A Prescription for Progress? Doctors Express Bills Itself as an Rx for Emergency Room Waits, Expenses

When the financial services giant UBS decided a year or so ago to downsize its branch managers from full-time to part-time employees, Rick Crews, who directed the Springfield office for several years, concluded that it was time for a career change.

And with a desire to satisfy a strong entrepreneurial urge, he started exploring a number of franchising options. He said a consultant who specializes in matching individuals with franchise opportunities presented him with several possible opportunities, from what he called the “ink-cartridge thing” to “a spa concept … Planet something.” He even considered opening a sports bar in Hartford.

He kept looking at, and eventually ruling out, possibilities until he came across one he said made too much sense to pass on — Doctors Express, the national urgent-care franchise, touted as a sound alternative to crowded emergency rooms, that is quickly expanding its reach.

Crews started discussing the concept with friend and fellow Longmeadow resident James Brennan, owner of Brennan Associates, LLC, an investment-management company specializing in small-business investment, mezzanine financing, and commercial real estate. After considerable research that convinced them that both the concept and business model were sound, the two decided to partner in the project and are now what are known as master franchisees for Northern New England — Massachusetts, New Hampshire, Maine, and Vermont.

They have ambitious plans to open five to 10 Doctors Express franchises over the next five years, and will start with a location in the Stop & Shop Plaza at the corner of Allen & Cooley streets in Springfield. Now taking shape, and slated to open later this month, is a facility that will feature four examination rooms, an X-ray room, a triage area, a lab, and a reception area. Dr. James Laurenzano, a board-certified emergency room physician formerly with Mercy Medical Center, has been hired to be medical director and lead physician. He will direct a team of three doctors.

The partners say the 2,000-square-foot office can easily handle 40 to 80 patients a day, and they are quite confident that they will be at the lower number soon after opening. Still, they understand that this is a new concept for Massachusetts and the Greater Springfield area, and know that they will have to educate the public and business community, as well as primary-care physicians (PCPs) about how Doctors Express operates and why it is a viable alternative to the emergency room.

That work, they say, is already underway. Indeed, both partners have met with area physicians and business-group leaders to introduce their concept, and advertisements featuring the headline ‘You Live. We Fix,’ and bullet points such as ‘experienced physicians,’ ‘physicals and workers’ comp,’ ‘walk-ins welcome,’ and ‘most insurances accepted,’ have started appearing in area media outlets.

Meanwhile, there has been considerable press coverage already for a business that hasn’t yet opened its doors, and more is expected, including a piece in the Boston Globe.

Brennan told The Healthcare News that he does not view Doctors Express as competition for area emergency rooms and PCPs. Rather, it is filling a void in the region’s roster of care options. It is intended to be a destination for those who clog ERs unnecessarily with non-life-threatening cases, he explained, and also for those who can’t seek help from their PCP because their needs come on weekends, after hours, on holidays, or at other times when the doctor’s office is closed.

“I was just talking to two primary-care physicians the other day, and the first thing out of their mouths was, ‘uh-oh, here comes more competition,’” said Brennan. “I said, ‘no, we’re not competition, we’re actually an alternative, and we’re here to help your patients.’ Explaining how, I said, ‘your office is closed at night and on weekends — your patients need someplace to go.’”

For this issue, The Healthcare News takes an indepth look at how Doctors Express will become that ‘someplace,’ and why Crews and Brennan are brimming with confidence as they bring this concept to the local market.

Catching On Fast

After talking at length about the Doctors Express model and how it is expected to work, Crews drew from a recent personal experience to show how he believes it will effectively save time and money for individuals and insurance companies.

“This past May, I had to go to the ER,” he explained. “I was sick as a dog; I had a high temperature, I was really under the weather. My wife and daughter said, ‘dad, you’ve got to go; we’ve never seen you this sick before.’

“I went to the ER and was there for six hours, and seen by 10 different people,” he continued. “I had two chest X-rays, an ECG; they said I had a slight case of pneumonia, and gave me a prescription for an antibiotic. My total bill was $1,850. Had I made a visit to a Doctors Express instead, I would have been in and out of there in an hour, seen three people, and paid $311. My co-pay to go to the emergency room was $150, while my co-pay to go to Doctors Express would have been $35.”

Scenarios, and numbers, like these are what eventually sold Crews and Brennan on Doctors Express and propelled them to seek the Northern New England territory. Before buying in, though, they said they did the due diligence that is, or should be, part of such an entrepreneurial gambit.

“My strength is in sales and marketing, and I’ve always had an entrepreneurial spirit, so I wanted a business I could own and manage myself,” Crews told The Healthcare News. “I looked at nine different franchises, narrowed it down to three, and kept coming back to Doctors Express, because I tried to look at each business from every angle I could to determine what the risks and the upside were, and this one had the most potential.

“We both agreed that there was a huge need for urgent care in the area,” he continued. “But we wanted to make sure we were getting into the right company with the right business model. So we really started digging into the business model of Doctors Express.”

