-Kuskokwim Delta Regional Hospital is available to address a medical emergency. For Kotzebue, the Maniilaq Health Center is open for emergencies. Barrow’s Samuel Simmonds Memorial Hospital, Dillingham’s Kanakanak Hospital, Ketchikan’s PeaceHealth Medical Center, Dutch Harbor’s Iliuliuk Family & Health Services, Homer’s South Peninsula Hospital, and the Kenai Peninsula’s Central Peninsula Hospital in Soldotna all have comprehensive emergency services, and there are many more smaller facilities in communities throughout the state.
Along the southern Seward Peninsula coast of Norton Sound at the Bering Sea sits the iconic dog sled and gold mining city of Nome.
Norton Sound Regional Hospital is responsible for serving approximately 10,000 people in the region, including 3,300 people in Nome, fifteen surrounding villages, an itinerate summer workforce, and tourists.
Deanna Jackson, RN, CEN, is the hospital’s emergency department nurse manager. Jackson explains that while there may not be an urgent care facility in the region, the emergency department helps keep area residents healthy and safe by offering four cardiac monitoring beds and four additional beds for urgent care. Upstairs from the emergency room is the inpatient acute care unit with eighteen beds and two labor/delivery beds.
Norton Sound Regional Hospital is also home to a cadre of ER staff, including medical doctors and nurses as well as technicians, radiological, and laboratory personnel who operate the hospital’s ultrasound and radiological equipment. The hospital doesn’t perform surgery at this time.
“Our emergency protocol is unique in Alaska because an injury response, particularly in one of the fifteen neighboring villages of Nome, starts with the Norton Sound Health Corporation Nurse Call Line, the first in the state to provide locally-based, after-hours advice and emergency support to patients in our region,” says Jackson.
The hospital treats heart attacks, injuries and trauma, fractures and bone breaks, abdominal and respiratory problems, and basic pediatric medical issues including childbirth. Norton Sound Health Corporation focuses first on stabilization, diagnosis, and treatment and then makes decisions about transferring severely-injured patients.
“We’re a critical access hospital. While we don’t have urgent care facility models like Anchorage, our paradigm and telephonic connectivity is as good or superior to the smaller, private sector urban emergency offices. If a patient needs a higher level of care, we coordinate with other facilities, particularly in Anchorage, to ensure patient transfer is expedited and proper medical treatment received,” says Jackson.
Alaska Regional Hospital’s Take on the Business of Urgent Care
Hospital ER and urgent care models can work together to coordinate a continuum of care, says Julie Taylor, CEO of Alaska Regional Hospital. “Urgent care and emergency care facilities provide different levels of care, and it’s important for healthcare consumers to use the least expensive, yet most effective level of care,” says Taylor. “For instance, an urgent care center is a good choice when the diagnosis is known, but a same-day appointment with a primary care physician is not available or for conditions that are not life-or limb-threatening but require immediate care.” Taylor cites examples such as sprains, sore throat, or urinary tract infections as good cases for urgent care clinics.
Taylor says an emergency department is appropriate for treatment of broken bones and dislocated joints; deep cuts that require stitches, particularly on the face, head, or eyes; severe flu or cold symptoms; fainting or loss of consciousness; severe pain, particularly in the abdomen; or bleeding that will not stop. She adds that the Alaska Regional emergency department is staffed with board certified emergency physicians and teamed with experienced clinical and support staff to provide fast diagnosis and treatment of time-sensitive medical conditions such as stroke, heart attack, and sepsis.
“An important distinction between these two models of care is that emergency care is more expensive than urgent care because the level of care is higher, and emergency departments are open 24-hours-a-day, 365-days-a-year,” she says.
While Taylor acknowledges healthcare can be expensive, she says that expense is why it’s important to seek out the appropriate level of care.
“Different than an urgent care center, an emergency department is intended for more acute conditions that require medical interventions such as cardiac monitoring, respiratory support, and injury evaluation,” she says. Urgent care centers generally are not open 24/7 and often do not accept Medicare, which is an important factor for seniors, the largest growing population in Alaska.
Alaska Regional Hospital is supportive of the urgent care option because urgent care centers provide an important level of care to the community, according to Taylor. “The only concern we have is that not all urgent care centers take patients with Medicare or Medicaid. However, our Alaska Regional Senior Clinic in South Anchorage and our recently-opened Alaska Regional Community Health Clinic in Mountain View are available for these populations of patients,” she adds.
The Future of Urgent Care in Alaska
The American Academy of Urgent Care Medicine highlights the attributes of the urgent care option on its website under a “Future of Urgent Care” section. The benefits are compelling.
“The extended hours and immediate availability of care at urgent care centers provides convenience for patients. As the specialty of urgent care medicine grows, the public is learning that urgent care is a better choice over the emergency room for their immediate, non-life threatening healthcare needs. There are an estimated 20,000 physicians practicing urgent care medicine at roughly 10,000 locations, and those numbers continue to grow.”
UCMC’s Laura Bailey notes that with Alaska’s large and diverse population, the more options there are for medical treatment, the more communities gain access to healthcare.
“When people are in pain and need treatment fast, they want a medical provider who is knowledgeable, competent, fair in price point, and can remedy their problem,” she says. Together, urgent care clinics and ERs can work together to offer patients every level of healthcare possible at price points and times that fit their specific needs and allow every Alaskan to receive the best care possible, no matter the emergency.
Tom Anderson writes from across Alaska.
This article first appeared in the July 2017 print edition of Alaska Business.