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Urgent Care Fills Niche Between Primary Care and the ER

New England Urgent Care owner says his business efficiently treats injuries and illnesses which might otherwise result in a costly and lengthy emergency room visit. They are located in West Hartford and Enfield and will soon open in Simsbury.

The scenarios are dreaded by most and experienced by many.

Your toddler has a raging fever. Could it be an ear infection, a virus, strep throat? The pediatrician's office is closed.

It's dinner time and your son doesn't seem to be shaking off a twisted ankle sustained in an after-school soccer game. Is it a sprain? Could the ankle be broken? Do you really want to spend hours waiting in the emergency room?

You've spent Saturday afternoon clearing out a corner of the backyard. Sunday morning the itching is so intense you can't even think straight, but your doctor's office doesn't open until 9 a.m. Monday.

These are just some of the situations that Dr. Michael Gutman, owner and Medical Director of New England Urgent Care, says his business is ideally suited to manage.

"We're trying to cultivate an environment that is warm, friendly, and service-oriented, yet also efficient and competent," Gutman said. New England Urgent Care opened in West Hartford in February 2011 and just opened another facility at 55 Hazard Ave. in Enfield on Sept. 9. The Simsbury location is set to open at 30 Dorset Crossing (just off Hopmeadow Street) in October at a St. Francis Hospital access point.

Gutman and his wife Yahel, who is the Clinical Director for New Englad Urgent Care, both have extensive Emergency Department backgrounds, but believe that hospital emergency rooms have become victims of their own competence.

"Emergency medicine is designed as a specialty to treat people who are critically ill or about to become critical. Emergency departments have to treat the sickest, and as a result their service deteriorates," Gutman said.

Gutman said many people go to emergency rooms because in their minds it's an emergency, but really only about 10 percent of those people have life-threatening conditions. "Ninety percent could be treated in another venue," he said.

New England Urgent Care's business model includes providers (MDs, APRNs, PAs) as well as RNs (who he says are very good at multi-tasking), and X-ray technicians, all with extensive training and background in emergency care. Nothing replaces good clinical judgment, said Gutman, who believes the experience and background of the staff is what makes the business a success.

New England Urgent Care is open 365 days a year, with hours of operation that are more extensive than most doctors keep. Although that's an advantage, Gutman doesn't see himself as competing with primary care physicians and won't become anyone's primary care doctor.

He also seeks to differentiate New England Urgent Care from other "walk-ins" where doctors end up getting overwhelmed by primary care. Other "urgent care" centers are often staffed with internists, Gutman also said, and they don't feel comfortable treating orthopedic or gynecological problems, nor do most treat children under 12.

New England Urgent Care is one of only handful of urgent care centers in Connecticut to be certified by the Urgent Care Association of America. Part of that certification requires the ability to handle pediatric injuries and illnesses.

"I'm not in the primary care business. Some primaries get it, and send me patients all the time for X-rays or abdominal work; others are intimidated," he said. 

Primaries aren't trained to deal with "acute" problems, and Gutman says he's not providing primary care. They can work together, he said.

"If you need IV fluids, they'd send you to the ER," he said. New England Urgent Care will give IV fluids, perform X-rays on site, and cast simple fractures that don't require surgery or sedation. He'll even treat dislocated shoulders if sedation isn't needed and do minor surgery for abscesses.

They also have an in-house pharmacy with antibiotics, ointments, and GI medications, and can deal with pain management. Durable medical equipment is stocked as well.

Gutman said that the most common situations he sees are upper respiratory infections, earaches, strep throat, and gastrointestinal complaints. He sutures plenty of lacerations.

He also sees a lot of sports injuries and is continuing to cultivate relationships with trainers at local high schools.

"I do not deal too much with the urgent care centers, but I definitely feel that there is value in having them around, both as a parent and as an athletic trainer," said Kelly Stokoe, athletic trainer at Farmington High School.

Alison O'Connor, athletic trainer at Avon High School, said she typically relies on team physicians but refers students to urgent care "if they need stitches or I suspect a fracture." She'll also send patients to urgent care if a parent is concerned and wants information quickly.

Gutman said that because of their practioners' emergency medicine focus, New England Urgent Care is even comfortable treating head injuries. "If an athlete is head-injured, not unconscious or vomiting, we can treat them. In most cases they don't have an operative lesion, but we will arrange a CT scan if necessary."

Cost of treatment is also important. "It's no secret that our health care system is under duress," Gutman said.

He sees misuse of resources as a major part of the problem and thinks his niche business is a major part of the solution.

"In emergency departments, you pay a 'facility fee.' There's a huge overhead and it's legitimate, but it's unnecessary for most people," he said.

"My vision, which is relatively new in New England, is that people will use a less expensive form of treatment if it's equally good if not better," said Gutman. As an example, he said the cost of treating an ankle sprain in an emergency room is at least $1,500. New England Urgent Care can do it for a fraction of the cost, and they also have competitive pricing for those who do not have medical insurance.

Sometimes patients really do need to be admitted to a hospital, or receive testing or services for which New England Urgent Care is not equipped. For those cases, Gutman has a partnership with St. Francis Hospital which "lubricates the process" of getting treatment in a hospital setting. His patients can completely bypass the waiting room at the St. Francis emergency department. New England Urgent Care will also interact with other local hospitals, depending on the nature of the situation and the affiliation of the patient's other doctors.

"The best marketing is the service we give our patients," Gutman said. He said he and Yahel are a "mom and pop" business. "I'm the guy who hatches the plans; she makes it happen," he said. He hopes to continue to expand the business to at least five to 10 facilities in the next six or seven years.

Patients have been coming to West Hartford from all over the Farmington Valley and the rest of the state as well as Massachusetts, especially on Sunday, he said. The additional locations should make those trips easier for patients.

"It's a model for how the future of medicine is going to unfold as far as I'm concerned," he said.

More information about New England Urgent Care is available on their website.

shannon September 26, 2012 at 01:22 PM
My family has been to New England Urgent Care 3 times this year and I can't say enough great things about them. I am so glad we have this resource in our town.

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