After years of watching patients with minor ailments languish in his emergency room while those with life-threatening conditions were seen, Dr. Siva Reddy embarked on opening a walk-in clinic with extended hours to treat patients with urgent but nonlethal afflictions.
But local banks wouldn't give him a loan. Colleagues discouraged him. Health plans wouldn't provide coverage.
Still, he quit his job as the emergency room director at Kenmore Mercy Hospital, put up his personal assets, including his life insurance policy, as collateral for a loan, and opened Reddy Care Walk-in Clinic in 1994 in East Amherst.
Reddy risked it all on the belief that the absence of care for non-emergency conditions created a need for a walk-in clinic. And he was right.
"My patients came from all over Western New York -- Buffalo, Orchard Park, Cheektowaga," he said.
In the past eight years, the region's explosion of urgent care centers has further confirmed Reddy's belief. There are now about 20 practices, including a dozen stand-alone facilities owned and operated mostly by groups of emergency medicine physicians.
"It's a pleasant thing," Reddy said. "It means residents have more access to health care. And it's also validation for me."
While urgent care was integrated in Lifetime Health Medical Group's broad scope of medicine in the late 1980s, Reddy's clinic was the area's first walk-in center devoted solely to the practice. The growth since then has solidified urgent care medicine as a valid health care niche.
With the shortage of primary care doctors and crowded ERs, urgent care medicine has been on the rise nationwide. The convenience of the clinics continues to win over new patients each year. Their lower costs also have made them an affordable alternative for the uninsured. Locally, centers charge between $100 to $200 per visit.
Coverage spurs growth
The proliferation of the centers is largely due to the health insurance industry's about-face on providing coverage, making urgent care medicine one of the fastest growing sectors of health care.
Health plans embraced urgent care as a cheaper alternative to the emergency room and crafted a reimbursement model for these health care facilities with extended hours of operation.
"On the food chain, the ER is the most expensive and most inappropriately utilized in the market," said Dr. Raghu Ram, medical director of HealthNow New York, adding that urgent care, when used properly, could divert patients from the ER and potentially cut costs.
Urgent care medicine has become a big business, and the centers receive more in reimbursements than primary care practices.
Dr. Thomas Rosenthal, professor and chairman of the University at Buffalo's Department of Family Medicine, commended urgent care centers for filling a niche created by primary care doctors' lack of evening hours. But he said the reimbursement model that pays urgent care doctors $30,000 to $40,000 more a year is unfair and problematic because those higher salaries will attract more doctors and contribute to the shortage of primary care physicians.
"If the payers could pay enhanced reimbursements to family doctors, maybe we could figure out a way to stay open for extended hours," he said.
In addition to increasing access to health care, the clinics have turned local doctors into entrepreneurs. In New York State, only physicians can open free-standing urgent care centers. Physicians are now providing care and juggling the administrative responsibilities of running a business.
"I now have to hire secretaries, receptionists, janitorial services and laundry services," said Dr. Joseph Takats, medical director of Express Medical Care of WNY, a center that opened last year in Kenmore. "I'm responsible financially for the entire operation -- from changing the light bulb to buying the equipment. But it's very rewarding. Being in control of the entire operation improves the care."
Business was so brisk at the Exigence Group's first Immediate Care location that after a year Dr. Gregory Daniel stopped practicing medicine and became the company's full-time CEO, directing its rapid growth. Exigence's business model requires its physician partners to invest a portion of their salaries toward the company's operational costs.
These centers also have created additional jobs.
"There are employment opportunities from the providers, to administrative professionals to the medical assistants," said Lou Ellen Horwitz, executive director of Urgent Care Association of America.
In six years, Exigence has gone from under a dozen local urgent care employees to 184. The company said it treated 96,000 patients last year at its area centers.
"All of our facilities, except the Transit Road one, were built from the ground up," said Daniel, who also has an MBA and is Exigence's majority owner.
"Just building those facilities by themselves provides jobs. Our economic impact in Western New York has been very significant. We build and own all of our facilities, so we have a real estate arm, too."
With at least two centers going up each year in Western New York, the health and economic impact could continue.
