The new clinic will be located in the Providence Mill Creek Medical Building - 12800 Bothell Everett Hwy, Ste. 150, Everett, WA 98208.

The clinic will provide treatment for children, teens and young adults ages 0-21 needing non-emergency medical care in the evenings, over the weekends and during the holidays.

No appointments or referrals are necessary.

Providence Mill Creek Medical Building - 12800 Bothell Everett Hwy, Everett.

In general, the cost — and time waiting — are less at urgent care clinics than they are at emergency rooms.

Hours of operation for Urgent Care at Seattle Children’s Mill Creek Clinic will be the same as Children’s Urgent Care Clinics in Bellevue and Seattle:

• Monday through Friday from 5 p.m. to 10:30 p.m. and

• Saturday, Sunday and holidays from 11 a.m. to 8 p.m.

Children’s Urgent Care Clinics are not intended for serious or life-threatening emergencies, hospital officials cautioned, and if a child being seen at a Children’s Urgent Care Clinic has an emergent medical need, the patient will be transferred to an Emergency Room (ER).

To help parents decide whether to take a child to the ER or to urgent care, Seattle Children’s has prepared a quick guide:

The number deaths due to suicide, accidents and opioid overdoses also fell, the report says

Overall, 12,959 people died in the county last year.

Of those, 2,060 fell under the Medical Examiners jurisdiction, including suspicious, sudden, unexpected or violent deaths.

 Other findings in the report:

• Traffic fatalities declined by nearly one-third over the past ten years, falling steadily from 220 in 2001 to 150 last year.

• While accidental drug overdoses declined from 2009 to 2010, they still comprised more than a third of all accidental deaths.

• Firearms were the most frequent instrument of death in homicides and suicides.

Opioid deaths down

There was a substantial decrease in the number of methadone and oxycodone deaths from 2009 to 2010.

• Methadone was present in 77 deaths in 2010, compared to 129 in 2009, and was the primary cause of death in 67 of those deaths in 2010, compared to 85 in 2009.

• Oxycodone was present in 77 deaths in 2010 compared to 105 deaths in 2009.

To learn more:

• For a copy of the full King County Medical Examiner’s 2010 annual report, please call 206-731-3232 or visit www.kingcounty.gov/health/examiner
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This story was produced in collaboration with 

CAPITOL HEIGHTS, Md. — After Dwayne Duckenfield banged his right elbow working around the house on a recent Saturday, he grew worried when the swelling didn’t go down and the pain worsened.

Concerned he may have broken a bone, the project manager who lives in Washington, D.C., didn’t go to the nearest emergency room or wait until Monday to call his physician for an appointment. Like an increasing number of Americans looking for fast and affordable health care, he went to an urgent care facility.

Duckenfield, 41, visited Concentra Urgent Care just inside the Washington Beltway, a center that’s part of the nation’s largest urgent care chain. Within 75 minutes, he was examined by a physician’s assistant, had an X-ray that came back negative, and was prescribed a pain medication.

“This was so convenient and now I have peace of mind,” he said, after paying his $25 insurance co-pay.

Across the country, an estimated 3 million patients visit these centers each week, according to the Urgent Care Association of America, a trade group based in Chicago. To meet increased demand, the number of facilities has steadily increased from 8,000 in 2008 to more than 9,200 this year, the association said. About 600 new urgent centers opened this year.

Fueling that rise are two longstanding trends — crowded emergency rooms and a lack of primary care doctors. Urgent care operators also say another factor is helping to propel business: the drive to lower costs.

Urgent care centers’ fees are at least half those charged at a hospital emergency department for the same condition, although they are similar to what physicians charge for office visits.

Still the savings in ER costs are a big draw for patients without insurance, as well as insured patients facing higher out-of- pocket costs because of rising deductibles.

Those lower fees have also drawn the attention of hospitals and insurers — both of which increasingly see the facilities as a way to hold down costs and boost their bottom lines.

Difficulty Finding A Primary Care Doctor

Tom Charland, the CEO of Merchant Medicine, a Minnesota consulting firm specializing in walk-in clinics, said the urgent care centers are poised to attract more patients in 2014 when the federal health law begins to expand health coverage to 32 million Americans. Finding a primary care doctor could become more difficult then, he said.

