New, Expanded Clinics Open Care Options

Patients have increasing options when it's time to see a doctor.

The health care landscape is changing in Northwest Arkansas as new clinics open in more convenient locations, have extended hours and provide alternative payment plans.

Northwest Arkansas medical professionals point to population growth and expanded health insurance coverage as driving forces behind the increase in clinic options. The number of clinics is hard to track because there's no local, state or federal registration requirements. Physicians individually must be licensed.

"It's great when consumers have choices," said Cheryl Fish-Parcham, private insurance program director at Families USA, a nonprofit health care advocacy group. "More locations and extended hours provide less expensive options than a visit to an emergency room."

The growth ranges from hospital systems opening large, multispecialty clinics to a national chain opening several urgent care sites. Even some existing clinics are extending hours to help meet patient demand.

"Patients want convenience, and it's important to open clinics that help meet that demand," said Dr. Steve Goss, president of Mercy Clinic Northwest Arkansas.

Mercy opened three clinics in the past three weeks. None add to the area's total clinic count as two are relocations and one is the purchase of a private practice.

A growing number of physicians are opening up their own clinics using a model called direct primary care. This format is financed by direct payment and usually involves patients paying a monthly fee that covers services rather than billing to insurance.

"Even though there may be more people with insurance, many of those people have plans with very high deductibles. Direct Primary Care can help those people with routine visits" said Dr. John Furlow of Direct Primary Care in Fayetteville.

The U.S. Census Bureau's American Community Survey shows about 465,000 Arkansans lacked health insurance in 2013. This year, 44,160 people bought insurance through the state's marketplace created by the Affordable Care Act. An additional 204,811 signed up for coverage under the expanded Medicaid program, according to the Arkansas Insurance Department.

Enroll America reports the uninsured rates were cut in half in the two-county area between 2013 and 2014, dropping from 16 percent to 8 percent in Benton County and 20 percent to 10 percent in Washington County.

Model Of Care

Dr. Joel Fankhauser said the stresses of working in a system reliant on insurance payments prompted him to open a direct primary care clinic with Dr. Dan Weeden. The clinic opens in January in Rogers. Both doctors work at Mercy Northwest Arkansas where they will stay until year's end.

He said a traditional clinic charges a patient or his insurance company for services provided at each visit. This means only one medical condition will be addressed at an appointment. Providers also need to see as many patients as possible to earn enough money to cover expenses, he said.

Patients pay a flat monthly fee and see a physician when necessary under the direct primary care model. Fankhauser said the model also allows for more patient interaction such as email and phone calls that traditional practices don't provide because they cannot be billed to insurance.

"The monthly fee is paying for access to us in a way that is more comprehensive than the traditional model works," he said. "This model of care allows us to be more accessible and address more problems before they become big problems that end up in the hospital or emergency room."

The monthly fee varies by patient age and from provider-to-provider, but averages between $60-$100 a month in Northwest Arkansas.

Most direct primary care clinics don't have labs or X-rays in-house.

Long Wait, Short Visit

Although patients don't use insurance to pay for this health care model, Fankhauser said he expects most of his patients will have coverage. He compared health insurance to auto insurance, saying car insurance doesn't cover routine care such as oil changes and new tires, but accidents. He said people shouldn't rely on health insurance for routine care either.

He said the current health care model creates long waits and short visits for patients.

"Sooner or later, patients will find themselves as a patient who gets rushed through because the doctor is pressed for time," he said. "People get used to how it works and don't realize what a bad deal it is for them."

The Heritage Foundation, a conservative public policy research and educational institution, reports there are about 4,400 direct primary care physicians nationwide, up from 756 in 2010 and 146 in 2005.

Furlow began his Direct Primary Care clinic a little over a year ago and has about 650 patients. He said about 45 percent use the monthly payment services, and the remainder pay for individual services. Since he doesn't bill insurance, he's able to offer lower cash prices outlined on his website.

He said most of his patients have insurance, but many have such a high deductible it's hard for them to use. All the record keeping and coding required for insurance prompted him to start his clinic.

"The traditional model is a frustrating model," he said. "With direct primary care, you don't have to file and don't have to do nearly as much documentation."

He said he now has more time to spend with patients, giving him time to address more than just one issue. Patients can also call him and discuss if they need to come in for an office visit, or, if it's a reoccurring problem, he can call in a prescription.

"It gives you time to stop and look at the big picture and explain options," he said.

Convenience Counts

Annie Jamieson, communications manager for MedExpress, said the company's convenient care clinics fill the void for people who get sick after hours or can't get in to see their primary care physicians.

