Walk-in doc: FirstMed hits 51,000th patient mark

Thirteen years ago, William G. "Gaines" Talbott and his family took a big risk, selling their home to purchase UVA's urgent care unit on Pantops without a single patient lined up. It was a risk that appears to have paid off. Just last week, Talbott's FirstMed clinic assisted its 51,000th patient.

"Business is growing," says the 61-year-old physician, who points out that FirstMed is Charlottesville's only locally owned urgent care clinic. "We have ten examination rooms, and there are three to four providers working every day."

His risk paid off for some patients as well. As detailed in the Hook several years ago, one man who came into FirstMed complaining of abdominal pain might never have made home if it weren't for Talbott. Suspecting it might be something severe, Talbott got doctors at Martha Jefferson Hospital to rush a CT scan on the 57-year old patient, John Wade.

Turned out it was an abdominal aortic aneurysm, a rare condition for someone that young, which can cause massive internal bleeding, and, if not treated immediately, death. It was the same thing that killed television star John "Three's Company" Ritter in 2003. Doctors at MJH ordered surgery immediately, and Wade survived.

"Gaines has a great practice there," says Greg Gelburd, founder of Downtown Family Health Care. "His hours allow me to refer people to him when I'm closed and unable to see them or if I feel they need x-rays which I don't have. My patients like his practice and would rather go there than the ER, as the wait time is non-existent and the physicians there are high quality."

However, not all is rosy in the medical profession. Talbott says that CT scans, like the one he ordered for the man with the aneurysm, often get delayed because insurance companies now require pre-authorization, a procedural hoop that might have cost Wade his life.

"Pre-authorization is becoming more of an issue," says Talbott, "and it's going to get worse."

Recently, Talbott says, he had a patient who needed a Doppler ultrasonograph on her leg to detect a possible blood clot, but it was after 6pm and they couldn't get pre-authorization. So Talbott had to direct her to an ER.

Talbott points out that ERs have long been known as "safety nets" for indigent care, but pre-authorization can make them safety nets– "way stations" he calls them– for doctors trying to treat patients who do have medical insurance.

"We've still got the best medical care in this country," says Talbott, "but the system just needs to be tweaked."

Another worry on the horizon: a mandated change in the 32-year-old medical coding system. By 2014, all medical conditions will get new codes to qualify for insurance reimbursement.

"The current system has about 17,000 codes," says Talbott, "but the new system will have anywhere from 120,000 to 155,000 codes that have absolutely no relationship to the current ones. So my 32-plus years of coding familiarity will be useless. "

So why do they want this new system?

"More data," says Talbott. "On you and me."

What's more, the system will make medical records available on the Internet.

"You have to ask yourself," says Talbott, "is  it a good idea that my medical records will soon be accessible over the internet? Will passwords and encryption work to prevent professional hackers from finding a way in?"