Story and video: Central Vermont Medical Center opens urgent care center

BERLIN — Central Vermont Medical Center’s Express Care urgent care center began treating patients this week, giving area residents a lower cost alternative to the emergency room for non-life-threatening conditions.

Express Care will be open from noon to 8 p.m., 365 days a year. Patients don’t need an appointment and the center’s hours will allow them to get treatment for conditions such as fevers, infections, colds and minor cuts or fractures when they can’t get in to see their primary care provider.

Treatment at an urgent care center is roughly half the cost of the same procedure in an emergency department, according to CVMC officials, and the out-of-pocket costs for people with health insurance are lower as well.

Emergency departments are more expensive settings in which to be treated because laws allow them to bill differently for services in order to stay open 24/7 and treat people regardless of their ability to pay.

CVMC Express mapThe Express Care center saw 18 patients Thursday, the first day it was open. Dr. Richard Burgoyne, CVMC’s medical director, said he expects Express Care will see roughly 30 patients per day once operations are in full swing.

Urgent care centers will not only save patients money, but it is hoped they will reduce system-wide health care costs by keeping people who aren’t experiencing a medical emergency out of hospital emergency rooms.

“It fills a real need and ends this misallocation of resources where people are using the emergency room … and delivers the necessary services appropriately at physician office prices,” said Rep. Tom Koch, R-Barre Town, who attended a Friday ribbon-cutting at the center, located at 1311 Barre-Montpelier Road.

ClearChoiceMD, a New London, N.H., company, expects to open its own urgent care center less than a half-mile away, offering the same services. Concentra, a subsidiary of Humana Inc., operates an urgent care center near CVMC – though it closes at 5 p.m.

Vermont has tightly regulated the build-out of its health care system, especially since the creation of the Green Mountain Care Board in 2011, but urgent care centers aren’t subject to oversight because of an exemption for physician’s offices.

The proliferation of urgent care centers – ClearChoice plans to open five in the state this summer, and other hospitals are planning their own – raises questions about the duplication of services, which could ultimately drive up the fixed costs in Vermont’s health care system.

“Whether it’s excessive will be determined by how much people are using them,” Koch said. “If they’re not used fully and efficiently, one or more of them will probably close. That’s the way the market works, and I think people make a mistake when they say that market forces don’t apply to health care.”

That’s the view of ClearChoice executives who welcome the competition saying it will benefit consumers by forcing hospital-owned urgent care centers to offer competitive prices.

CVMC Chief Executive Judy Tartaglia said ClearChoice’s entrance into the market is troubling.

“What I worry about with out-of-state for-profits is whether they have the same sort of mission and philosophy that we do,” Tartaglia said. “We treat anybody who walks through the door regardless of their ability to pay … and I’m not sure that necessarily applies to for-profit companies.”

All 14 Vermont hospitals are nonprofit organizations, and won’t turn away patients who can’t afford their services.

ClearChoice has said its clinics will accept Medicaid and will provide a discounted fee structure for the uninsured, but if somebody doesn’t have the ability to pay for their services the company has said it will stabilize their condition and transfer the patient to another location, likely a hospital-run urgent care center or an emergency room.

The Vermont Legislature this year passed a law that will require urgent care centers, or any walk-in clinic to treat patients regardless of their insurance status.

That provision was in response to concerns that private companies operating urgent care centers might skim off the patients with private insurance, leaving the state’s hospitals to care for patients with public health coverage.

ClearChoice President Michael Porembski has said the law is discriminatory, because it singles out urgent care centers and does not apply to other private physicians offices, which aren’t required to accept Medicaid or Medicare patients.

Both programs reimburse providers at lower rates than commercial insurance, Medicare at roughly 75 percent of commercial rates and Medicaid at closer to 50 percent.

Porembski said hospitals, unlike private practices, have access to public payment models that compensate based on the proportion of uninsured and subsidized patients they serve.

But ClearChoice plans to take all patients as long as they are able to pay, so the law is unlikely to hurt their business, Porembski said.

He left open the possibility that his company may challenge the new law in court.

Correction: An earlier version of this article incorrectly stated that the Legislature passed a law requiring hospitals and private companies to go through the certificate of needs process before opening urgent care centers.

Cutting the ribbon at CVMC's new Express Care facility are (from left): CVMC President & CEO Judy Tartaglia, Express Care Medical Director Richard Burgoyne, MD, Steve Connor, Connor Construction, CVMC Facility Project Coordinator Nicole Duncan, Rep. Tom Koch and CVMC Board Chair Greg Voorheis.  Courtesy photo

Cutting the ribbon at CVMC’s new Express Care facility are (from left): CVMC President and CEO Judy Tartaglia; Express Care Medical Director Richard Burgoyne; Steve Connor, Connor Construction; CVMC Facility Project Coordinator Nicole Duncan; Rep. Tom Koch; and CVMC Board Chair Greg Voorheis. Courtesy photo

Morgan True

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