MedExpress is headquartered in Morgantown, W.V., and has 140 centers in 11 states. It's an independent company of neighborhood medical centers and doesn't offer franchises.

The company opened centers in Fayetteville, Springdale and Bentonville in the past five months. The Rogers Planning Commission approved plans Tuesday for a center in Rogers.

"We look neighborhood to neighborhood to find places we feel would benefit and welcome us," Jamieson said.

Clinics are open from 8 a.m. to 8 p.m. seven days a week, only closing on Thanksgiving and Christmas.

The Urgent Care Association of America reports there are about 9,000 urgent care centers in the United States.

Samantha Frost, the association's spokeswoman, said urgent care use is growing because it helps meet the daily health care needs of patients, serving as a link between the emergency room and the primary care physician.

She said patients want treatment during the evenings and weekends.

Dr. Rob Karas, owner of Karas Urgent Care in Fayetteville and Lowell, has worked under this model since 2008. He spent more than five years working in an emergency room setting before starting his own clinic. He splits his time between the two sites and employs a physician assistant and advanced nurse practitioner.

"I knew there was a need. Working in the emergency room, I saw they were so overrun," he said.

Between 20 and 30 patients visit each of his clinics every day, and Karas said he sees himself as a hybrid between a walk-in and primary care clinic.

Lakita Houston of Fayetteville was at the Fayetteville clinic Wednesday with a pulled muscle in her back. She uses Karas as her primary care provider.

"He sees me for everything," she said.

Karas was a cash-only business until January when he started accepting insurance because so many people had new coverage, he said. He still offers a lower price for cash paying customers, and he has his prices outlined on his website.

Medical Associates of Northwest Arkansas recently added a walk-in clinic at its Northwest Arkansas Pediatric Clinic that's open from 8 a.m. to 7:30 p.m. weekdays and from 9 to 11 a.m. Saturday, said Jason Wilson, MANA chief executive officer.

MANA is a physician-owned network of 71 physicians in 16 locations across Northwest Arkansas. It has three family practice walk-in clinics in Fayetteville in addition to the pediatric walk-in clinic.

"We expanded hours and added walk-in clinics to meet patient demand and see other medical groups doing the same," Wilson said.

Michael Cash, Washington Regional director of clinic operations, said the Fayetteville-based system added an urgent care clinic in Fayetteville that is open from 10 a.m. to 10 p.m. Monday through Saturday and from noon to 8 p.m. Sunday.

Washington Regional added four clinics and a mobile dental clinic in the past 12 months and plans to open Advantage Primary Care in Lowell in January.

Location, Location

Brittany Frankhouse of Centerton was thankful Mercy's new multispecialty clinic was open Thursday. Her 3-year-old daughter, Lydia, had a bad cough for a few days, and she wanted it checked.

"It takes about two minutes for me to get to the clinic," she said. "It's very convenient."

Lydia was fine, but Frankhouse said she needs to keep an eye on her cough and can take her back to the doctor again if needed.

"Good and easier access is really better health care and lower-cost health care," Goss said.

Goss said market research shows people don't want to drive more than 14 minutes to reach their health care facility, and the new clinics are in sites closer to the patients.

Mercy's relocated centers include the one in Centerton and one in downtown Rogers. Mercy also entered Washington County after purchasing Dr. Lawrence J. Schemel's Northwest Arkansas Clinic for Families at his office at 1110 W. Robinson Ave., in Springdale.

"Washington County is where we felt we needed to expand," Goss said. Acquiring an established practice allows Mercy to hit the ground running in Washington County, he added.

Location also prompted Mercy to add an emergency room to its Bella Vista Clinic. The emergency room sees up to 25 patients a day with one or two requiring hospital admissions, Goss said.

Mercy also unveiled a mobile health unit earlier this year. The 40-foot-long motor coach is equipped to provide mammography and cardiovascular screenings as well as blood draws, education and charity care. It travels to rural communities, corporate offices and schools.

"We are creating access," he said. "We are getting out of a couple of the buildings we were in and getting into more efficient places. It's allowing the patient and the physician to have a better experience."

Northwest Health Systems is adding providers to clinics after undergoing massive expansion last year. The system opened 12 clinics in 2013.

Sharif Omar, Northwest chief executive officer, said he would like to see one more clinic open in each county, but the focus has shifted to access, including expanded hours and location.

"We will set up in key geographic areas. It's about taking those larger clinics, adding providers and being open seven days a week with longer hours," he said. "It's all about access and giving the patients what they want and need."