# Revolutionary New ER Cuts Wait Times



## Sasha (Jul 10, 2009)

*Revolutionary New ER Cuts Wait Times*
Full Article Here: http://www.clickorlando.com/news/20006227/detail.html


> The Mini ER, located on Lake Underhill Road near Waterford Lakes, was co-founded by Brantley Molpus, an emergency room doctor who was fed up with long lines.
> 
> For Cara Fair, a trip to the emergency room is no longer an all-day event. When she previously spent hours waiting to see a doctor, she now spends just minutes.
> 
> "Probably today with him we have been here about 20 minutes. Normally, we are not here that long," Fair said.


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## WuLabsWuTecH (Jul 11, 2009)

So its not an ER but an urgent care center.

Although I have seen ERs now that allow you to make a reservation for an additional fee.  There are potential EMTALA problems with that, but in this case its looks to be just an Urgent Care center and not a real ED.


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## Ridryder911 (Jul 11, 2009)

This is nothing new or different. What it is a free advertising and the marketing person for the hospital doing their job as placing it in the news section. 

Something here that is really catching on is physician (or P.A.'s, N.P's) now making house calls. It is Medicare and most Insurance covered and much cheaper than a ER visit and most can be seen in < than a hour. I know of many ED Physicians that were former Paramedics going this route. Seeing cases that does not have to be seen in the ED. I know of some that are hiring EMT's to "screen" thier calls as they do not take life threating type calls but rather will notify EMS. 

R/r 911


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## Sasha (Jul 11, 2009)

WuLabsWuTecH said:


> So its not an ER but an urgent care center.
> 
> Although I have seen ERs now that allow you to make a reservation for an additional fee.  There are potential EMTALA problems with that, but in this case its looks to be just an Urgent Care center and not a real ED.



Yeah, it's an urgent care with "ER" in it's name. I don't think it's a good idea at all. But of course the Mini ER is located in an affluent area, and rich people don't like to wait.


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## SurgeWSE (Jul 11, 2009)

Urgent care or not, it will be good for the system as a whole if more people would use these type facilities.  I like the idea of the physicians making house calls again.  One of the things I love about working EMS as opposed to a clinical setting is that you can learn a lot about a patient by seeing the environment in which they reside.  Having people receive primary care in their homes can not only treat simple ailments, but will help their provider better understand their needs at a preventative level.


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## WuLabsWuTecH (Jul 11, 2009)

Physicians making house calls is an ineffective us of time.  I can see certain situations that it can be of help, but with the anticipated doctor shortage (some people claim we are already in that shortage right now) the time it takes for a doctor to travel would be better spent treating patients that come to him.


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## VentMedic (Jul 11, 2009)

WuLabsWuTecH said:


> Physicians making house calls is an ineffective us of time. I can see certain situations that it can be of help, but with the anticipated doctor shortage (some people claim we are already in that shortage right now) the time it takes for a doctor to travel would be better spent treating patients that come to him.


 
No it actually isn't a waste of time as patients would not be able to go by POV or taxi can now be seen without calling a BLS truck to transport. We have many elderly, quadriplegics and otherwise physically challenged people who must be seen regularly that can now avoid the hassle. Parents also see it as an advantage when they don't have to find a babysitter or take 3 other kids to a doctor's office. And yes there are private practices that do have roving doctors do followup on their patients for routine checkups. Sometimes this may even be done in their place of employment. It cuts down on missed work days and affects productivity overall. It also gives physicians an opportunity to do patient care without the stress and expense of maintaining an office where they must see 10-15+ patients per hour just to stay afloat. 

Several years ago a couple members of my family used a physician that made house calls and the setup the doctor had in his van was pretty incredible. He could also take this mobile unit to the NHs where he was on service and could do X-Rays and lab tests without waiting for the middle company.


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## WuLabsWuTecH (Jul 11, 2009)

well for a nursing home it makes sense and such, but if he had to see 10-15 patients an hour to stay afloat (which I know is just a number you pulled out of the air) then wou;dn't he have to charge 5-7 times as much since he has to drive to all the different houses and can only see one pt every 20-30 minutes instead of one pt every 5?


