Filling The Void from page B5
"The cost difference between urgent
care and the ER is significant;' Horwitz
says.
That's because insurance companies
generally reimburse at the rate they would
individual physicians.
"Insurance [companies] should be edu-
cating their patient base Horwitz says.
Urgent care practices may be staffed by
primary care doctors taking their turn at
an after-hours center, by hospitals provid-
ing after-hours care at a satellite center,
or by ER-trained medical professionals
at facilities that are open evenings and
weekends, and sometimes during the day
as well.
More family practice physicians are
involved in urgent care centers, Horwitz
says. But, "We are seeing an increase in
ER physicians choosing this as a second
career!'
Local Ties
Two local urgent care facilities — Lakes
Urgent Care in West Bloomfield and
Meadowbrook Urgent Care in Novi
— have chosen to build their care around
ER specialists.
On a recent Sunday morning, a steady
stream of patients checks in at Lakes
Urgent Care, 2300 Haggerty Road, founded
four years ago by Dr. Sanford Vieder, D.O.,
a West Bloomfield resident.
Vieder's day job is as chairman and
medical director of the Emergency Center
at Botsford Hospital in Farmington Hills.
He is married to Carol, an interior design-
er, and has three boys, Brandon, 17, Alex,
14, and Nicky, 9.
"We've been a part of the Jewish com-
munity forever;' he says.
His father, Larry, is cantor emeritus at
Adat Shalom Synagogue in Farmington
Hills.
"I need to see a doctor:' a repeat cus-
tomer tells Lakes Urgent Care receptionist
Maria Holtzer. The Walled Lake man has
come in with a bad cough, worried that
he might develop a strep infection like his
child at home. "You guys are pretty fast:'
he says, as he's beckoned into one of the
nine examination rooms.
Another patient from Wixom, holding
hands with his wife, says he slipped and
fell on a previously injured leg. He was
treated at Lakes Urgent Care once before,
B6
April 24 • 2008
iN
Dr. Sanford Vieder: "We made a conscious decision not to be open in the day time and not to compete with primary physicians."
for bronchitis. "I was in and out very fast!'
Neal Barnett of Bloomfield Township
has come in for a sinus infection. "My
primary care physician is in this office and
I would have had to wait until tomorrow:'
he says.
The Difference
Although the vast majority of urgent care
patients seek treatment for fevers, aches
and falls, Vieder says, two emergency
room-trained physicians and equipment
and medications to stabilize emergencies
are always present.
He makes a distinction between true
urgent care and after-hours centers. "Can
they take care of fractures, lacerations,
chest pain? We can initially stabilize them.
We come pretty close to having everything
but hospital beds.
"The ER physicians aren't afraid of
what's coming through the door. They see
it every day," Vieder says. At the same time,
"You've also got to recognize your limita-
tions. We've transferred maybe a dozen
patients to a hospital."
Lakes Urgent Care is open 5-10 p.m.
weekdays and 10 a.m. to 6 p.m. Saturday,
Sunday and holidays. "We made a con-
scious decision not to be open in the day
time and not to compete with primary
physicians," Vieder says.
A Step Beyond
Meadowbrook Urgent Care in Novi,
soon to be joined by a sister facility in
Birmingham, opened its doors several
months ago from 8 a.m. to 8 p.m. week-
days and 10 a.m. to 4 p.m. weekends.
After 12 years of working as a certified
hospital emergency room nurse, Yisroel
Sigler, R.N. and emergency room physi-
cian, Dr. Rona Wadle, D.O. "decided to take
a leap into the area of urgent care, but to
take it a step further," Sigler says.
The two had worked together in ERs
at Botsford and at Providence Hospital in
Southfield.
Although Sigler is careful to caution
those with life-threatening situations to
head for the ER, "What we bring to the
table is the experience of an ER doctor
and the technology to treat higher acuity
patients:' the Huntington Woods resident
says.
"People have to be educated on what
is life threatening and what is not;' says
Sigler, who was born in Israel, is married
to Danielle, an attorney, and has a daugh-
ter, Maliyah, 21/2.
"We've actually resuscitated several
people here in only the few months we've
been open and transferred them to a
higher facility:' he says.
James Noble, 50, of Livonia is one of
them. He and his wife, Cathy, bypassed
a nearby urgent care center to head for
Meadowbrook after he was two weeks
into fighting a sinus infection and having
trouble breathing.
But while he was being examined, Noble
went into cardiomyopathy and atrial fibril-
lation, precursors to a serious situation.
"Yisroel and Dr. Wadle stopped him
from having a heart attack," Cathy, a physi-
cal therapist, says. "They managed the
incident from start to finish!'
Novi EMS took him to Botsford ER,
where the ambulance carrying Noble was
met by an ER intern and he was taken
care of immediately. "We have experienced
other urgent cares:' Cathy says. "Clearly,
there is a difference in the quality of care.
"As everyone at Botsford told us, if they
hadn't given him the proper medication
and oxygen and called ahead, he wouldn't
be here right now."
Still, not everyone agrees that urgent
care demands ER-trained staff. "I don't
think you have to have ER physicians to
provide urgent care," the medical society's
Frank says.
Both Vieder and Sigler would like to see
urgent care centers licensed by the state.
Arizona is the only state that does so now
"I would be surprised if in the coming
years, more [state]) regulation isn't intro-
duced," says the Urgent Care Association's
Horwitz. Her association currently gives
an Accreditation Award of Distinction to
centers that meet its standards. ❑