With 21 years invested in the practice of emergency medicine, Dr. Evan Ratner gradually shifted his focus toward the trend in urgent care clinics - a smart alternative to hospital emergency rooms.

Dr. Ratner found a future partner in Dr. Charles Patrick Isbell.

Ratner’s first venture with Isbell was in founding Impact Medical Services 13 years ago. Impact Medical Services has provided emergency physician staffing for three different hospitals in San Antonio: the Methodist Specialty and Transplant Hospital, Santa Rosa Northwest and Methodist Ambulatory Surgical Hospital.

Collectively, Ratner and Isbell have over 40 years of emergency medicine experience. Frequently, they would see patients using the ER for illnesses and injuries that, while requiring immediate medical care, weren’t classified as true emergencies. Often patients felt the ER was their only option because they couldn’t get in to see their regular doctor, needed more services than their doctor offered or didn’t have a regular doctor at all.

“After seeing what goes on in an emergency room, we both felt there was a real need to provide timely, affordable health care in a neighborhood setting,” Ratner said.

Three years ago they began working out a partnership that led to the March 1 opening of Impact Urgent Care Inc. The April 21 afternoon ribbon cutting, a Greater San Antonio Chamber of Commerce event that brought out Mayor Julian Castro, capped the roll-out of their first clinic.

Unlike most emergency rooms, Impact Urgent Care is a free-standing facility that is closely integrated into its surrounding neighborhoods.

Located halfway between South Texas Medical Center and Stone Oak, Impact Urgent Care is also halfway between a typical primary care office and an ER. Ratner envisions a local facility that can manage the majority of its neighbors’ needs.

“The people who will choose us will come from the surrounding neighborhoods,” Ratner said. “Our expectations are that service will be better, faster, cheaper than an ER, routinely, we are dramatically faster than the ER experience. The majority of our patients are in and out in an hour.”

The national average time spent in an emergency department in 2007 was 4 hours, 5 minutes, according to the American College of Emergency Physicians. That was a 5-minute increase over the previous year. Urgent care medicine has been marketed for the past few decades as the sensible alternative to hospital emergency departments. Designed to relieve the load of ERs by providing immediate care for non-life threatening medical conditions and injuries, urgent care centers can operate with lower overhead.

“Considering all that an ER provides, it is not that inefficient,” Ratner said.

However, hospital ERs include many redundancies to provide for any eventuality. Anyone who has visited an ER and kept track of the subsequent billing process realizes the patient never receives just one bill. There is a facility cost that starts at over $100 before any of the patient care costs or physician costs gets added.

Laboratory tests trigger a bill from the pathologist. If an X-ray is done, the radiologist fee comes next. And there is a fee from the emergency physician. Doctor’s charges are separate from the use of the facility.

“Oftentimes, we are several multiples less expensive than an ER visit,” Ratner said. And the patient does not get deluged with bills. There is one statement. Urgent care clinics are increasingly a component of the medical safety net upon which people rely.

The American Academy of Urgent Care Medicine advocates for a health care system that will increase the capacity to handle more patients by re-directing those who could be cared for in a less intense setting than in the ER. And as millions of new patients enter the system under the national health reform act, the trend toward more urgent care clinics appears certain to continue.

Many urgent care facilities rely on general family practitioners. Ratner and Isbell, as emergency medicine specialists, have worked to design a service that is more adept at responding to whatever might come through their doors.

Open from 9 a.m. to 9 p.m., seven days a week, the clinic always has a doctor on staff, and at his side is a registered nurse, a licensed vocational nurse, a licensed X-ray technician, medical assistants and paramedics.

Linda Ratner, Evan’s wife, is the chief executive officer. She is also an experienced emergency nurse with additional experience in intensive care nursing and home health. She worked in ERs at University Hospital and Christus Santa Rosa Hospital, and is now in the process of obtaining her business degree.

Nurse Ratner spent considerable time ensuring that communications will be improved between the patients, their families, their regular doctors and any specialists to whom they may need to be referred.

“We are here to assist the primary care practices that are already overcrowded, or need something beyond what they offer,” she explains. “The use of advanced technology allows us to take an X-ray, review it, have it over-read by a radiologist, and sent to a patient’s primary doctor, or a specialist all in short order.”

“We’re finding people are having a harder and harder time getting in to see their primary care doctor,” Evan said.

The primary care doctor may be booked weeks in advance, on vacation, or simply be unavailable because it is after hours. He cites the example of a child who arrives with a laceration. Rather than go to the ER, because her doctor is unavailable, the girl’s parent came to Impact Urgent Care.

“Being a resource for the primary care doctor is exactly the right role for us,” Ratner said.

Their first facility, located at 16403 Huebner Road, is half of an 8,000-square-foot structure built on speculation by a commercial real estate developer. Ratner had intended to design from the ground up, but the recession provided an opportunity to finish out a building that was in need of a tenant.

However, he intends to design the next clinic on vacant land. A site has been selected in northeast Bexar County, near the San Antonio and Converse city limits boundary.

“I hope to start building within six months,” he said, “and be open within a year.”