“Focus on the patient for every decision, and then the decision will be the right one,” commented Dr. Robert Graw, CEO Righttime Medical Care, about his business model. Righttime has grown to 15 centers in Maryland evolving from an evening pediatric clinic to full service urgent care clinics and a key player in providing cost-effective care.
Dr. Graw’s entry into urgent care comes from his ability to look beyond traditional practice models and see what patients need. He came to Washington DC from Los Angeles, a newly minted pediatrician, to spend 2 years research at NIH. He stayed 9 years, eventually leading a team of 50 clinicians and scientists who worked with HLA-typing laboratories, pioneering platelet and leukocyte transfusions, and bone marrow transplants.
How does being an NIH hematology/oncology researcher lead to urgent care? Well, Dr. Graw commuted from a farm in Davidsonville. Friends said: we need a pediatrician in Davidsonville. Dr. Graw placed a sign in the front yard announcing his practice. Soon he had converted the living room to a waiting room and two upstairs bedrooms to exam rooms. The community needed more and he left scientific research to grow his practice to 5 pediatric offices. He saw a need to provide care for children after hours and opened Nighttime Pediatric Care. His partners would staff the pediatric urgent care clinic after they finished their regular day in the office. The parents sometimes had the same health issues as the children and the practice evolved to “Pediatrics and parents too,” and then to adults without children, and finally to a daytime/evening urgent care clinic called Righttime Medical Care.
While the goal of population health and accountable care organizations is laudable, Dr. Graw does not see a future for providers in its current deployment. Providers are rewarded for reducing waste by sharing half the proceeds of their waste-reduction. He asks, “How many years can a provider reduce waste and still provide the services that patient’s need?” Further, how can an organization reap the rewards of reducing waste, if it’s already following the guidelines and if it’s already scrupulously avoiding waste?
Reducing Emergency Department visits and hospital re-admissions is a goal of Maryland hospitals. Dr. Graw notes their success in this arena. Nationwide, urgent cares refer 4-5% of their patients to hospital ERs for further care. Righttime Medical Care refers 1.5% of their patients to the ER for further evaluation. He attributes this success to providing clinical oversight for urgent care physicians. Any case that might be diverted to an ER is reviewed with a senior medical officer on call for suitability for transfer. In many cases, Righttime’s relationship with primary care providers and specialists allows for the ideal patient placement without putting the ER in the triangle.
Righttime participates in health information exchanges. Records from a Righttime visit are available to ERs through CRISP. Primary care physicians can typically access electronic Righttime records through a Carefirst HIE. Dr. Graw remarked, “What I wish for is a thumb drive with all of the patient’s X-ray and laboratory findings.” This epitomizes Dr. Graw’s thinking, instead of doubling down of the multi-billion dollar investment in EHR that attempts to share data perfectly and yet is too complicated to use, why not a simple cheap system that works most of the time.
Historically, pediatricians have been paid less than other types of specialists reflecting the lack of affluence of their young families as customers. That concern for the financial well-being of the patient echoes in Dr. Graw’s discussion of modern healthcare. With the average American carrying only a $500 bank balance, the challenge of an ER visit with potentially a $1200 deductible are daunting. Medical care is the leading causing of bankruptcy in the United States. Insurers recognize the cost effective care provided by urgent cares and set their deductibles lower.
The most common factor found in patients re-admitted to hospitals is a lack of a primary care follow up in the first 30 days after discharge. Urgent cares with their daily availability can get patients seen quickly pending their primary care appointment. Urgent care thus helps both sides of the equation, protecting ERs from low acuity patients and serving as a tool to rapidly integrate patients back into the primary care healthcare system. It turns out the Righttime’s model of convenient cost-effective care is just what the healthcare system was looking for. “Focus on the patient for every decision, and then the decision will be the right one.”
Dr. Robert Graw was interviewed by Dr. Thomas Masterson, editor, Vox Salutem, Inc.
Dr. Graw is CEO of Righttime Medical Care. He is also the President of Ancillary Services, Inc., a medical services organization that delivers a wide array of services to health care organizations, and the Managing Partner of the Pediatric Group, a private pediatric practice. Dr. Graw is also Founder and Chief Medical Officer of Righttime’s program, HeadFirst Sports Injury and Concussion Care, which he launched in 2012 as the result of years of research, training, and planning.
Dr. Graw obtained his B.A. from Pomona College in Claremont, California and his M.D. from the University of California in Irvine, California. Dr. Graw completed his internship and residency in Pediatrics and Pediatric Hematology and Oncology at the Children’s Hospital in Los Angeles. He is Board-certified in pediatrics, with a sub-specialty Board certification in pediatric hematology-oncology, and has published more than 100 articles in medical literature. At the National Cancer Institute, he headed the section on Experimental Hematology in conjunction with a broad-based hematological support service for the transfusion of platelets and white blood cells.
Dr. Graw sees pediatric patients in his private practice, focusing on complex medical and family issues and mentoring young physicians in the art of medicine. He is a licensed pediatrician in Maryland, Virginia, California and the District of Columbia. Dr. Graw has raised four children, two of whom are surgeons, and has six grandchildren.