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Business Observer Friday, Jan. 14, 2011 10 years ago

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The fragmented business of urgent health care has a new player on the Gulf Coast. It's a big bet on the ability to alter patient's habits.
by: Mark Gordon Managing Editor

Rick Kimsey believes the chore and hassle of going to the doctor on the Gulf Coast is primed for a shot of Starbucks.


And Kimsey, an entrepreneur who ran the Southeast region of Sprint PCS in a past business life, plans to back up his ambitious convictions with more than $1 million. His agent of change: Doctors Express, a Maryland-based franchise operation that claims to be the first company to open urgent care facilities in a systematic and orderly manner nationwide.


Kimsey, a Sarasota resident, recently bought the Doctors Express franchise development rights for 16 counties in west and central Florida, including the Gulf Coast. The first of what Kimsey hopes will be 100 Gulf Coast Doctors Express centers opened earlier this month, a few miles from Sarasota Memorial Hospital on U.S. 41.


“We want to define urgent care with the ubiquity of Starbucks,” Kimsey says. “It's a very fragmented industry with lots and lots of individual owners and no brand recognition to tie it all over.”


Urgent care is also a rapidly growing health care subsection. Indeed, the Urgent Care Association of America reports a 7% growth in urgent care centers nationwide since 2007, to nearly 9,000 facilities.


But even that number could underestimate the popularity in the concept, some medical professionals say, because urgent care is broadly defined. “A lot of people don't know what urgent care is or what we can do,” says Peter Ross, co-founder and CEO of Doctors Express.


Essentially, urgent care is the gray area between a primary care physician and the emergency room. In general, a good place for urgent care would be when your doctor's office is closed but it's not a serious enough medical concern for the ER.


Moreover, walk-in clinics found at places like Publix or Walmart might not have the medical capabilities or be staffed with physicians like Doctors Express is, says Kimsey. And urgent care clinics run by hospitals, adds Kimsey, might not have the hours, or the high-end customer service approach, offered by Doctors Express.


“This is an industry that needs some definition and a leader who champions the cause,” says Ross, who runs the corporate side of Doctors Express from its Towson, Md. headquarters, but recently moved with his family to east Manatee County. “We want to be the industry leader.”



Early and often


Kimsey is a key part of that mission. His west-central Florida franchise territory, which covers 5.5 million people, has the potential to be one of the largest geographic regions for Doctors Express. The parent company, which launched its first Doctors Express in 2005, currently has 28 urgent care centers in 24 states.


The Sarasota Doctors Express was built straight out of the corporate playbook, which focuses on doing all the outside work so physicians and staff can concentrate on patient care. In fact, Dr. Eric Buete, the chief medical officer for Kimsey's franchise group, says the Sarasota facility came together in less than two days, when a small army of Henry Schein medical supply employees assembled it.


“There was a template for everything,” says Buete, down to which drawer held the Band-Aids, the make and fold of the gowns and the size of the Kleenex boxes. “It's a neat way to start a medical practice.”


A Sarasota native, Buete is an old hand at urgent care. He practiced urgent care medicine for 13 years at centers run by Bayfront Medical Center in St. Petersburg after he graduated from USF medical school. Like Kimsey, Buete, who is also an investor in the Gulf Coast franchise group, believes the Doctors Express model holds several competitive advantages over other urgent care facilities.


For starters, Buete says the medical gear and equipment at a Doctors Express office is top-of-the line for an urgent care facility. Says Buete: “We have a lot of stuff that's pretty normal for an ER.”


The complete blood count machine, for instance, commonly used for dozens of blood tests, is a step up from old models in terms of accuracy and efficiency, says Buete. “It's the newest model of a machine that's been around forever,” Buete says.


Several other high-end blood test and digital X-ray machines dot the office, a converted plastic surgery practice. Kimsey spent $600,000 to get the facility Doctors Express-ready, costs that included more than equipment. Other expenses went to employee training, build-out and fees for insurance companies.


Past equipment, Buete says one lesson he has repeatedly learned in urgent care is the hours — and the hours a doctor is on the premises — is an integral component to success. The hours have to be early, late and often, he says; the Sarasota Doctors Express is open seven days a week, from 8 a.m. to 8 p.m.


