YOUNSGTOWN – In the health care sector today, the name of the game is access. It isn’t enough for medical systems to staff a slew of doctors in their hospitals who see patients there when they have a concern. Instead providers must offer a vast array of services across diverse footprints, delivering care where patients need it most.
It’s in this landscape that walk-in clinics, where patients can get treated for issues as they arise, have found their place.
“They know what ER is and they know they can call their primary care office for things that aren’t acute. Urgent care fills that gap in needs,” says Dr. Lena Esmail, CEO of QuickMed Urgent Care. “Rather than delaying care to get into primary care or using an ER for nonemergency uses, urgent care is in between.”
Since it was founded in Liberty Township in the summer of 2019, QuickMed has added five other sites – Cortland, Howland, Lake Milton, Austintown and Columbiana – and is working on expansions in Parma and Westlake near Cleveland. It also staffs in-school clinics for Youngstown City Schools.
QuickMed was founded in the wake of the closing of Northside Medical Center, which created a vacuum in care. The closest hospitals are St. Elizabeth Youngstown Hospital and St. Joseph Warren Hospital. For those seeking immediate care, travel to the emergency rooms wasn’t always feasible, from both an urgency standpoint and a cost perspective. Where walk-in clinics fit into the medical landscape, Esmail explains, is as a temporary replacement for primary care and a permanent one for the ER in non-emergency cases – coughs, colds, cuts, strains, sprains and other minor injuries.
“If you’re going to have a major transplant, you’re willing to go halfway across the country for that care. If you’re having surgery, you’re still willing to drive a bit,” says Steve Davenport, chief operating officer of Southwoods Health. “But as you dial that back to more straightforward conditions for things like doctors’ visits or imaging, those are things that people need more frequently and want it in the community they reside in.”
In August 2019, the company opened Southwoods Express Care in Boardman and expanded in November to a second site in Campbell inside the Community Literacy, Workforce and Cultural Center. While Southwoods’ network of physicians provides primary care in both areas, the clinics serve as a supplement, not a competitor, Davenport says.
“It comes down to the old real estate saying: location, location, location,” he says. “It’s got to be fast and convenient, which means it needs to be close to where patients are coming from. Nine times out of 10, that means close to their home.”
In its 2019 benchmark report, the Urgent Care Association reported that almost all patient visits – 92% – took less than 20 minutes. Just 3% of visits took more than an hour. Like many other sectors, Davenport says, immediate, on-demand service is making its way to health care.
“Younger generations are saying that the relationship with a doctor is less important than having access to convenient care and getting on the road to recovery,” Davenport says.
That trend has meant a boom for urgent care clinics. The trade group reported 9,616 operating urgent care clinics in 2019, a 9.6% jump from the year before. The number has increased every year since 2013. A quarter of patients using urgent care, the association reported, lack a primary care provider.
At Mercy Health, that figure is concerning. Although walk-in care is an important part of the system’s mission to expand access to care, it doesn’t serve as a replacement for seeing a doctor regularly.
“Most things can be managed, even things like chronic conditions such as oncology, in an outpatient setting,” says Rod Neill, chief operating officer of Mercy Health-Youngstown. “We don’t want people coming back again and again and again for the same chronic conditions. We want to get them established with a primary care provider so they can get help with all of their issues.”
In recent years, Mercy has developed a walk-in system that finds a middle between primary care and urgent care. In sites like Wick Primary Care on the campus of Youngstown State University, patients can walk in without an appointment; Neill likens it to “extended primary care.
“You get that same experience and low cost as you would at your regular doctor’s without an appointment,” he says.
In recent years, clinics have been a key part of Mercy’s expansion, with sites added in Vienna Township, Mineral Ridge, Columbiana, Salem, East Palestine and East Liverpool. The sites were chosen because the communities have few options for immediate care, Neill says.
“It’s been well received because people can step out their door and in five minutes be at a primary care provider,” he says.
Urgent care doesn’t need to be limited to medical offices. After launching On Demand Immediate Care early last year, the company recently expanded the service to offer business clients on-site clinics. The move, says Ruth Bowdish, managing director of On Demand Occupational Medicine, combines the national trend of on-demand access with On Demand’s mission of providing employers with services to keep their workers on the job.
“If we’re able to go out on-site and see individuals who have a scratchy throat, we might be able to prevent that from escalating to something that turns into taking time off work. If they have an injury, they may question if it’s worth standing in line and going through tests,” she says. “[Workers know] we’re going to have a clinic on-site Thursday morning where you can get checked out at work. By making care more accessible, we’re creating a healthier community.”
On Demand Immediate Care also has its clinic inside the Austintown campus where On Demand Occupational Medicine, which operates the service, has primary care offices, drug testing, physical exams and workplace training. All of the facets of care, Bowdish says, are interlinked, making the creation of On Demand Immediate Care a logical step for the company.
“If a client has an accident on the job, say someone gets a laceration, they’re going to bring [the employee] to us for a drug and alcohol test,” she says. “Now, they can bring them in and we can treat them, getting them back to work faster. We can do the test here and the laceration care here. Those services can be done concurrently.”
QuickMed took a similar tack with its expansion into Youngstown City Schools, where it provides the district with pediatric nurse practitioners and a pediatric medical director in each in-school nurse’s office.
“Aside from telling the nurse what’s wrong, there’s not much [students] can do. She can’t diagnose. She can’t treat. She can evaluate,” Esmail says. “By adding a provider, you’ve completed the circle so the student doesn’t have to leave school and get in with their pediatrician if they have one … where their parents also have to find the time to take them.”
That means students are spending more time in school while also getting treatment for medical issues, whether it’s an acute problem such as a cut or cold or a chronic health condition.
“This is an adjunct service that puts power back in nurses’ hands. They can focus on education for students,” QuickMed’s CEO says. “We tell them to help students with their chronic conditions … and that we’ll handle the acutely ill children – strep throat, headaches, broken bones.”
Pictured: Dr. Lena Esmail is CEO of QuickMed Urgent Care, which does COVID-19 testing.