But some doctors’ groups worry that increased reliance on urgent care may hurt efforts to better coordinate care and get patients into so–called “medical homes” where they have a regular physician, strategies promoted by the health law to improve quality and lower costs.

Urgent care is not as good as having a regular physician, says Dr. Glen Stream, president of the American Academy of Family Physicians. He is concerned the surge in urgent care use could lead to fewer patients having an individual physician monitoring their care.

“No one really gets to know them, if they use a different urgent care each time,” he said. “One of the best predictors of health outcomes is having a usual source of care where you can go for acute and chronic illnesses and develop a relationship with a doctor.”

Urgent care centers typically treat a wide range of injuries and illnesses — including coughs and colds, broken bones, cuts and back pain— and do blood and urine tests, X-rays and even drug testing.  They see patients without an appointment and often are open evenings and weekends.

Unlike small retail health clinics that have opened in the past decade in department stores and pharmacies and mainly employ nurse practitioners, urgent care centers usually have physicians on site.

About half of the facilities are owned by doctors, according to the urgent care association and 28 percent are hospital-owned, the American Hospital Association reports.

Humana last year became the first major insurer to get into the urgent care business when it bought Concentra, which has more than 300 centers in 40 states.

“We want to make sure we have access to providers in key areas,” said Paul Kusserow, Humana’s chief strategy and corporate development officer.

As Humana and other insurers shift to using smaller networks of doctors and hospitals to hold down premiums, urgent care will be a vital outlet when doctors’ offices are too busy, he said. Humana and other insurers have expanded the number of urgent care centers in their provider networks to reduce unnecessary ER use.

Hospitals See Role

Hospitals also are adding urgent care centers to increase admissions, and in the future they see it as a way to keep their costs down in treating patients.

“A lot of people don’t have regular doctors and so this is a way of getting them into our system,” said John Anderson, chief medical officer at Duke Primary Care in North Carolina.

Duke University Health System has five urgent care centers — including two added in the past two years — that complement its 27 primary care physician offices. “We want to be a medical home for people, and urgent care helps fill out the niche,” he said.

In addition, hospitals such as the John Muir Health System in Contra Costa, Calif., see urgent care as way to control spending, which will become important as they take steps to form an accountable care organization, a health care financing arrangement where hospitals will have an incentive to hold down costs.

While hospitals today financially benefit from seeing insured patients in their expensive ERs, under the new models of health care, they will want to see patients in the most cost-effective location, said Paul Swenson, CEO of John Muir’s physician network, “We know where the world is going.”

But while John Muir is considering adding to its compliment of four urgent care facilities, it’s been cautious for fear of upsetting its 800 affiliated physicians.

“There is a lot of concern that we will take patients away from them,” Swenson said. The hospital has tried to reassure its doctors, saying urgent care centers can fill in when their offices are too busy and be a referral source for new patients.

The growth of urgent care also is changing the way doctors operate, said Stream, a family doctor in Spokane, Wash. More doctors are adding evening and weekend hours and leaving more room on schedules for same-day appointments, he said. “In that sense, the urgent care movement has been a good market pressure on primary care doctors to offer more convenient care.”

Convenience was a key factor for Duckenfield when he came to Concentra, and he was not alone. The waiting room was nearly full at noon. Three people were waiting for their physical for the Maryland Transportation Department, and Prince George’s County police brought in a car accident victim to test her for drugs or alcohol. Another man was there with flu symptoms. A woman was seeking treatment for her daughter with pink eye.

The center, staffed by doctors during week, has a physician’s assistant on weekends. Hiep Truong, the physician’s assistant working that Sunday, seemed unfazed, taking a moment between patients. “You should see us during the week, when it’s really busy,” he said.

“Hospital-industry leaders say they’re doing what patients want and what makes good business sense,” Ostrom writes, but critics say the free-standing emergency rooms are “cash cows for hospitals, strategically built in affluent areas to lure busy, well-insured patients and collect fat reimbursements.

Hospitals say the new ERs will streamline care and help reduce costs, but Ostrom points to research that suggests the opposite:

Last year, the Center for Studying Health System Change, a national research group, noted concerns that increased competition around Seattle could increase overall costs. It found hospitals invading one another’s turf with free-standing ERs and vying to provide big-ticket specialty procedures in cardiac, cancer and orthopedic care.

