ER physicians offer service alternatives

With the promise of a 30minute or less wait time to see a physician, Dr. Jeffrey E. Sterling and Donald G. Little combined a public health initiative with a business opportunity to create the DFW U rgent Care facilities in Fort Worth and Arlington, Texas.

Sterling, DFW Urgent Care founder, president and CEO, saw a locally unmet medical need - a facility to help those who use the emergency room as their chief source of care.

He referenced figures from the Te x a s Medical Association - 75 percent of emergency room cases do not constitute appropriate use of the ER - to substantiate his premise for the urgent care facilities. Further, the association figures show the average emergency room visit costs about $1,200.

So, not only are valuable resources being detoured from those who need it, but also the cost of the care is also much higher, Sterling said.

“We are less than half of [$1,200] on average, and we’re talking about the same physicians working in both places, offering the same types of services. The only difference, when you really narrow it down, is the wait time and cost,” Sterling said.

The birth of an idea

When Sterling moved to Fort Worth about four years ago, his first post was with JPS Health Network, where he served as chair of emergency medicine and medical director. Not long after, he realized a niche in the health-care market.

“It occurred to me that the area was dramatically underrepresented in providing appropriate access of medical care to certain types of individuals,” he said. “In running the county hospital’s ER and many other ERs across the country, I’ve seen people who would be better served in other settings.”

In searching for alternatives for these patients, Sterling noticed an absence of facilities that would take these patients who needed care but did not require an emergency room.

“The area was ripe for this type of opportunity, and what I set about doing at that point was surveying the landscape,” he said. “One of the first things I noticed was that none of the existing clinics accepted Medicare and Medicaid.”

Sterling said he sees the clinics as less of a business proposition and more of a public health initiative.

“I was born in a county hospital and trained in a county hospital,” he said. “I’m not going to turn my back on that segment of the population. I want to provide additional access points to people who have not had access to health care outside of the emergency department. I want them to have the same quality of care.”

Variations on a health-care theme

DFW Urgent Care is designed to meet the needs of a broad population.

“With hours that extend far beyond normal operating hours for physicians, the clinic offers care for most anything that doesn’t require hospitalization or emergency treatment,” Sterling said. “We also offer complete workers’ compensation and occupational health services.”

Life-threatening situations like a stroke or heart attack require treatment at a hospital emergency room.

Open from 10 a.m. - 10 p.m. Monday through Friday and 10 a.m. - 8 p.m. on weekends, the facility features on-site radiology, laboratory, durable medical equipment and even pharmacy services.

Sterling said DFW Urgent Care is the only clinic in the Metroplex that backs up its 30minute guarantee by refunding the patient’s copay if their wait exceeds this time frame.

While crafting the unique urgent-care model, Sterling knew a trained team was essential.

“It became apparent to me that I would need some qualified assistance when I came up with this concept,” he said. “That is where Dr. Little came in. We went to college together; he was ER board certified. So, I just had to convince him to move his family to Texas.”

For Little, the challenge of supervising the physicians and moving to the administrative side of the business was one he was ready to take.

“It is surprising to some, but it is extremely gratifying to us to see the receptiveness of the ER physicians to work outside of the ER setting,” Little said. “The care issue is the easiest for us. Our physicians are all emergency-medicine physicians and the level of care is going to be no different than if you went to an emergency [room].”

Additionally, the clinic has created a discount card designed for patients without insurance or high deductibles who want a plan that can provide access to the clinic for a fixed cost over the course of a year.

“It is not insurance, but a way to budget health care expenses without co-pays,” Sterling said.

Without the challenges of staffing, Sterling said he anticipates having about 15 facilities open by the end of 2009, intending to grow in a controlled and reasonable manner based on the targeted needs of the community.

“Our commitment is unlike what has come before us because our focus is to service the cities in addition to other areas,” Sterling said. “Given that there is core penetration, [it] allows us to grow without any significant barriers to entry. We are the void between primary care and hospital services; we want to create a paradigm.”