These free-standing emergent and urgent care
clinics treat patients for acute, but non-life
threatening conditions, including conditions that
are more acute than most urgent care centers will
handle. Because they do not have the overhead
and facilities costs of emergency departments (EDs)
their charges are a third to a fifth of the charges for
equivalent care given in EDs.
1Application Profiled Here: Exer
What it is
Acute care clinics are free-standing clinics where patients may, without appointments, have care for urgent and emergency care for non-life-threatening conditions, such as wounds and fractures that would normally require treatment in a hospital
emergency department. Acute care clinics differ from urgent care centers in that they are staffed by emergency medicine clinicians and nurses who care for more acute conditions. Acute care clinics also tend to have more diagnostic capabilities, such as ultrasound and laboratories, and can administer IV infusions.
Unlike EDs, acute care clinics do not treat life-threatening conditions, do not receive patients from ambulances and do not admit patients for hospital stays. Patients requiring hospital admission are stabilized and transferred by paramedics to a hospital. Unlike EDs and free-standing emergency clinics, acute care clinics are not equipped or staffed for life threatening emergencies and do not charge facility fees, but only professional fees for their services.
Summary
Application Profiled: Exer Category Documented, FocusedSavings Level 1 Access Experience NR Engagement NR Outcomes NR Barriers Workforce shortage Patient acceptance Investment $ to $$$ Training Not necessary EMR Integration Favorable Potential for Spread
User Sites 3 clinics
Acute Care Clinics
Global Lab
for
Innovation
Problems addressed
• High charges for emergency department care for non-life threatening conditions that can be treated in less costly
settings. Non-life threatening care comprises an estimated 13% to 27% of emergency department cases.2 • Overcrowding in hospital-based emergency departments where demand for services is rising.
• A shortage of hospital-based emergency departments resulting from hospital closings. • Long wait times in hospital-based emergency departments.
• Long travel times to hospital-based emergency departments.
How it works
Acute care clinics offer walk-in care and are typically located in suburban and urban retail areas. Patients may receive care for non-life threatening emergency conditions or for basic primary and preventative care. The clinics are equipped and staffed to conduct diagnostics, to administer IV antibiotics and to treat fractures, lacerations and most non-life threatening trauma conditions. They are open for evening hours and on weekends.
Acute care clinics achieve savings by having lower overhead costs than hospital emergency departments and free-standing emergency clinics. Acute care clinics charge professional fees similar to those charged by other emergency care providers. However, unlike hospital-based emergency departments and free-standing emergency clinics, acute care clinics do not charge facility fees.
Innovators
Exer, headquartered in Calabasas, California, has three acute care clinics in Los Angeles and three more under
development to open by the end of the year. There are other chains of acute care clinics in selected urban areas, such as Acute Care Express in Columbus, Georgia.
Complexity
(How complex are the organizational requirements)Focused. Implementation can be completed in much less than a year if healthcare delivery systems (including integrated health systems, traditional payers and workman’s compensation groups) contract with an existing acute care clinic to provide care to members. The chief constraint is that acute care clinics are only available in some urban and suburban areas. Exer reports that it contracts with HMOs, PPOs, and insurance plans on fixed fee service terms.4 Exer is developing a shared savings plan option as an alternative to the emergency department
Savings
Yes. Exer reports that their prices are on average 300% to 500% lower than the prices and total charges for emergency department care for equivalent services. Fee examples for care offered by Exer include: metacarpul fracture at $217.00; lacerated elbow at $277.00.6 The majority of savings derives from the fact that Exer charges standard professional fees
for emergency care, but does not charge facility fees as do hospital emergency departments and many free standing emergency clinics. Emergency department facility fees range from $200 to more than $1,100.7
Savings are realized by health plans contracting with Exer to cover emergency care. Patients also accrue savings in lower out-of-pocket charges.
Exer’s savings are achieved in emergency care, but not in primary care. Exer’s charges for primary care and preventative care services may be higher than those charged by primary care clinics or by urgent care clinics.