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## Shishkabob (Jul 11, 2009)

> The Mini ER is able to handle all types of non-life-threatening emergency cases, but with a fraction of the wait time, thanks in large part to their unusual approach to checking in via the Internet.



So... it's a Care Now clinic.  Where does the "Mini ER" part come in to play, and how is it revolutionary?  I have this just down the road from me...


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## Sasha (Jul 11, 2009)

Linuss said:


> So... it's a Care Now clinic.  Where does the "Mini ER" part come in to play, and how is it revolutionary?  I have this just down the road from me...



Mini ER is the name of the independent urgent care clinic.


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## VentMedic (Jul 11, 2009)

WuLabsWuTecH said:


> well for a nursing home it makes sense and such, but if he had to see 10-15 patients an hour to stay afloat (which I know is just a number you pulled out of the air) then wou;dn't he have to charge 5-7 times as much since he has to drive to all the different houses and can only see one pt every 20-30 minutes instead of one pt every 5?


 
The fact that a doctor can spend 20 minutes with a patient vs 2 - 5 is definitely a plus for some.  

Do you know how much it costs to operate a physician's office?   Like other small business owners, the physician can no longer stay afloat.  With rents between $100 - 700/sq. ft just for the office space, insurance, labor costs and low reimbursement from insurances, physicians are looking for other options.  And, if they have the misfortune of having an office in California, they get an IOU from the state.


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## Sasha (Jul 11, 2009)

> The fact that a doctor can spend 20 minutes with a patient vs 2 - 5 is definitely a plus for some.



Who said that the doctor would spend that 20 minutes with a patient? You aren't accounting for fuel cost, travel time, etc. I would think the time with a patient would be even shorter in an effort to fit as many patients in to the day as they possibly could travelling from house to house.


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## Shishkabob (Jul 11, 2009)

Ok than---

How is it an ER if it's not made for life-threatening emergencies?  And how is the internet check-in "revolutionary"?



Like I said, I have this exact model down the street at a Care Now, and I don't see it in the news for being revolutionary.


What am I missing that the author caught?


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## Sasha (Jul 11, 2009)

Linuss said:


> Ok than---
> 
> How is it an ER if it's not made for life-threatening emergencies?  And how is the internet check-in "revolutionary"?
> 
> ...



Jeez louise. It's a catchy cute name. "Mini ER" It is not a real ER, it's just the name. When you go to an italian restraunt, you are not really in Italy, even if it has Italy in it's name.

Get your local news to write an article, if it will make you feel better. It's "revolutionary" because it's the first one in the area (my area) to offer such a service. Never claimed it was the first.


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## VentMedic (Jul 11, 2009)

Sasha said:


> Who said that the doctor would spend that 20 minutes with a patient? You aren't accounting for fuel cost, travel time, etc. I would think the time with a patient would be even shorter in an effort to fit as many patients in to the day as they possibly could travelling from house to house.


 

Fuel costs at $3/gal. vs $30,000 - $50,000/month (easily) for rent, $15,000 - $30,000 for labor and several thousand more for misc. costs.  The physicians that I know who are doing home visits see maybe 10 patients a day or maybe more with their corporate visits which are now popular.   When working for a large medical group that provides health care for the insurance of these corporations, they may do preventive visits and routine script renewal which usually just consists of a BP check.   They could several patients during a scheduled visit and save the pt/company missed worked days.


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## Shishkabob (Jul 11, 2009)

Never said you, Sasha, said the author.


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## Sasha (Jul 11, 2009)

VentMedic said:


> Fuel costs at $3/gal. vs $30,000 - $50,000/month (easily) for rent, $15,000 - $30,000 for labor and several thousand more for misc. costs.  The physicians that I know who are doing home visits see maybe 10 patients a day or maybe more with their corporate visits which are now popular.   When working for a large medical group that provides health care for the insurance of these corporations, they may do preventive visits and routine script renewal which usually just consists of a BP check.   They could several patients during a scheduled visit and save the pt/company missed worked days.



And what do the patients and doctors do when they need more than just a BP check?


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## Sasha (Jul 11, 2009)

I reread the article, Linuss. I don't see where the author claimed it was the first to provide such a service.


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## Shishkabob (Jul 11, 2009)

Correct, I put "revolutionary" in the wrong sentence, my bad.