To learn more:

• Read Ostrom’s article: ER building boom is wrong prescription, critics say.

By Julie Appleby
KHN Staff Writer

In-store medical clinics like those at Walmart – having established a beachhead with relatively healthy patients looking for convenient, low-cost care for simple problems – are eyeing a bigger prize, the millions of Americans with costly illnesses such as diabetes and heart disease.

Just as Walmart and other retailers shook up the prescription drug business by offering $4 generic drugs, the industry now aims to apply its negotiating and marketing clout to tackle problems that vex consumers and the health sector: unpredictable costs, a lack of primary care doctors and inefficient management of chronic illnesses, whose costs drive the majority of health care spending.

“It’s sad that the existing health care establishment has not figured out a way to make primary care affordable and accessible,” says Jerry Avorn, a professor of medicine at Harvard.  ”We should not be surprised if someone outside of our world comes in and does it for us.”

Last week, Walmart’s ambition to become the nation’s largest provider of primary health care services became known when a confidential document the giant retailer sent to some of its strategic partners leaked out.

The request for information sought partners who could help Walmart in a variety of areas, including monitoring patients with diabetes, asthma, high blood pressure, heart disease, obesity and other conditions.

Walmart backed away from parts of its own document, saying it did not intend to build a “nationally integrated, low cost primary care platform.” Indeed, it is hard to imagine what a national platform would look like given the wide variation of state laws governing health care delivery.

Already, CVS Caremark, the largest operator of in-store clinics with nearly 550, and Walgreens have set up programs aimed at helping diabetics monitor and control their condition, which includes counseling chats with pharmacists. Weight loss programs and counseling are on tap at some retail clinics. Truck drivers can pull their 18-wheelers into the parking lots of more than 600 such in-store centers nationwide to get their mandatory federal health exams.

“There are real savings to containing the cost of the chronically ill in this country,” says Helena Foulkes of CVS/Caremark, which offers in-person and telephone conversations with pharmacists to diabetic patients enrolled in its “Pharmacy Advisor” program. Some employers also send workers to the firm’s MinuteClinics for blood tests and other health screenings. “More and more of clients are actively looking for wellness programs and they see retail clinics as one element.”

In part, the clinics see a pure business opportunity based on consumer convenience and cost savings, which they can market to the public, employers, insurers and hospitals. Costs are roughly 30 percent to 40 percent less than similar care at a doctor’s office and 80 percent cheaper than at an emergency room, according to a study in published this year in the American Journal of Managed Care.

That’s attractive to insurers. Use of retail clinics among patients with insurance rose tenfold from 2007 to 2009, the study found, with clinic visits representing about 7 percent of all medical visits for 11 common acute conditions: “If these trends continue, health plans will see a dramatic increase in retail clinic utilization … particularly among, young, healthy and higher income patients living close to retail clinics,” the study concluded.

Still, while less expensive than going to an emergency room or doctor’s office on a per-visit basis, “if more people seek care, that could increase health care spending,” says one of the co-authors of the study, RAND researcher and medical professor Ateev Mehrotra of the University of Pittsburgh School of Medicine.

“That contrasts with most people’s experience of health care, where if you walk into a doctor’s office or an urgent care clinic, you have no idea what the charge will be,” says Mark Smith, president and CEO of the foundation.

Interest in clinics is also spurred by the federal health law, which, among other things, will create incentives for small businesses to offer wellness programs for workers.

“An employer with 50 to 250 employees can’t afford to bring in a company to do corporate wellness,” but it could partner with a retail clinic and send employees there for blood tests, nutrition counseling or diabetes management, says Stewart Levy, president of Health Promotion Solutions in Newtown, Pa., a consulting firm that is working with the retail clinic industry.

The growth of retail clinics – both in sheer numbers and the scope of services they offer – is one of several avenues being pursued to revamp primary care, which is facing a shortage of physicians. The Association of American Medical Colleges estimates a shortfall of 21,000 primary care doctors by 2015.

Done right, supporters say, expanding services through retail clinics could provide better access for many patients and lower costs, and provide an outlet for an expected jump in demand for care in 2014, when millions more Americans get insurance through the federal health law.