“Your best patient might only need you two or three times a year,” says Buete. “They need to know you are there.”


The fact that every Doctors Express has a doctor on staff anytime the doors are open, adds Kimsey, is also significant. “That's a rare and sustainable competitive advantage,” he says.


Another competitive advantage, say Buete and Kimsey, is Doctors Express offers occupational health services, so it can treat patients for workplace injuries covered by worker's compensation insurance. It's a paperwork and bureaucratic-heavy niche within a niche that not many practices will take on, says Buete, especially urgent care centers.


“It's not something you can dabble in,” says Buete. “You have to plunge right in.”



Big change


In many other ways, however, Doctors Express is similar to other general medicine practices. The practice will see patients with anything from a broken toe to a urinary tract infection. It also has a stock of antibiotics and other medicines it can distribute to patients. Doctors Express accepts insurance and Medicaid and Medicare.


Despite its wide array of services, Kimsey says he will take a do-what-you-do best approach with Doctors Express. “We aren't going to be everything to everyone,” says Kimsey. “We are just going to be urgent care.”


Kimsey and Ross, the co-founder of Doctors Express, are Corporate America kindred spirits. Both were senior-level executives for global companies until each tired of the life. They met in 2009, when a friend of Kimsey's in Sarasota told him about Doctors Express.


Ross's career included stops with Ernst & Young and Intuit, a small business consulting firm. In 2001, Ross and fellow executive Tony Bonacuse founded Senior Helpers, a franchise-based home care firm for seniors. Then, in 2005, Ross and Bonacuse partnered with Dr. Scott Burger, a New York ER physician, to launch Doctors Express.


Kimsey, meanwhile, comes to urgent care from telecommunications. His corporate career pinnacle came with Sprint PCS, when he ran regions for the cell phone company in Dallas, and later, in Boca Raton. At one point Kimsey oversaw Sprint operations in 13 states with more than 3,000 employees. Kimsey also previously ran the Caribbean division of a London-based firm that provided wireless and broadband service to 14 Caribbean islands.


Going from a behemoth like Sprint to Doctors Express has been a refreshing change for Kimsey. But the refreshment comes with a big recession-era challenge: Financing. “Capital is probably the most significant hurdle,” says Kimsey. “To banks, this is a startup.”


Kimsey says he will instead look to raise private equity to open more Doctors Express centers. His goal is to open five to 10 centers a year. The corporate office also projects fast growth, to the point where it will ultimately have 3,000 Doctors Express urgent care clinics nationwide and 40% of the urgent care market share.


Says Kimsey: “There's nobody out there that's a startup that wants to be that big.”


A Growing Practice

Richard Kimsey with Doctors Express isn't the only Floridian who believes entrepreneurialism and stellar customer service can mesh with health care.


Across the state from Sarasota-based Kimsey is Solantic. Florida Gov. Rick Scott founded the Jacksonville-based chain of urgent care centers in 2002, back when he was an entrepreneur himself. The company has since grown to 32 centers, all in Florida, with more than 600 employees company-wide.


Solantic is in growth mode, just like Doctors Express, but in a different region of Florida. Solantic, which opened six facilities last year, has clusters of urgent care centers in north, south and central Florida, but nothing on the Gulf Coast, where Kimsey is focusing.


It hopes to open a dozen more in 2011, CEO Karen Bowling says, and plans to eventually expand into Georgia.


Some other facets of the strategies of the two firms are similar: Both strive to bring high-end customer service to an industry normally devoid of it. Both firms run centers staffed by physicians full-time and are open seven days a week.


Solantic, however, recently added a few elements to its business model. Online patient registration, for example, is one of its newest customer service-focused features.


And one of Bowling's favorite recent strategy enhancements is Solantic's three-day feel better guarantee. Just like it sounds, Solantic centers will give a patient their money back if their ailment isn't gone three days after the visit. “It's hugely unique in the industry,” says Bowling. “People love it.”


Solantic has also begun to partner with hospitals in some of its locations. For example, the locations in Jacksonville are now called Solantic Baptist Urgent Care, in a deal with Jacksonville-based Baptist Health. Solantic centers in Gainesville, Vero Beach and Boynton Beach also have partnerships with local hospitals.


“It made sense to reach out to hospitals,” says Bowling. “It helps us get known in the community.”

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