Exer provides services directly to patients, for a combination of insurance plan reimbursement and out-of-pocket payments by patients. The only independent source to validate their costs is the publicly available list of prices for specific diagnostic or therapeutic services.
Access
Yes. Patients have shorter average wait times in acute care clinics than in hospital-based emergency departments. Acute care clinics serve some patients who would have sought treatment in an emergency department, and thereby increase the available capacity of emergency departments, allowing them to focus on truly life-threatening emergencies. Exer reports average visit wait times of less than one hour.
Patient experience
Likely positive, but no information was available.
Engagement
No information was available concerning Exer’s impact on patient engagement.
Outcomes
No information was available for patients’ clinical or functioning status outcomes.
Spread
Exer currently has three clinics in the Los Angeles metropolitan area and reports plans to open two more clinics in the same region.
There were reportedly more than 400 free standing emergency clinics in the United States in 2012 and plans are reported for additional free-standing emergency clinics to be opened by hospitals, emergency clinic chains, and physician entrepreneurs.8 Some hospital systems have free-standing acute care clinics and plan to open more
including Adventist HealthCare (Maryland and DC), Mt Sinai (Florida), and Swedish Medical (Seattle.)9 Some of the
free-standing acute care clinics in Florida and Maryland follow a model similar to Exer and do not charge facility fees.
Barriers and Drivers
Barriers
Workforce Shortage: There is a shortage of emergency care clinicians.
Patient Acceptance: Competition from urgent care clinics and consumer confusion about the distinction among urgent care, emergent clinics, and acute care clinics is a barrier to consumer adoption.10
Drivers
Patient Preference: Consumer demand for health care in convenient walk-in clinics with extended hours.
Cost of Care:Acute care clinics have substantially lower overhead costs compared to a hospital-based emergency department, which translates into significant patient and payer savings.
Strategy Preference: Hospitals and delivery systems prefer to establish acute care clinics rather than open a new hospital or outpatient clinic as they have lower costs and do not require certificates of need. Acute care clinics are a cost-effective strategy to expanding market penetration and case referral networks.
Similar innovations
Acute Care Clinics are the most recent developments in a long-running trend of moving healthcare to convenient “retail medicine” sites of care. Free-standing emergency clinics preceded acute care clinics, and are differentiated by their higher fee structures that include a facilities fee. First Choice Emergency Room opened in 2005 in Dallas, Texas, and claims to be the first and largest emergency clinic firm in the United States. First Choice maintains 32 emergency clinics in Texas and three in Colorado. In 2011, Saint David’s Health opened a free-standing emergency clinic in the Austin area and Baptist Health opened the first of five emergency clinics in the San Antonio suburbs. The Baptist Health Emergency Clinics operate under a management services agreement with Emerus, an emergency service provider that staffs hospital emergency departments and maintains its own, independent free-standing emergency clinics in Houston
Innovation contact
Cherlin Johnson, M.D.,CEO & Chief Medical Director, Exer
E-mail Address
Website
www.exerurgentcare.com
Endnotes
1 Subject to revisions as final data for total Medicare and VA utilization and expenditures for target patient group.
2 Wiencke, R, “Patients Seeking ED Care”, Health Affairs, 2010, doi: 10.1377/hlthaff.2009.0748Health Aff September 2010 vol. 29no. 9 1630-1636.
3 Exer clinics are located are in Calabasas, Newbury Park, and Beverly Hills, California. 4 Communication by e-mail with Cherlin Johnson, CEO & CMO, Exer, April, 2014.
5 Communication with an investor in Exer, Eve Kurtin, Senior Advisor, Vantage Point Capital Partners. April, 2014. 6 Communication by e-mail with Cherlin Johnson, CEO & CMO, Exer, April, 2014.
7 These ED facility fees examples are for charges to Medicare and will vary among hospitals. These do not include additional test, medical supplies, etc. http://grandriverhospitaldistrict.org/emergency-department-procedures/. Viewed April, 2014.
8 Ayers, op. cit.,
9 Appleby, More Emergency Rooms Open Away from Hospitals, USA Today, 2014, http://abcnews.go.com/Business/story?id=4721981. Viewed April, 2014.
