Hospitals wary of urgent care facilities in their backyards


A New Hampshire-based company with plans to build five urgent care centers in Vermont is encountering resistance from hospitals in the communities in which they hope to locate.

ClearChoiceMD of New London, N.H., intends to open facilities in Rutland, Burlington, Brattleboro, St. Albans and Barre.

The centers would provide an alternative for people with non-life-threatening injuries or illnesses, such as fevers, infections or fractures, who can't get in to see their primary care doctor and don't want to seek care in an emergency room, according to owner Marcus Hampers, an emergency medicine doctor at Dartmouth-Hitchcock Medical Center.

"I've been practicing emergency medicine for the past 20 years in both New Hampshire and Vermont," Hampers said, "In that time I've watched emergency departments become increasingly overburdened with patients, who through no fault of their own, present with non-emergencies."

Often those patients have called their primary care doctor and were unable to get an appointment, he added.

Treatment in emergency departments is far more expensive than in a primary care setting or an urgent care clinic. A chest X-ray in Vermont's emergency departments can cost from $300 to $600, while the same X-ray at a ClearChoiceMD facility would cost $50.

Interest in urgent care centers is on the rise nationally due to growing concern about a shortage of primary care doctors, and the systemwide costs of treating patients in emergency departments.

Several hospital executives agreed that there is a need for lower-cost options to provide people with urgent care when they can't see a primary care physician.

Northwestern Medical Center in St. Albans and Central Vermont Medical Center in Berlin both have plans to build their own urgent care facilities that would compete with ClearChoiceMD.

"Any concern I have with a new urgent care provider in town is surrounding the potential duplication of services," Northwestern CEO Jill Berry Bowen said.

"(ClearChoice) is an out-of-state business and they're for-profit," said Judy Tartaglia, CEO of Central Vermont, pointing out that Vermont's hospitals are nonprofit organizations.

Tartaglia expressed concern that as a for-profit company ClearChoice might not provide care to Medicaid patients, the uninsured or people who are underinsured and can't afford care.

"We treat everyone who walks through our door," Tartaglia said, "In Vermont, we collectively have a responsibility to care for the people who can't afford to pay for medical care or are underinsured."

ClearChoiceMD accepts Medicaid patients as well as payments from all public payers, according to Hampers. It also has a discounted fee structure for the uninsured. The company does require payment up front, unlike Vermont's hospitals, which will treat patients and then seek payment.

Tartaglia serves as chair of the Vermont Association of Hospitals and Health Systems. ClearChoiceMD has come up at the organization's board meetings, she said.

"I think at one of our meetings we talked about ClearChoice, and I know other hospital CEOs have concerns on ClearChoice and what impact it will have on their business, but I personally refrain from the conversation," Tartaglia said.

Several hospital executives brought their concerns to the Green Mountain Care Board, asking chairman Al Gobeille if the urgent care centers would require a certificate of need process.

Part of the purpose of a certificate of need is for regulators to determine if Vermont's health care system needs the proposed facility or an addition to a current facility, Gobeille said.

ClearChoiceMD has asked the board to determine if its plans to build urgent care centers trigger the certificate of need process, which appears unlikely because current law has an exemption for physician's offices.

However, the board has yet to make its determination, and has several times requested that the company provide more information about their planned operations.

Gobeille said he could not comment on matters before the board.

Earlier this week, Rep. Mike Fisher, D-Lincoln, introduced a proposal that would change the statute governing certificates of need to require that urgent care facilities go through the process.

He said he became aware of the need to expand the process to urgent care facilities from media reports and "conversations in the building," but said hospital executives had not contacted him.

Jill Olson, a lobbyist for the hospital association, said she had talked with Fisher about ClearChoice and her organization's concerns about their plans to enter the Vermont market.

Gobeille said he could not comment on whether a law passed after ClearChoice requested a determination of whether their facilities will require a certificate of need could be applied to that request.

He referred that question to the board's attorney or the Attorney General's office.

Mike Donofrio, the board's attorney, was on vacation and could not immediately be reached. The consumer protection division of the Attorney General's office said it could not comment on a potential legal situation it could be called upon to address in the future.

Michael Porembski, ClearChoice COO, said the company is optimistic their request to avoid a certificate of need process will be granted by the board but added, "we will pursue any and all legal remedies available to us so that we can commence operations."

ClearChoice received approval from New Hampshire's Health Services Planning and Review Board to build seven urgent care centers in the Granite State.

A law there went into effect in February requiring greater review of proposals to build urgent care facilities, but because ClearChoice had already applied they were not subject to it, according to a Valley News report.


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