ER Doctor Plans Urgent Care Clinics in West Lebanon, Claremont
ClearChoiceMD owner Marcus Hampers, of Plainfield, N.H., has won approval to open five urgent-care facilities in New Hampshire and is awaiting approval for West Lebanon, N.H., and one other site. Photographed at his New London, N.H., office on Feb. 3, 2014, Hampers has scaled back his hours as an emergency room doctor at Dartmouth-Hitchcock Medical Center to launch the business. (Valley News - Jennifer Hauck) Purchase photo reprints »
West Lebanon — An emergency-room physician who practices at Dartmouth-Hitchcock Medical Center plans to open two for-profit urgent care centers in the Upper Valley and many others around the Twin States for patients who have health problems requiring immediate attention but aren’t life-threatening.
Claremont and West Lebanon are among 1 2 communities in Vermont and New Hampshire that may soon have a ClearChoiceMD urgent care center.
The facilities would offer an option to patients who have fractures, fevers, cuts, sprains, infections or other problems, but who can’t get in to see their primary care doctor and don’t justify a trip to the emergency room.
The centers would be independently run by the New London-based company and not affiliated with any hospital. Athough the physician-owner, Dr. Marcus Hampers, said he is interested in coordinating with primary care physicians, some expressed concern that it could lead to inefficient care and incomplete medical records among patients.
Hampers, a Plainfield resident who has practiced emergency medicine in the Upper Valley for 20 years, said he hopes to plug a gap in the local market and, in so doing, alleviate the burdens on emergency departments and primary care practices.
“I’ve seen how emergency rooms are becoming overcrowded with patients who, through no fault of their own, either they don’t have a (primary care physician) or they can’t get in to see their PCP for an acute visit,” Hampers said Wednesday. “When the emergency rooms become overcrowded like that, it has ramifications for the entire hospital.”
Two weeks ago, New Hampshire’s Health Services Planning and Review Board approved Hampers’ proposals to open centers in Claremont, Portsmouth, Keene, Belmont and Hillsborough. They were among a batch of 13 nonemergency walk-in centers — seven by Hampers’ competitor, ConvenientMD, and one from Wentworth-Douglass Hospital — approved at the board’s Jan. 16 meeting. Hampers has filed applications for two others in West Lebanon and Pittsfield, which the board will consider Feb. 20, and also intends to open Vermont centers in Brattleboro, Rutland, Barre, Burlington and St. Albans.
The timing of the New Hampshire projects is not coincidental, as the applications came just before a change in state law went into effect Feb. 1 that could have triggered a more comprehensive review. Because they were submitted prior to Feb. 1, the West Lebanon and Pittsfield locations will be reviewed under the old standards.
But the surge in urgent care centers coming to the region isn’t just about state regulations, Hampers said. There is a real need he is trying to meet.
“It’s happening all over the country because emergency rooms are overcrowded, patients aren’t able to get in to see their primary care provider,” Hampers said.
Hospitals and health experts agree that urgent care services may provide an important service, but caution that they could also set back efforts to control costs and coordinate patient care.
“There are clearly some advantages to these organizations, but we can’t be blind to the possibility that costs may increase in certain ways,” said Tyler Brannen, a health policy analyst with the New Hampshire Insurance Department.
Researchers at Dartmouth have found that expanding access to care does not always lead to lower costs for patients, and in some ways, forces spending higher because patients avail themselves of more care that they may not need.
Brannen also worried that because these organizations are independent, they would be less likely to work with other providers and add redundancy into the local health care system. Patients could end up going to an urgent care facility for something that is better addressed in a less intensive primary care setting.
“If we’re hoping to get patients into the most appropriate setting, there’s a balance between cost and access,” Brannen said.
ClearChoice does not intend to compete with primary care, Hampers said, and the prices it charges will be far less than what patients pay in the emergency room. A chest X-ray that might cost several hundred dollars in the ER would only be $30 at a ClearChoice center, said Michael Porembski, chief operating officer at ClearChoice.
“We provide services for a fraction for what a hospital emergency room can provide,” he said. “Better, cheaper and faster.”
Hospital officials have also expressed concern about fragmentation of care. If these independent walk-in centers are not sharing information with the patient’s primary care doctors, then there could end up being gaps in the patient’s record.
“We’re looking at the continuity of care,” said John Clayton, spokesman for the New Hampshire Hospital Association.
Valley Regional Hospital CEO Peter Wright shared that concern.
“My concern is that, how do we ensure that, as the principal provider of health care in the community, how do we ensure that it’s being done with good quality, that it’s being done in collaboration with the primary care providers in the community,” Wright said.
Valley Regional was actually considering an urgent care center in Claremont when Wright learned that ClearChoice was coming to town. Now, that plan is likely to change. He has been talking with ClearChoice officials about how they can work together. Porembski said he has reached out to other hospitals in the communities where a center is planned.
“We’ve been warmly received,” Porembski said. “Just about every one of them, we’ve offered them access to our electronic patient records, we’ve offered that we would like access to their electronic record and, to a hospital so far, they’ve been very cooperative.”
There is more than just hospitals. Independent primary care practices also stand to be affected, and Hampers said he has been in touch with them, as well.
In December, Dartmouth-Hitchcock partnered with CVS Caremark to open six retail walk-in clinics around New Hampshire, including one in West Lebanon. These “MinuteClinics” offer similar same-day health services, including diagnosis and treatment of illnesses and tending to minor wounds.
Dartmouth-Hitchcock declined to comment on ClearChoice’s plans to come to West Lebanon. Hampers said his centers were more comprehensive than a retail clinic. For example, MinuteClinics do not offer X-rays.
Hampers and Porembski would not say where they intend to open the West Lebanon or Claremont centers, as they have not yet signed leases. They hope to open their Vermont locations this summer and the New Hampshire centers by late summer or fall.
Until then, they hope to keep reaching out to other providers. Their success relies, in part, on a certain degree of trust.
“Once they do gain confidence in us, I’m going to bet they’ll be referring patients to us when they are unavailable or the patient needs a higher level of care than they can provide in the office, but not quite a level that arises to emergency care,” Hampers said. “I think it’s going to be a very positive relationship between us and the care providers in the community.”
Chris Fleisher can be reached at 603-727-3229 or firstname.lastname@example.org.
Plainfield resident Marcus Hampers has won approval to open five urgent-care facilities in New Hampshire and is awaiting approval for West Lebanon and one other stie. An earlier version of a caption for a photograph with this story incorrectly described how many had been approved in the Granite State.