But obstacles remain. Will retail clinics be able to translate their success with simple acute problems to a more long-range and intensive monitoring of complex conditions? Will employers and consumers embrace the idea? Will clinics become components of new, integrated collaborations between doctors, hospitals and insurers?

“Asthma and diabetes are not something you get one time and get fixed,” says health care consultant Ian Morrison, who follows trends in the industry. “How effective will they be in managing that over the long term?”

While studies have shown that retail clinics provide similar – or even better – quality care for simple conditions such as sore throats, researchers haven’t yet looked at their ability to do more complex monitoring of patients, often called disease management.

Data is mixed on the success of such programs and some have been shown not to save money. Recently, a study of eight disease management firms that used nurse-based call centers failed to save Medicare money.

Another challenge is the wide variety of laws governing medical centers. Some states, including New York and California, prevent clinics (or hospitals) from directly employing physicians, nurse practitioners or physician assistants.

Other states cap the number of nurses each doctor can oversee. Efforts to expand nurses’ or physician assistants’ ability to practice autonomously are often fought by state medical associations.

“It’s interesting that I can go from Washington D.C., where I can be certified to take care of patients autonomously, to Georgia, where I can do very little because I have to have a supervisor who is a physician overseeing what I do,” says Ken Miller, an associate dean in the school of nursing at Catholic University and a past president of the American College of Nurse Practitioners.

While a few centers operated by retailers have doctors on site, the vast majority of staff are nurse practitioners or physician assistants. According to the Convenient Care Association, the industry’s trade group,there are more than 5,000 nurse practitioners working in the clinics, making up 95 percent of the clinicians.

If more patients with chronic illnesses can be seen in settings like retail clinics, where they can stop by on the way home from work or on the weekends, Miller and others say they may be more likely to take their medications, monitor their blood sugars and take other actions to prevent a worsening of their disease.

“If you have a stable diabetic, why should that person be going in to see a physician when a nurse practitioner can manage care of that patient?” he asks.

Primary care doctors fear retail clinics will skim off the healthiest patients, leaving them with more complex or older patients, with no corresponding increase in reimbursement from insurers or the government. They also worry that the expansion of retail clinics into caring for patients with chronic illnesses will further fragment the care such patients receive.

In a statement, the American Academy of Family Physicians says a better answer for such patients is “the development of a health care system based on strong, team-based … care.”

For their part, the clinic industry says it can be an ally for overworked doctors. In the future, clinics could use nurse practitioners and physician assistants to do triage, particularly on the least complex patients,  so doctors could “use their training and skill to focus on patients with long term needs,” says Caroline Ridgway, policy and communications director at the retail clinic industry’s trade group.

But unless payment incentives are changed to reward quality over volume – and laws changed so nurse practitioners and physician assistants can provide more direct care in all states, there will be an increasing burden on primary care doctors as more Americans become insured, she says.

“Insuring 30 million more people isn’t going to matter if they don’t have anywhere to go,” says Ridgway.

The majority of retail clinics are in the South and Midwest, according to a 2010 RAND Study. They’re more likely to be in areas with lower overall poverty and only 12.5 percent were in medically underserved areas, the RAND report said, although 21 percent of the U.S. population lives in such areas.

“The research did not support the claim by some champions.. that these clinics are improving access to care for the medically underserved: retail clinics are more likely to be located in relatively affluent sections of large urban areas,” the report concluded.

Still, about 35 percent of clinic patients are either uninsured or have high deductible insurance plans that put them on the hook for hundreds, if not thousands, in out-of-pocket costs, says Tine Hansen-Turton,  executive director of the Convenient Care Association.

“We are seeing people who are vulnerable,” she says.

For much of their brief history, retail clinics have focused their services on a narrow menu, mainly treatments for acute conditions, such as strep throat or ear infections, vaccinations, and physical exams needed for summer camp or other programs.

But retail clinics are moving beyond just a simple menu of services in part because “it wasn’t a financially sustainable model to be restricted to those things,” says Smith at the California HealthCare Foundation.

Now, the medical community is seeing what other industries have experienced: an interloper gaining a foothold in a market niche, then expanding. “Think about Toyota, they didn’t start off by competing with Cadillac and BMW. They started with cheap little cars but got better and better over time,” Smith says.

PHOTO CREDIT: Michael Lorenzo

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.