Bringing Professional Reads and Dose Awareness to Urgent Care

Marcus J. Hampers, MD, MBA, is on the clinical staff in the emergency department of Dartmouth-Hitchcock Medical Center, Lebanon, N.H., and also on the teaching staff at the affiliated Geisel School of Medicine, but he is not practicing much emergency medicine these days. Instead, he is leading the rollout of a network of 10 urgent care centers in Vermont, New Hampshire and Maine, two of which opened in June, with two more scheduled to open this month.

As CEO of ClearChoiceMD Urgent Care, a physician-owned and -led urgent care company with ambitious expansion plans that stretch from coast to coast, Hampers has been engaged in staffing and equipping the company’s state-of-the-art urgent care centers, where he also occasionally practices medicine.

His company is part of a care-delivery model that is gaining traction throughout the country, as payors and policy makers attempt to rein in medical costs. “I’ve been practicing emergency medicine for the last 20 years in Vermont and New Hampshire, and in those 20 years, I’ve watched the emergency departments become increasingly overburdened by patients who, frankly, don’t have an emergency,” Hampers says. “The cost of taking care of those patients is astronomical; it’s about 10 times the cost of what it would be in an outpatient setting.”

This observation coupled with a national shortage of primary care providers was the impetus behind ClearChoiceMD, Hampers says. Although he shares the urgent-care space with national retailers Walgreen’s and CVS, Hampers says ClearChoiceMD and the retailers occupy opposite ends of the urgent care spectrum.

“Typically, they have one examination room, they have a nurse practitioner and they might do some immunizations and upper respiratory, but they don’t have the capabilities that we do,” Hampers explains. “The middle of the spectrum is family care physicians, who might have an x-ray machine from the 1980s, and they can do x-rays in the office and some labs.”

Upper end of the spectrum

ClearChoice MD has state-of-the-art facilities, each with 10 examination rooms, laboratories, pharmacy and digital x-ray. The staffing model includes a physician, two medical assistants, a nurse and a radiology technologist. “Everyone is cross trained,” he says. “The radiology technologist, for example, may not have 12 hours of x-rays on any given day; he or she might do four one day and 30 the next. We expect that person to be able to check your vital signs, dip your urine, and give you a flu shot: The model works best when everybody can wear everybody else’s hat.”

Hampers chose Viztek’s Ultra DR System, which features a straight-arm configuration and high-absorption cesium detectors, for its ease of operation, small footprint and the lowest possible radiation dose. The tube and the detector are always aligned by design, and the collimator light can be operated from the operator booth for a final positioning check to prevent retakes.

Hampers also acquired pediatric dose software with a built-in date range that brings dose awareness to the operator, prompting the technologist to adjust the dose and remove the grid when appropriate. 

“We are employing smart radiology technology in response to the Image Wisely and Image Gently campaigns promoted by the American College of Radiology,” Hampers says. “The dose to the patient is tailored to the patient’s age and body size, it’s not one size fits all. If my son needed an x-ray, I’d want to make sure he was getting just the amount needed for a good x-ray and no more. You can’t x-ray a football player’s ankle and use the same dose that you would for a six-year-old.”

Hampers contracted with an Arizona-based teleradiology company to provide professional reads and required an image management system that could quickly transmit studies to Arizona, and then back to a radiologist in the state where the x-ray is acquired. He opted for Viztek’s web-based Opal-RAD PACS,

“X-rays have to be read by a radiologist in the state where they are performed, so they get pushed to Arizona, and then, for example, a Vermont radiologist, or New Hampshire or Maine—or wherever we happen to be—radiologist reads the image,” he explains. “We have a report, generally, within 30 minutes.”

The system includes built-in web-based CD-burning, with DICOM routing and DICOM print functionalities, so that when patients leave the facility, they do so with their x-ray in hand.

A boon for urgent care

Health care reform has created a boon for urgent care, most immediately in Vermont where the 2011 passage of Act 48 put the state on the path toward a single-payor solution, Hampers says. “They are searching for more convenient and less costly health care alternatives for the people of Vermont, and what could be more reformative than urgent care? We don’t cost nearly what a hospital visit would cost, and we are open every day, 365 days a year.”

Hampers, who also is board-certified in urgent care, believes urgent care jibes well with health care reform, not just in Vermont, but across the country. Long-range, ClearChoiceMD is seeking a national footprint, and currently has consultants identifying additional markets in the Northeast, East Coast, Midwest and California. “Insurers are driving the consumption as well: They are going to stop paying if you go to the emergency department with a strep throat. They are going to direct you to the nearest urgent care center.”

ClearChoiceMD can do a lot of things that primary care physicians are not able or comfortable doing, Hampers says. That includes suturing lacerations, splinting broken bones, and administering IV fluids or medications. While some primary care physicians in Northern New England are uneasy about ClearChoiceMD’s expansion plans, Hampers says many are not opposed to urgent care.

“A lot of them would rather focus on primary care,” Hampers notes. “If a primary care physician can be unburdened by what we call add-on visits, or acute care visits, they can focus on what they really want to do, which is sit down with you and counsel you on smoking cessation or your blood pressure. We know that makes a difference, we know people live longer when primary care providers provide that level of service. A lot of primary care providers are not opposed to urgent care because it increases their capacity to practice primary care.”

Nonetheless, many patients in Vermont, New Hampshire and Maine will soon have a 24/7 option for urgent care in their communities—other than the emergency department of the local hospital. By this time next year, ClearChoiceMD intends to have at least 10 sites in operation in Northern New England.