By Taylor Knopf
Historically, the residents of rural Robeson County have relied heavily on the Southeastern Health Emergency Department for much of their medical care, even for non-emergent issues such as sore throats and sprains.
The hospital, located in the county seat of Lumberton, has about 90,000 ED visits per year, according to Southeastern Health CEO Joann Anderson.
“If you ask a lot of people in Robeson County who their primary care provider is, they are going to give you an emergency department physician name,” Anderson told the legislative Committee on Access to Healthcare in Rural North Carolina earlier this year when lawmakers traveled to Columbus County to meet with hospital CEOs and rural health providers.
ED overuse is not just a problem in Robeson County. The hospital CEOs from Columbus and Scotland Counties also told state lawmakers about similar issues in their communities. All these health care CEOs want patients to instead use urgent care clinics for non-emergency conditions such as the flu, a urinary tract infection or minor cuts.
“There’s really no reason for them to be there,” Anderson said. “So how do we make that happen?”
The answer has come with making urgent care clinics easier to get to than the hospital. In Lumberton, that means there’s an urgent care right inside the entrance of the local Walmart.
Overused
All the CEOs said there’s several reasons why it’s hard to break the habit of turning to the emergency room for everything. For starters, there are uninsured people who use emergency departments because they know they can’t be turned away. That’s because once a patient sets foot inside an emergency room, providers there are obligated by federal law and other rules to treat and stabilize them.
In Robeson County, Anderson said she doesn’t know exactly how much money her ED loses each year, but said Southeastern Health’s finances have little room for error.
“The operating margin for the last five years has been about 1.3 percent, which is low,” she said. “Last year we actually lost money.”
Southeastern Health looks to its walk-in urgent care clinics – including the Walmart location – to take the pressure of the ED. Anderson said the Walmart site is “unique” and is one of Southeastern Health’s busiest.
Prices are posted on the wall, so patients know exactly how much they are going to spend. And since it’s located inside a major shopping destination, many customers see it. Plus, Walmart’s pharmacy is located nearby, so patients can get their prescriptions filled immediately.
Inside Walmart
Will Von Taborsky works at the Walmart vision center just next to Southeastern Health’s urgent care clinic. He finds the clinic to be very helpful for his family and his boy scout troop.
“We’ve used it as a family for personal things like colds and flus and shots and that type of thing,” he said. “But the other thing I find it very convenient for, hanging out with young people in the community, is sports physicals or summer camp physicals.”
He’s the scout master and will tell parents the walk-in clinic is a “quick, easy and inexpensive” place to get that last-minute physical. Those are only $25.
If you don’t have health insurance, a sick visit at the Walmart clinic is $65.
Brooke Grooms is a nurse practitioner there. She said compared to other urgent cares, the Walmart location is a “fast-paced, ‘street and treat’ kind of clinic.”
It only has one exam room.
“They are in and out within 15 minutes,” she said. “We don’t see complex issues here, just sinus infections, colds, flu… There are times where I’ll do more complex things like suturing, abscess drainage, but that’s only if I don’t have a line.”
She sends those needing more advanced care to the Southeastern Health’s “mall clinic,” which has four patient exam rooms, more staff, and the ability to set fractures and perform X-rays.
“If we see it’s something where there’s chest pain, shortness of breath, and high blood pressure, they go straight to the ER,” Grooms said. “If they look bad enough, we can call the ambulance.”
She said she’ll see some of the same patients over and over.
“Some are regular Walmart shoppers,” she said. “We are the only Walmart with a clinic. People walk by and see us.”
Grooms emphasized that she is not a primary care provider, even though many patients try to treat her as such. She can give prescriptions refills on a limited basis, because she said it can be difficult to get in to see a primary care provider.
Her mother was a primary care doctor in Robeson County for 27 years, and Grooms said her mom frequently saw her patients the same day they called. But that’s not the case anymore.
Grooms said she believed the urgent care clinics take the load off primary care offices more than the Emergency Department.
“I use to be an ER nurse. It was bad. We had 13-15 hour waits, and a lot of this county is unemployed,” she said. “With unemployment comes no insurance. The only place in town that will see you regardless of anything is the ER.”
Across from the hospital
Another way Southeastern has sought to divert patients on their way to the emergency room is by placing another urgent care clinic right across the street from Southeastern Health’s hospital emergency department.
Barry Graham is a physician assistant there in the “health mall.” He said it’s difficult to say how many patients come to the urgent care instead of the ED. Some people definitely walk into his clinic who should be getting emergency care.
The health mall is in a strip mall next to a JC Penny and has a variety of providers and services. Within the health mall, there is an express lab, an urgent care, a pharmacy, a surgical center, weight loss center, and a diabetes community center.
The health mall urgent care clinic is open Monday through Friday from 8 a.m. to 5 p.m., as well as some weekend hours and Graham said the clinic is in the process of expanding to evening hours. He sees about 30 patients a day, which is more than most primary care providers will see in the same time period.
But Graham agreed with Grooms, saying his clinic likely takes more pressure off of primary care physicians with busy offices than the ED.
“I mean, they try to see walk-ins but, but you know, especially as it gets later on in the day, it’s hard to have a walk-in,” he said. “They feel comfortable having folks come see us.”
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