ELLSWORTH — Stop in at Hannaford for milk and eggs? Check. Pick up dry cleaning? Check. Get a blood panel or have that shoulder that’s been bothering you looked at? Check.
Come next summer, the Maine Coast Mall plaza will add one more amenity to its lot: an alternative to the emergency room in the form of urgent care clinic Convenient MD.
“We’re really kind of a hybrid between a traditional urgent care clinic and an emergency department,” said Max Puyanic, CEO and founder of the New Hampshire-based company.
“We can see 70 to 80 percent of patients that walk into an emergency department — pretty much anything that’s not immediately life-threatening.”
While hospitals, particularly in rural areas, have struggled to keep their doors open, the number of urgent care centers has exploded in recent years.
By 2018 there were nearly 9,000 urgent care centers across the country, compared to 6,210 hospitals, according to the American Medical Association and industry trade group Urgent Care Association.
That growth is in part, say researchers, because such centers are generally located in highly visible locations, offer long hours, online booking, walk-in appointments and fixed, transparent pricing.
A visit to Convenient MD, for those without insurance, will never cost more than $250, Puyanic said.
“It’s $150 to be seen. That includes a visit and basic lab work.” An X-ray costs $50, more extensive lab work, such as a CDC panel, is $50.
“If you’re insured it will vary,” Puyanic said. “But all cash pay visits are capped at $250. It’s rare that they’ll get to $250 anyway.”
That’s in line with a study published in the Annals of Internal Medicine, which found that the cost of treating three common ailments — ear infections, sore throats and urinary tract infections — averaged $156 at urgent care clinics, compared to $570 in the emergency department.
How do urgent care clinics keep costs down?
Low overhead and efficiency, Puyanic said. Centers are designed exactly alike, with 12 exam rooms, a lab and X-ray machines just a few steps away.
“The physical plant is really important for improving our efficiency,” he said. “We don’t have to send you to a different department to send you to get your X-ray done.”
“The other thing that we do is we have a very efficient [electronic medical records] system. It’s totally customized for urgent care and the way we practice.”
They also keep administrative costs low: “As an organization we’ve eliminated all the back office work, basically,” Puyanic said.
“We have 650 employees now, only 15 people that are non-patient facing.”
Urgent care clinics have other potential financial advantages: payment is required up front, and they can be choosier about who they treat.
Urgent care clinics are regulated differently than hospitals. Under current rules, they are not legally required, as hospitals and hospital-owned clinics are, to treat anyone who walks through their doors.
“Unless the urgent care clinic is owned by a hospital,” said Maine Department of Health and Human Services Spokeswoman Jackie Farwell in an email, “we would not license it — they are considered physician practices and are not required to be licensed.”
She continued: “Private physician practices (that are not hospital-owned) may decide which patients they will treat and would not be required to treat any patient presenting for care.”
While it is not legally required to do so, Puyanic said the company will work to find a payment plan for those who have trouble affording care.
“Most people that are uninsured,” he said, are happy “to pay a fair price for a good service.”
And while many hospitals in Maine are run as part of large nonprofit hospital groups, Convenient MD is privately held, funded by venture capital and private equity.
(It was purchased by Starr Investment Holdings in November 2018 for an undisclosed sum.)
The company is not yet profitable, in Maine or overall, Puyanic said.
“Keep in mind that health care is not a highly profitable industry. We have a lot of labor. We have really qualified people and it’s expensive to pay their salaries.”
Venture capitalists are not the only ones seeking to divert patients from the emergency department. Hospitals also have branched out into walk-in clinics in recent years in an effort to ease some of the burden on crowded emergency rooms.
The Northern Light Maine Coast walk-in clinic, which opened last year off Resort Way, has been busier than expected, the hospital’s President and CEO John Ronan has said in previous interviews. That facility also has longer hours to cater to busy residents, open seven days each week from 7 a.m. to 8 p.m.
In an emailed statement, Maine Coast Senior Physician Executive Sheena Whittaker said the hospital was “happy to foster a collaborative and friendly relationship with Convenient MD and other providers,” and looked forward to “assisting with additional services of complex treatments that are referred our way.”
“We firmly believe that having a primary care provider overseeing personal health care needs is essential and therefore would encourage follow-up with our providers after any walk-in care services are rendered.”
Not everyone is on board with the urgent care model.
The American Academy of Pediatrics worries that such clinics “fragment medical care,” noting in a statement that pediatricians often “use the opportunity of seeing the child for something minor to address other issues in the family, discuss any problems with obesity or mental health, catch up on immunizations, identify undetected illness and continue strengthening the relationship with the child and family.”
The former president of the American Academy of Family Physicians expressed a similar worry to a Washington Post reporter.
“Family doctors take a more holistic view of a person,” Glen Stream told the paper.
“If a teenager comes in with lacerations, for instance, a family doctor might broach the subject of alcohol or drug use,” he said. “Similarly, a series of seemingly minor illnesses might indicate a larger, less obvious problem.”
Puyanic said he expects the Ellsworth Convenient MD to open by June or July of next year. How to decide when to go?
“If your life is in immediate jeopardy, go to the [emergency room],” Puyanic said. “Heart attack, seizure, bleeding from your head.”
“If you’re not having an immediately life threatening event, if you got a fish hook stuck in your hand, a broken arm, a migraine headache, a piece of metal in your hand, something in your eye. All those are perfect things to come to us.”