But the title says it's a "Revolutionary New ER" when it is neither revolutionary nor an ER.


It's a neighborhood clinic.  Nothing more.  And because of such, I fail to see the news-worthiness.  That's all I'm saying.


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## VentMedic (Jul 11, 2009)

Sasha said:


> And what do the patients and doctors do when they need more than just a BP check?


 
They are referred to the appropriate facilty which might be a hospital admission.  

This isn't that difficult of a concept nor is it new.


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## Sasha (Jul 11, 2009)

It's revolutionary to the area it's in, and it was a local news article. The article was mistaken on the type of facility in the title but not in the article. Sorry it did not meet your standards, but if you don't feel it's news worthy, you are welcome not to read the article.



> This isn't that difficult of a concept nor is it new.



I was curious, nothing more, nothing less. No need to get condescending.


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## Shishkabob (Jul 11, 2009)

Hey, you brought up a local article on a (inter)national EMS news section.  Sorry if my response doesn't meet your expectations of a discussion on more examples of public errors on something medicine related.


You brought it up for discussion, I'm discussing it.




EDIT-- Happy face to not incur the wrath of the mods.


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## silver (Jul 12, 2009)

we have an urgent care clinic for our hospital system, yet we still have one of the busiest ERs in the country and people still go to the ER and wait and wait and wait...

In theory it is great, but everyone still goes to the ER. In fact they didnt decrease the number of visits at our ER but instead increase its combined number (ERs + urgent care).


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## WuLabsWuTecH (Jul 12, 2009)

The ER in the name is misleading.

Like it was mentioned, when you go to an Italian Restraunt, you know you're not in Italy.  But I do think you would expect more than burgers and fries--that is, italian food!

If you go to something with the name ER, I think that while its expected it might not be a Level I Trauma Center, you do expect that you can get care for a life threatening EMERGENCY (the 'E' in "ER") and not just urgent care.


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## Sasha (Jul 12, 2009)

WuLabsWuTecH said:


> The ER in the name is misleading.
> 
> Like it was mentioned, when you go to an Italian Restraunt, you know you're not in Italy.  But I do think you would expect more than burgers and fries--that is, italian food!
> 
> If you go to something with the name ER, I think that while its expected it might not be a Level I Trauma Center, you do expect that you can get care for a life threatening EMERGENCY (the 'E' in "ER") and not just urgent care.



I don't think that's true. It's a cute little name. "Mini ER" MINI.. would you go to a mini anything for your life threatning emergency? Would you go to somewhere with no hospital attached (and there is no way to mistake the shopping center it is in for a hospital, you will have to take my word for it.) for your life threatning ER? Most people have enough brain power to realize that it is just being cute and is not in fact an emergency room. 

If that were true, people would also bring their life threatning emergencies to anything with urgent care in the name, yes? Urgent is just a synonym of emergency.


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## CAOX3 (Jul 12, 2009)

Doc in the box, we have these in our area.  They relieve the the over crowding of the ER's with the promise of no waits.  In reality its an hour wait versus an eight hour wait.


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## WuLabsWuTecH (Jul 12, 2009)

Sasha said:


> I don't think that's true. It's a cute little name. "Mini ER" MINI.. would you go to a mini anything for your life threatning emergency? Would you go to somewhere with no hospital attached (and there is no way to mistake the shopping center it is in for a hospital, you will have to take my word for it.) for your life threatning ER? Most people have enough brain power to realize that it is just being cute and is not in fact an emergency room.
> 
> If that were true, people would also bring their life threatning emergencies to anything with urgent care in the name, yes? Urgent is just a synonym of emergency.



I respectfully dissent.  As long as we continue to show up on scenes and ask, "What were they THINKING?" and realize that they weren't thinking, we will have people showing up something with ER in the name and thinking that while it's a smaller ER, its still an ER.

Urgent is not a synonym for emergent, emergent is more serious.  Most people however, have heard it for long enough that they know an urgent care is not the ER.  That being said we still do have people with chest pains or other life threatening emergencies showing up at urgent cares (we know this b/c the urgent care calls 911 every so often!).  Naming an urgent care an ER will just add to the confusion.


