Back to Table of Contents | February 2011

Pulse

Reinventing the ER

Twin Cities facilities try new ways to offer urgent and emergent care.

By Carmen Peota

Until recently, hospitals were the only place to get emergency medical care in Minnesota. In the Twin Cities area, that’s starting to change. Last fall, physicians from Minnetonka-based Emergency Physicians Professional Association (EPPA) launched the Urgency Room, which offers emergency medical care 12 hours a day, seven days a week in a building next to a strip mall in Woodbury. On February 1, Waconia-based Ridgeview Medical Center opened a stand-alone emergency department in Chaska’s new Two Twelve Medical Center. Although there are differences between the two facilities, both will be staffed by board-certified emergency medicine physicians and equipped to provide high-level emergency care. And both say they will be able to charge less than hospitals do for the same services.

The Urgency Room
For years, Gary Gosewisch, M.D., president and CEO of EPPA, was bothered by the wait times in the EDs where he worked. It sometimes took hours for people to get into an exam room. By then, they were often frustrated as well as sick or injured.

Although the six hospitals Gosewisch and his colleagues staffed were constantly seeking to reduce the length of those wait times, the problem persisted. Gosewisch knew that was because what happens elsewhere in a hospital affects its ED. A patient needing blood, for example, might have to wait while the hospital’s blood bank dealt with a more critically ill patient in the OR, or a patient needing a CT scan might wait in line behind a sicker inpatient. In addition, he knew that between 75 and 80 percent of the patients treated in a typical ER were discharged, never needing the services of the hospital attached to it.

About four years ago, Gosewisch, came up with the idea of taking the resources of an ED out of the hospital and dedicating them to the care of those patients who didn’t need hospitalization. Last October, that idea came to fruition with the opening of the Urgency Room, a 12-bed facility that, like its name implies, is a hybrid urgent care clinic/emergency room and bills itself as an ER alternative.

Set in a refurbished Video Update store, the center looks like a clinic when you first walk into its small waiting room. The treatment area, however, looks more like a hospital ER with a nursing station surrounded by exam rooms. It has digital X-ray, ultrasound, and CT capabilities; an on-site lab that can handle complex tests; and the tools to do procedures ranging from spinal taps to shocking a heart. And it’s staffed by a board-certified emergency medicine physician, paramedic, and nurse as well as imaging and lab technicians. “We can duplicate a lot of ER services,” Gosewisch says.

What the Urgency Room can’t do is call itself an ED because it’s not affiliated with a hospital. As a result, it doesn’t receive ambulances, which Gosewisch points out ensures that those patients with high-acuity needs end up at hospitals. They’ve made arrangements with Regions, United, and other hospitals to admit patients quickly if needed.

Gosewisch says the most difficult aspect of getting the Urgency Room up and running was figuring out how to get paid. “When we went to payers, they thought it was a fabulous idea, but they had no idea how to pay us because it’s not a hospital, a clinic, or an urgent care.” He says it took more than nine months to hammer out a plan, the result of which is that the Urgency Room charges (and insurers pay) 25 to 30 percent less than if the patient went to a hospital ER. Patients who have copays pay what they would for an urgent care visit, rather than an ER visit. He notes that they will see patients once, regardless of their ability to pay.

Another challenge has been getting the word out about what the new facility is. A sign on the building and on Interstate 494 attracts some patients to the Urgency Room, as has a direct marketing campaign. They’ve also reached out to area clinics’ and insurers’ nurse lines, which now refer patients. Those efforts appear to be working. “Within a few days of being open, we started to exceed all of our projections,” Gosewisch says. “Our patient volumes are running 400 percent greater than what we had anticipated.”

Gosewisch admits that success has created its own challenges. “We didn’t have enough staff on New Year’s day. We were inundated,” he says, explaining that some patients waited as long as two hours to be treated. Other than that, the Urgency Room seems to be doing what it set out to: getting patients in and out within minutes.

The Stand-Alone ER
Patients who come to the new stand-alone emergency room in the Two Twelve Medical Center in Chaska, which is home to a number of specialty clinics as well as a pharmacy and imaging center, won’t have to know ahead of time whether they need urgent care or emergency care. That’s because the new facility offers both.

Although it is staffed and equipped like a hospital ER, it won’t treat every patient as an ER case. Nor will it charge ER rates for all visits. “At any time of day, patients can come to our ER and we will classify them as either an urgent care or emergency medicine patient,” says David Larson, M.D., medical director of emergency medicine for Ridgeview.

The market provided the impetus for this new approach to emergency care, according to Bob Stevens, CEO of Ridgeview. He says Ridgeview leaders saw a growing population in the southwestern suburbs who had to travel to hospitals in Minneapolis, Edina, St. Louis Park, and Waconia for emergency services.

Believing that the metro area did not need another hospital, they began to explore the idea of a stand-alone ER, and three years ago sent a team to look at one started by Swedish Hospital in Seattle. In addition, they thought about what they could do to be more cost-effective and came up with the plan to combine urgent and emergency care. “The key thing was to work with payers, to make sure they understood how we were going to deliver care in this model, and how we were going to assess patients and provide the appropriate care at the lowest cost,” Stevens says. “We’ve identified those codes that are strictly urgent care, so that patients know and insurers know how we’ll triage those patients,” he says.

The result is an 18-bed ER with full imaging and procedural capabilities that is open around the clock, 365 days a year that also offers urgent care. The ER will be staffed by the same emergency medicine specialists who work at Ridgeview. And pediatric emergency physicians from Children’s Hospitals and Clinics of Minnesota will be on hand evenings and weekends as well.

The ER also has processes in place to quickly transfer critically ill patients to the hospital of their choice. It will do so free of charge when the destination is Ridgeview Medical Center, St. Francis Regional Medical Center, Methodist Hospital, Fairview Southdale Hospital, or Children’s Hospitals and Clinics of Minnesota in Minneapolis. Unlike the Urgency Room, it will accept ambulances and ambulance staff can contact ER doctors for advice prior to arrival.

Stevens says they tried to think through every issue that might prevent someone from seeking health care in their area. “We think we’ve removed barriers such as, Are they open or not? Will they take my infant? What happens if this is more serious than I think it is?” he says.

Stevens believes their approach will save both insurers and patients money. “Patients can be assured if it’s only something minor,” he says, “it will only be an urgent care visit, whether it’s Sunday morning at 2 a.m. or Wednesday afternoon.” ■