Doctor Franchises Urgent Care

As a young emergency room doctor in New York City’s Harlem Hospital, Scott Burger, MD, performed triage on high stress injuries — everything from gunshot wounds to tiger bites. But the stress he felt didn’t come from these medical cases: it came from long lines of non-emergency cases that clogged the ER hallways at Harlem Hospital; at Beth Israel, where he had done his residency; and elsewhere in the city.

“There were these institutional inefficiencies,” Burger recalls. “But it wasn’t limited to a single institution. This was a systematic problem. And I had this idea of taking urgent care outside the emergency room.”

First, Burger needed to finish his residency. But six years later, in February 2006, he and his partners opened the first Doctors Express Urgent Care Center in a strip mall outside Baltimore, Md. Today, more than 120 Doctors Express franchises have been awarded in 23 states, making it the first ever nationally franchised urgent care.

Seeing the shortcomings

Burger recalls the small urgent care center that was tucked away in the rear of the emergency room at Beth Israel. The ER patients who were shuttled to the urgent care center had problems that often fell outside the scope of services provided by a primary care physician, such as a broken ankle or a laceration that needed stitches. But waiting to schedule appointments with the proper provider wasn’t practical.

“And regardless of how long you were waiting in the ER for your ankle X-ray, if someone came in acutely short of breath and needed a chest x-ray, they went to the front of the line, and rightfully so,” Burger says. “But with all these institutional inefficiencies, I just thought the process was broken.”

Burger finished his residency, and in mid-2005, when his wife, Kathleen, who is also a physician, completed a fellowship, they moved from Manhattan to Maryland. Less than a year later, together with partners Tony Bonacuse — a former college roommate — and Peter Ross, they opened the first Doctors Express in Towson.

Challenges before success

Burger knows medicine, and he knew how he wanted to take care of patients. But the operations — figuring out how to establish contractual relationships with the insurance carriers, how to bill for the services appropriately, how to collect for the services appropriately — was the greatest challenge. The credit for making that work, Burger says, goes to partners Bonacuse and Ross.

“They’re brilliant business guys,” he says. “Tony had been an entrepreneur since birth, we like to say, and Peter came from corporate America, but they had formed a professional relationship many years ago.

The Bonacuse and Ross had actually franchised another company before Doctors Express, and they were able to use that prior experience to open Doctors Express.

Together they set out to codify every single system in the center. They developed extensive operational manuals and training modules, a lot of it in the pre-opening phase, so that when the franchised centers are ready to open, they hit the ground running. Staff has already been out marketing to the community and letting people know they’re there. They have their insurance contracts in place. They have the billing company already set up. They understand the process for claims submission.

“We now have an electronic health record that does all the coding for us automatically just based on what we’re documenting,” Burger says. “We’re very structured in our format, so that people are able to open up and execute on the model from day one. They’re not learning on the fly as we did in 2005 and 2006.”

Rewarding experience

Burger recalls his initial expectations with Doctors Express were to open perhaps five to 10 centers and provide high-quality urgent care in the Maryland, Pennsylvania, and Virginia areas. He never imagined having centers open from coast to coast, but doing so has been incredibly gratifying.

“My center saw about 2,000 patients during that first year of operation,” Burger says. “And this year alone we’ve seen in excess of 200,000. We’re not saving lives in the emergency room, but I’m sure there are some lives that we’ve saved, and many other lives that we’ve been able to impact in a positive way. That’s very rewarding to me.”

And then there were the inefficiencies. The same technician would do the chest X-ray for a patient having a heart attack and an X-ray on someone’s ankle.