Episode 148
Urgent Care as Primary Care with Dr. Juliet Breeze of Next Level Medical
There are a lot of urgent care clinics all over the country. But few of them, to my knowledge, also operate as regular primary care clinics. But that is exactly what is happening today in the Houston, Texas area with the emergence of Next Level Medical. If you think about it, it makes perfect sense to leverage all the facilities needed for a primary care clinic - exam rooms, physicians, etc. and use it to deliver regular and sometimes non-urgent care. We've discussed free standing ERs before that lower the cost of care with transparency so this seems like the next logical step with urgent care. We have also discussed pediatric urgent care clinics but those never had the component of doubling as primary care.
What is Urgent Care?
Probably the most puzzling questions you can ask even someone who works in health care is: What is the difference between urgent care and emergency care? The answer is that it depends which is why you really need a better triage system that people (patients) can access before then head across town to either the ER or UC clinic. It's this triage that is probably the most important way to keep ER visit costs low and less frequent. This is one of the services offered by Next Level Medical to their members.
Why Urgent Care Membership?
At first, it seems strange that one would establish any sort of membership status with an urgent care clinic. But Next Level has made it work by basically selling it as a one stop primary care clinic. Or a primary care clinic on steroids that comes equipped with supplies for taking care of fractures, lacerations, laboratory studies, and imaging. And if you have the same staff working a regular schedule you can get physician continuity for patients making well care a very achievable goal.
Employers like the flexibility as it provides the primary care for their employees with convenience since there are clinics all over town. Additionally, the clinics can care for their employees who might get injured either at home or work. This added benefit means a whole lot less in expensive ER care and probably healthier employees since their primary care is taken care of without all the copays and hidden costs that keep lots of hourly employees from staying on top of their chronic conditions.
Doctors Like the Schedule
Doctors looking to become employed usually have to make a lot of concessions. First in their autonomy and second in the lack of control over their schedule. The amount of work they take home or 'unpaid' time can be large at times making a forty hour a week job quickly turn into 50 or 60. This is where Next Level can offer doctors the opportunity to truly do shift work, have a regular patient panel, but not take home their work and let the sophisticated call center triage their patients overnight.
show notes
Episode 146: Today's show
Next Level Medical: Dr. Breeze's urgent care clinic company.
jbreeze@nlucc.com - Dr. Breeze's email if you want to contact her.
Next Level UC on Twitter: @Nextleveluc
LinkedIn: Dr. Breeze's profile
Episode 035: Free standing and fully transparent ERs is Oklahoma
Episode 069: Pediatric urgent care clinics to eliminate a lot of the burden from the ERs.
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I enjoyed your guest. I always told my students when I was practicing not to base their practice decisions on the present situation. Who would have ever thought when I graduated med school in 1964 that medical practice would deteriorate into today’s morass. Hearing young people such as her make me almost certain that the pendulum is going to swing and that the present system will be the victim of its own inconsistency.
It does disturb me however that she has bought into the fallacy of condemning fee for service as responsible for medical economic ills. This is the method by which we pay for almost everything else and for good reason. It’s the most efficient way for the economy to function for all involved. I would include her program as a good example of fee for service in that she is providing an effective and economical form of medical care for the employees of her customers, primarily self-insured companies, who can go elsewhere if they are not satisfied. The problem with fee for service medical care is pretty clearly that the recipient of the service is paying the fee only indirectly.