'Everybody doesn't need a primary care doctor': The rise of urgent care


Editor's note: This article was updated on Friday, July 15, 2016, to clarify that an urgent care center opened on the MCLA campus in 2014 was only there temporarily. This center closed after a satellite emergency facility was opened on the former hospital's campus a few months later. The article also now clarifies that the 510 Medical Walk-In Urgent Care Center operates independently of Berkshire Health Systems.

PITTSFIELD — Urgent care centers have been around since the late 1970s, but Pittsfield in the past year has become a focal point for expanding this kind of walk-in medical care.

When MedExpress opened its neighborhood health center at 999 Dalton Ave. in late June, it became the third such center to open in the city in the past 10 months. Centers have also opened up in recent years throughout the county.

Pittsfield's first facility, the 510 Medical Walk-In Urgent Care Center on North Street, has been in operation for 33 years.

Berkshire Health Systems, the county's largest employer, joined the recent trend in offering quick, affordable health care services by opening walk-in care clinics in April 2015 inside Market 32 at Berkshire Crossing on Hubbard Avenue, and inside the Williamstown Medical Associates facility at 197 Adams Road back in February. In Pittsfield, BHS also opened Berkshire Health Urgent Care, located at 505 East St., in St. Luke's Square last September.

In April 2014, the Berkshire Medical Center Walk-in Care Center was opened on the North Adams campus of the Massachusetts College of Liberal Arts. This center, opened in response to the closure of North Adams Regional Hospital, shut down after a satellite emergency facility was opened on the former hospital's campus a few months later.

Dr. Ronald Hayden, Berkshire Medical Center's director of medicine, said the recent influx of urgent care centers in Pittsfield and elsewhere is due to the national shortage of primary care physicians available to treat patients.

There are currently 143 primary care physicians in Berkshire County, which puts the ratio of the local population to each doctor at 906 to 1, according to the County Health Rankings & Roadmaps, which are compiled by the Robert Wood Johnson Foundation. The state ratio is 940 people per one primary care physician.

"I don't think Pittsfield is different from any other United States community," Hayden said. "There's a lack of primary access care and people want to be wiser shoppers with their health care dollars.

"The need has always been there," he said, "but I think it's just a delayed need that we finally caught up with."

The 510 Medical Walk-In was one of the first facilities of its kind to be established in Massachusetts, according to one of its three owners, Dr. Ellis M. Fribush, who was BMC's chief of staff during the 1970s. It has continued to be successful.

"Last year we saw over 10,000 patients," Fribush said.

But with the Berkshires losing population at a faster rate than any other county in Massachusetts, will there be enough patient volume to sustain three urgent care clinics in Pittsfield over time? Fribush isn't sure.

"I think we're very close to the saturation point with three of them," Fribush said. "You've got one base of patients here, and it's not a growing area. Most of the time these places open in greater metro areas. There's going to be a limitation to how many people use urgent care."

When urgent care began it was created to meet a need in the community, according to the Urgent Care Association of America. The original concept, known as "doc in a box," took a while to catch on, and growth was slow during the 1970s and 1980s.

The concept has become more popular as patients began seeking easier access to care, and insurers pushed them to seek lower-cost options than hospital emergency departments, according to American Medical News.

As visits to emergency departments have continued to increase — in 2008 there were 124 million visits, or 222 per minute, according to the Urgent Care Association of America — urgent care centers have come to be seen nationally as both a cheaper alternative and a time saving option.

The difference in cost between an urgent care visit and an emergency department visit for the same diagnosis ranged from $228 to $583 as of 2011, according to a white paper published that year by the Urgent Care Association of America.

Between 2011 and 2013, the number of urgent care centers in the U.S. doubled from an estimated 300 per year to 600 per year, according to American Medical News. The outlet also reported that ownership of urgent care centers is nearly split equally among physicians, private investors and insurers, and hospitals.

There are currently 7,100 urgent care centers in the U.S., according to the Urgent Care Association of America.

Founded in 2001, MedExpress is the country's fourth largest urgent care chain with 165 sites in 14 states. The company is currently expanding into western Massachusetts — MedExpress opened a third urgent care center in the Springfield area earlier this week.

Alex Negle, a MedExpress field coordinator, said the chain looks "at a lot of factors" when determining where to locate its facilities, and saw Pittsfield as a good fit for the services that it provides.

"Ultimately, we chose Pittsfield to give people access to community health care and provide an option," Negle said.

Services offered by urgent care centers tend to vary by practice, according to the Urgent Care Association of America, but they generally offer a "broad scope" of both primary care type services as well as more acute care that is beyond the treatment of life or limb-threatening injuries.

"Nowadays, people have a lot of options when it comes to health care," Negle said. "Ultimately, what we want to do is create convenient access to health care where possible."

When BHS opened its East Street urgent care clinic in September, Dr. Hayden said the facility was intended to ease the burden on the hospital's emergency department, where the volume of patients has kept increasing.

BHS' urgent care facility has "exceeded expectations" so far, Hayden said. The facility has increased its daily hours since September, added more staff, and is currently planning to add more rooms at its site, which formerly housed the Pittsfield campus of the Mildred Elley vocational school.

"We anticipated that by this time we'd be seeing 30 or 35 (patients) a day," Hayden said. "We are consistently in the 40s, sometimes in the 50s, and in the 60s most recently. We've had to play catch-up because of the demand.

"We knew there was a need in the community to take all insurances," Hayden said. "The whole idea was to give people an alternative for care other than the emergency rooms."

Walk-in clinics are basically healthcare providers that allow patients to come in and be seen without an appointment. Most urgent care centers have at least one medical doctor on staff to see patients whenever the facility is open, according to urgentcarelocations.com. Of the two BHS walk-in clinics, the one at Market 32 is located less than a mile from the new MedExpress facility. It is too early to tell how that proximity will affect the walk-in clinic's traffic.

"We're kind of waiting to see," Hayden said.

The 510 Walk-In Clinic, which Fribush owns with James Gittzus and Bruce Rosenheim, is also located in the same building as the three doctors' medical practice, Pittsfield Medical Associates.

Fribush said his clinic has remained profitable because "we deliver good care."

"People seem to like it," he said. "It's oriented toward patients. The truth of the matter is there are a lot of people out there who don't want to have a formal relationship with a primary care physician, and that's their right. When you have a sore throat you want it taken care of, and then you want to go home.

"That's the whole idea behind it," Fribush said. "Everybody doesn't need a primary care doctor."

Contact Tony Dobrowolski at 413-496-6224.


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