"We'll see more growth in the country and the region over the next decade than we've seen to this point," said Dr. Mark Pundt, CEO of MedFirst Urgent Care, which opened its first of three centers in 2004 in the Dent Tower on Sheridan Drive.
There are now 9,000 facilities in the country, with 300 new centers opening each year, according to the Urgent Care Association of America. And their proliferation is very evident in the region, including a pediatric center in Amherst and orthopedic practices.
"There has been a lot of growth in New York, especially in Western New York," Horwitz said.
When the Exigence Group opened its first Immediate Care on Transit Road in Amherst in 2005, "there was no intention to open anything but that facility," Daniel said.
But in six years, Exigence has opened six more centers, including two in Rochester.
"There were so many people accessing our center, driving far distances, we recognized there was definitely a greater need, and we moved to fill that void in health care," he said.
The company is planning a third location in the Rochester area, and it has gone national with a center in Austin, Texas, along with partnerships with hospitals around the country to open more Immediate Care facilities, Daniel said.
Urgent care centers pride themselves on quality care without the wait. And with lower co-pays than ER visits, patients here and nationwide are increasingly turning to the walk-in clinics for care.
"I'm in and out so quickly," said Teresa Nash, a Buffalo resident, who has been treated in recent years at all of MedFirst's centers. "They treat you very professionally. I go to my doctor for regular checkups and health maintenance care, but if something needs to be taken care of immediately, I go to a MedFirst."
Many area urgent care centers are open until 9 or 10 p.m. during the week and weekends and also operate during the holidays. Patients can be seen within 15 minutes and visits can last about an hour. The clinics are staffed by physicians and nurses who do X-rays, lab tests, treat a variety of conditions, including colds and lacerations, and write prescriptions. Since most are recent builds, they are equipped with the latest in medical technology.
"Urgent care centers fit between primary care and the ER," Horowitz said. "Urgent care centers are for episodic care. Say you hurt yourself or all of a sudden you're sick and it's the weekend or at night."
When your primary doctor's office is closed or booked with appointments, but your condition isn't an emergency, that's when an urgent care center comes in, Horwitz said.
Health plans endorsed the model of care, thinking it would divert members from costly emergency rooms.
But Takats, who created the area's emergency room staffing model 40 years ago, said the presence of urgent care has not put a dent in ER visits, which are still on the rise. Instead, the clinics are having an impact on primary care practices as patients are going to urgent care centers out of convenience, not need.
"Urgent care has created a whole demand for services in and of itself," he said. "It's so convenient for patients -- we get them in and out. It's loved, and it's revered by patients."
To control costs, health plans are working to educate members on using the clinics and their role in health care. And urgent care physicians follow up with primary care doctors after providing care.
"We're not trying to take anybody's job," Daniel said. "We just want to provide a very credible alternative and be partners with [primary care physicians] and the hospital systems."
Ram said primary care physicians offer the most efficient and economical care, with the lowest co-pay for members.
"The primary care physicians have ongoing, strong relationships with patients," said Ram, who is also a family doctor. "They know their medical history and trust is present."
But the shortage of primary care physicians is a national problem. According to the Department of Health and Human Services, the insufficient number of family doctors has left 66 million Americans without physicians. Last year, 57 percent of people who had regular primary care doctors, could not get same-day appointments.
In Western New York, with a sizable aging population and higher rates of chronic diseases, the problem could be exacerbated because local family doctors are swamped providing health maintenance and disease management. This situation portends even more urgent care centers opening to handle the overflow from primary care practices.
But Pundt said the local market is bordering on oversaturation, and when that happens, centers that operate within their roles as a supplement to primary care physicians, will survive.
"The successful urgent care models, local and around the country, will be those that work with the health care system -- the payers, the hospitals, the primary care doctors -- to integrate and lower costs at the same time increasing access and enhancing efficiency."
Reddy is astonished by the business urgent care turned out to be. In the past eight years, he has seen a significant drop in patients as new clinics have opened. Reddy now closes his clinic hours earlier. But he didn't go into urgent care medicine for the money, especially since there was none back when he started.
"I felt there was a need for this," he said. "And I was at a point in my career where I wanted to do something that would really help people."