What they found while doing such digging was that urgent care is much more prevalent in other parts of the country than it is in New England, and that Doctors Express, started in 2005 in Baltimore by en emergency-room physician seeking a more efficient, affordable system for urgent care, was enjoying success in the markets it had penetrated. These include the Southwest and many mid-Atlantic states.

The preliminary research by Crews and Brennan led to the next obvious questions: why isn’t urgent care more prevalent here? And could it catch on?

To the first question, there is plenty of speculation. “In the early ’90s, HMOs were big, and there were urgent cares tied into the HMOs back then,” said Crews. “Eventually, the HMO thing blew up here in New England, and many of those urgent-care facilities simply ceased to exist. So while urgent care has come into the marketplace throughout the country, New England has been been slow to adapt to that. There are pockets of it, but not much.”

As to the second question, both partners agreed that it can work here, but only if done right, as history has shown.

Challenges include credentialing (a lengthy, paperwork-intensive process), hiring the right people, choosing the right locations, and effectively educating the public and other constituencies. Failure in one or more of these areas has doomed previous attempts to introduce similar types of facilities in this region, said Crews.

In the Quick

As they draw closer to the opening date for their first Doctors Express, the two partners believe they have the requisite pieces in place to script a success story.

One of the key pieces, obviously, is the operating model, said Crews, adding that Doctors Express franchises are designed to provide care for non-life-threatening illnesses and injuries in a manner that saves time and money. The first area location will be open 363 days a year (it will be closed on Christmas and Thanksgiving). Hours will be 8 a.m. to 8 p.m. Monday through Friday and 8 a.m. to 5 p.m. on weekends. The average wait time will be 15 to 20 minutes, say the partners, as opposed to several hours in most area ERs.

The three doctors on duty will be able to treat most common illnesses and injuries, from colds and flu to fractures and sprains, said Crews. “In addition, we’ll be a dependable, accessible source for employment and sports physicals, drug screenings, occupational medicine, and travel immunizations.”

Visits to Doctors Express will be put into the category of ‘specialist care’ for insurance purposes, he continued, adding that this means co-pays that, in most circumstances, will be perhaps half what would be charged for a trip to the emergency room.

Part of the business model, said Brennan, is effective follow-up with primary-care physicians, something he believes will enable Doctors Express to achieve some form of buy-in from that important constituency.

“We have terrific followup procedures,” he noted, “so not only are we going to take care of these patients, we’re going to follow up with their primary-care physicians to let them know their patient was here, what was done, how the patient was serviced. There will be effective communication, which should work very well for everyone involved.”

Beyond the working model, location is also a key consideration, said Brennan, adding that the site at Allen and Cooley was chosen after careful consideration of geography and demographics. “We did a demographic study and came back with a number of sites, with the strongest report back being for the site we’re building now, in terms of population, economics, traffic flow day and night, and other factors. We expect to draw from Springfield, East Longmeadow, Hampden, Wilbraham, and Longmeadow as well.”

The chosen location easily meets the corporation’s target goals for a model franchise — 50,000 people within three miles on the site, and an average household income of at least $50,000, Crews told The Healthcare News, adding that these numbers will drive future decisions as well.

Another important piece is staffing, said Crews, noting that Laurenzano has 25 years of experience in emergency medicine and is a perfect fit for the first Doctors Express.

Still another piece of the success quotient is effective marketing and awareness-building, said the two partners, noting that they began the work of introducing the concept — and the name Doctors Express — months ago.

Using a number of media, they have been working to get the word out and build visibility in the community, which should enable the facility to get off to a solid start.

“We’ve started our sales and marketing and public-relations work long before the scheduled opening to help us get a better start,” said Crews, adding that this aggressiveness is one of many things he and Brennan have seen work well for Doctors Express franchises that have opened in other markets over the past several years.

Looking ahead, but not too far, the two partners are already considering sites for a second location in Western Mass., with most of the attention focused on West Springfield, with expectations to open late next spring. From there, while expanding in the 413 area code, Crews and Brennan will also look to penetrate the Boston market.

A location will open in Natick late this fall, they said, noting that it will be operated by a separate franchisee they will oversee, and a move into Boston itself will follow.

“We want to expand in this market, obviously,” said Crews, “but Boston is a much bigger market, and we see tremendous opportunities for growth there.”

The Bottom Line

When asked about his transition from employee to business owner, Crews said he’s enjoying most all aspects of his career change — including the fact that he no longers wears a suit and tie to work every day (he and Brennan both opt for golf shirts with the Doctors Express name and logo on them).

“I’m loving it; I believe I can thrive in this environment,” he said. “The change has been great; it was scary at first, but it’s better now.”

Most of the fear has been replaced by confidence that the two partners will successfully fill a recognized void in the health care sector. Time will tell if they’re right, but it appears that Doctors Express will make an impact — and quickly.

George O’Brien can be reached at obrien@businesswest.com