Urgent care pushed in Howard; emergency room crowds drop

County's only hospital emergency room sees less crowding

May 26, 2011|By Larry Carson, The Baltimore Sun

Crowding appears to be declining at Howard County's only hospital emergency room, and a citizens group is promoting the use of a dozen private urgent-care clinics in the county as a cheaper, more convenient option to help keep that trend going.

"Our purpose is to let the people of Howard County know that the providers are here," said Barbara Russell, a Howard County Citizens Association member who serves on the group's three-person committee studying emergency medical care.

To that end, the group hosted a meeting Monday night at the Hawthorne Community Center featuring the county's top medical officials.

Del. Shane Pendergrass, a Democrat who specializes in health insurance issues, and representatives of most of the dozen urgent-care clinics operating in Howard County attended the meeting. A visit to a clinic visit typically costs $95 in cash at the Righttime Medical Care clinic in Columbia, said the company's CEO, Dr. Robert G. Graw Jr. That's compared to more than $1,000 for a typical trip to the hospital emergency room, according to national statistics.

A list of the clinics and their hours, locations and contact information is also posted on the Howard County government website. Visitors can click "departments," then "health" and then "health information."

Stuart Kohn, a North Laurel resident and HCCA member who has led a personal crusade to reduce emergency room crowding at Howard County General Hospital in Columbia, told the group of about 40 people at the meeting that the situation has improved dramatically over the past 18 months.

"Yellow" alerts, which advise county firefighters to take patients to less-crowded facilities, have declined steeply, he said.

Kohn told the group, which included hospital President Victor Broccolino and hospital emergency room supervisor Dr. Walter Atha, that in 2008, the hospital emergency room was on yellow for 63 days.

That increased to 101 days in 2009, but dropped to 16 days in 2010; and so far this year, "there was less than half a day" on yellow," he reported from statistics kept by the state of Maryland. The hospital treated 75,600 patients in the emergency room last year, and Atha said each one has initial contact with a triage nurse within 15 minutes, though treatment can take hours. "It's quite a challenge to handle the volume," he said.

Broccolino said later the hospital's addition of 43 new beds plus new procedures for moving patients helped to speed people waiting for hospital admission out of the emergency room, leaving more room for new arrivals. He also encouraged people to go to urgent care if they don't have a true emergency. "I think it's good. It allows us to focus more on the sicker patients," Broccolino said.

It can also make a difference for Howard residents, Russell said, based on her experience four years ago when chest pains forced her to call for an ambulance at her Columbia home.

Because Howard County General was on "red," meaning no monitored beds were available, she was taken to St. Agnes Hospital in West Baltimore. She later found out she had not had a heart attack, she said, "but I almost had a heart attack when they released me around at 3 a.m., and I was trying to direct a Baltimore City cabdriver who thought Columbia was in another state."

She urged those at the meeting to pass information about the urgent-care clinics to others. "People in general don't have the information they need to access health care," she said.

Alex Adler, an insurance broker invited to speak, urged people to keep their primary-care doctors informed of any treatment they receive elsewhere, and said people can also use toll-free insurance company phone lines to get advice from a registered nurse. He advised people to "take a few minutes" before any emergency occurs to "learn who your closest urgent-care facility is, whether they have a doctor on staff, their hours and whether they take your insurance." Then, when something happens, patients will be prepared, he said.

Howard County health officer Dr. Peter L. Beilenson said the Healthy Howard access plan for uninsured county residents uses financial incentives to encourage members to use urgent care rather than the emergency room, and it has worked.

Nationally, he said, one-fifth of adults 19 to 64 use a hospital emergency room once each year. But for Healthy Howard patients, only 8.4 percent of that group have used the emergency room. Healthy Howard members pay $50 for an urgent-care visit, but are charged $100 for an emergency room visit if they are not admitted to the hospital.

The officials said in answer to questions that while individual doctors and nurses who work at private clinics are licensed by the state, the clinics themselves aren't tightly regulated. To qualify, they must have extended hours of operation and X-ray and lab facilities. Some have physicians on staff and others have them on call.

No one offered any statistics on how business at the private clinics has grown, though Graw, a pediatrician who is CEO of Righttime, located in the 6300 block of Cedar Lane next to Lorien Nursing Home, said business is "extremely good."

Righttime has the longest hours in the county, from 9 a.m. to midnight, seven days a week. Most of the others, located in Elkridge, Ellicott City and Columbia, are open until 8 p.m. weeknights, and until 4 p.m. to 7 p.m. on weekends. Patient First, now in Laurel, Anne Arundel County but with plans to open on Cedar Lane in Columbia in August, is open until 10 p.m. every day.

The newest private clinic is one called Kinder Mender, a walk-in clinic for children, preparing to open in July next to the new Toys "R" Us store on Dobbin Road in East Columbia.

A previous version of this article provided an incorrect number of visits to the emergency room at Howard County General Hospital.

larry.carson@baltsun.com

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