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## VentMedic (Jul 12, 2009)

When these urgent care centers started popping up in the 1980s,  they had contracts with private ALS ambulances for the emergent calls and they were kept very busy with CPs, GSWs and L&Ds.  They were also associated with the HMOs which wanted patients to utilize these facilities to keep cost down.   Just like their "call us first" instead of 911 campaign, many of these centers fell off the map as some of the HMOs failed.


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## Ridryder911 (Jul 12, 2009)

There are strict regualtions on what and how names can be placed within an emergency department. Alike the same as for chest pain center and so on. As a former ED manager, I can assure you there is as well regulations that are placed upon just the name Ugent Care Center. 

In fact, if one want to acclaim as such there is a different set of rules and billing policies. I worked in one ED that we had to label the rooms differently and the physicians billing was totally different and as well staffing had to be differentiated. 

It became such a hassle in one of the ER I managed, that we totally dissolved urgent care within the ED and placed it in another building with the charge person under the ER but separate as well. We changed the area of the ER into "fast tracks" but that is within the ED as part of the triage and that is allowed as part of within the ED scope. 

Beaurocracy is think in the regulations and rules of Medicare and Medicaid, as many Medicaid will not pay for Urgent Care Center for the same injury and illness but will allow for an Emergency Department....go figure?


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## marineman (Jul 12, 2009)

Reading the original article it seems that Cara Fair has had plenty of experiences going to the ER if she is able to come up with an average wait time. If there were fewer people like her maybe the waits wouldn't take so long. Maybe my area is different but I've never seen anyone with an honest to god emergency that had to wait anyway. I'm glad we now have urgent care clinics everywhere, there is one in the walmart, one in the grocery store, one at the mall and many others, hopefully we can now educate people as to what constitutes an emergency that requires care at the emergency room and what is ok to take to the clinic. I understand that it's always an emergency to the one in pain and I'm not saying get rid of anything that's not an MI, major trauma etc. just saying that hang nails and toothaches don't really need to be seen in the ER.


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## Sasha (Jul 12, 2009)

marineman said:


> Reading the original article it seems that Cara Fair has had plenty of experiences going to the ER if she is able to come up with an average wait time. If there were fewer people like her maybe the waits wouldn't take so long. Maybe my area is different but I've never seen anyone with an honest to god emergency that had to wait anyway. I'm glad we now have urgent care clinics everywhere, there is one in the walmart, one in the grocery store, one at the mall and many others, hopefully we can now educate people as to what constitutes an emergency that requires care at the emergency room and what is ok to take to the clinic. I understand that it's always an emergency to the one in pain and I'm not saying get rid of anything that's not an MI, major trauma etc. just saying that hang nails and toothaches don't really need to be seen in the ER.



Most clinics and urgent cares don't take people with no means to pay, and until insurance is more affordable or to see a doctor without insurance is cheaper, people will have nowhere to turn for their sniffles and toothaches and will continue to crowd ERs.


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## Shishkabob (Jul 13, 2009)

Sasha said:


> would you go to a mini anything for your life threatning emergency? Would you go to somewhere with no hospital attached (and there is no way to mistake the shopping center it is in for a hospital, you will have to take my word for it.) for your life threatning ER?



People have, and will.

I was at a Care Now to get a TB test... in the 45 minutes I was there someone came in for a seizure and someone for a facial laceration that needed stitches.

Both were told "You need to go to an ER"


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## WuLabsWuTecH (Jul 13, 2009)

Linuss said:


> People have, and will.
> 
> I was at a Care Now to get a TB test... in the 45 minutes I was there someone came in for a seizure and someone for a facial laceration that needed stitches.
> 
> Both were told "You need to go to an ER"


I thought urgent cares could do stitching?  Siezure needed ER though!


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## Sasha (Jul 13, 2009)

> someone for a facial laceration that needed stitches.



They can't suture there? We sutured at my old job.


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## Shishkabob (Jul 13, 2009)

I looked, pretty bad lac and considering she fell on the edge of a glass table, she needed more then just a suture.


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## Sasha (Jul 13, 2009)

Linuss said:


> I looked, pretty bad lac and considering she fell on the edge of a glass table, she needed more then just a suture.



Suture and a tetanus shot... should be able to be handled by an urgent care.


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## Shishkabob (Jul 13, 2009)

More like internal bleeding needing a CT scan, following positive LOC.


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