Dr. John Radford wants to treat at his telemedicine company, 247 Online Care

March 19--Dr. John Radford spent the first dozen or so years of his professional career as an emergency medicine doctor. He practiced in the emergency rooms of hospitals throughout Western and Central New York.

But all along, Radford was thinking about how change was coming to the health care industry -- and about how he could adapt to those changes to better serve his patients.

In 2012, he opened an urgent care clinic in Chemung County, the first in a chain of seven throughout the Southern Tier and metro Syracuse.

He opened his own billing company to keep those services in-house, and then he started an occupational medicine company that provides health, wellness and testing services to employers and their workers, operating out of his Five Star Urgent Care clinics.

Last June, Radford opened Five Star Family Care in Depew, combining the features of a primary care office with the convenience of an urgent care clinic.

And finally, this month, Radford and his team launched a telemedicine company, 247 Online Care. The technology allows patients using a mobile app to connect remotely with a doctor or another medical professional for a screen-to-screen "visit."

"As a doctor, I can see one patient at a time, maybe I can see 30 patients a day, for the five days or six days that I would work as a practitioner. What I think is fun and challenging is creating systems where you can have a very positive effect and have someone have a really great medical experience," Radford said in an interview. "So I don't directly see patients anymore. But I enjoy doing these sorts of things, offering a pediatric urgent care, offering new solutions in primary care -- that's really what drives me at the end of the day."

Radford isn't the only doctor in this area who has opened an urgent care clinic, or started a company based on an idea the founder thinks will change the way health care is delivered.

And other companies here and elsewhere in the state offer some form of telemedicine.

But Radford has an unusual entrepreneurial focus and an ability to look around corners to see where the industry is headed, friends and colleagues say.

He positions the companies to offer care that is faster, more accessible, more affordable and that takes advantage of advances in technology.

"He knows medicine well. He knows what's needed and he knows what works," said Dr. Gerald Gorman, director of the emergency department at Niagara Falls Memorial Medical Center, who first met Radford when Gorman was a resident and Radford was chief resident at University at Buffalo School of Medicine and Biomedical Sciences emergency medicine residency program.

Radford, who opened his first clinic four years ago, has about 200 employees today spread across his many businesses.

The name of several of the companies, Five Star, applies to the level of care he strives to offer to his patients and customers.

"We want folks to have a five-star experience," said Radford, who stopped practicing medicine full-time in 2013 to concentrate on his growing collection of businesses.

Moving fast

Radford actually got his start as an entrepreneur after his residency, when he launched F.D.R. Medical Services in 2000 with two of his fellow residents to provide doctors to staff the emergency department at Brooks Memorial Hospital in Dunkirk.

A Lackawanna native, Radford earned undergraduate and medical degrees from UB before doing his post-medical school training there.

Gorman said his friend's decision to start a company straight out of residency wasn't the typical path taken by a young doctor.

"That takes a lot of guts. You're spending money right away. You're waiting for all the money to come in. You don't know necessarily what you're doing with the insurance companies. But certainly he had that bent," Gorman said.

Radford worked as an emergency medicine doctor at Brooks, Erie County Medical Center and a number of other hospitals in and around Western and Central New York for more than a decade, while running his F.D.R. Medical Services company with his partners and, later, joining a company, the Exigence Group, for which he filled clinical and administrative roles in emergency departments in New York and Pennsylvania.

All the while, Radford said, he came to believe that not every patient was well-served in an emergency department, where patients could wait hours and receive poor customer service, and where the cost of care was exceedingly high. At the same time, many patients didn't want to have to wait for an appointment to see their primary care physician during daytime, weekday hours.

He was not alone in seeing the potential for urgent care clinics, but he was motivated enough to act.

"The short answer is I observed people that could be seen in a lot more cost-effective area and have a much nicer experience than sitting in a hallway or waiting four hours in an emergency department for a sore throat," Radford said.

Disney training

Radford opened his first Five Star Urgent Care location in Big Flats, outside Corning, in January 2012 and opened six more locations over the next four years.

The most recent site in the Syracuse suburb of Liverpool opened earlier this year with a pediatric urgent care wing.

Radford said he has purposely avoided opening sites in Buffalo and Erie County, where MASH, WNY Immediate Care and other companies dominate the urgent care market. The closest Five Star Urgent Care site is in Jamestown.

"It has to be done strategically at this point," Radford said.

The locations emphasize customer service, with televisions in all the rooms and with staff making a point to call back every patient within 48 hours, Radford said.

He said he sends his practice managers for a management training course at the Disney Institute at Walt Disney World.

In the same vein, Radford rewards his highest-performing employees with trips to various Ritz-Carlton hotels, and maybe 20 workers over the past several years have enjoyed a long weekend visit to absorb some of the chain's world-class customer service.

"To go get a sense of what it means to have every need anticipated," Radford said.

Seven days a week

Five Star Urgent Care was the first of several businesses Radford started through his JCR Medical Services.

Radford is owner of JCR and its divisions, though he has partners in some of the sites.

One business is an occupational medicine company, Five Star Occ Med, that is run out of the Five Star Urgent Care locations. It provides drug testing, pre-employment physicals, follow-up for workers' compensation cases, specialized physicals for workers who handle asbestos and other medical needs, Radford said.

Small occupational medicine companies had done this work previously, and hospitals had done this as well, but there was a need in the market, and today about half of all urgent care groups nationally, including many in the Buffalo area, perform some occupational medicine functions, Radford said.

"They do go hand in hand," he said.

Radford said he started the billing company, Ellivance Billing Services, because he didn't want to have to outsource those services and lose control over their quality when a patient calls with a question.

Finally, last June, Radford opened Five Star Family Care in Depew. He thinks of it as primary care meeting the convenience of urgent care. Patients don't need an appointment and don't need to be one of the practice's patients to get in the door. It has the extended hours of an urgent care clinic, but bills at the lower rate of a primary-care visit, not an urgent care or ER visit.

The location serves children and adults seven days a week, including holidays, and is closed only on Christmas.

It may be unusual for a physician to start so many businesses, but being a doctor-entrepreneur isn't surprising, said Dr. Philip L. Glick, a professor of surgery and management at UB who serves as the MBA liaison for the dual-degree programs offered through UB's Management School and its Health Sciences Schools.

"Doctors are amazingly entrepreneurial and amazingly creative, and we have to be always thinking out of the box to take care of patients. And we come up with a lot of amazing ideas. And most of them never make it beyond the back of a paper napkin, because people just don't know how to do that," Glick said.

But Radford may be taking on his most ambitious business challenge yet with telemedicine.

Telemedicine growing

Radford said he's been thinking about telemedicine since even before he opened his first urgent care clinic.

Telemedicine is becoming popular as health care consumers, the employers who pay a big part of the country's health care bill and other players in the industry try to find ways to deliver high-quality, low-cost care to people quickly and easily.

As video-conferencing technology such as Skype improves, along with the ability to share medical records confidentially across computer networks, telemedicine shows promise in serving rural and Native American populations, residents of nursing homes, prisoners, people who are managing chronic illnesses and other populations.

"It makes a lot of sense," Glick said.

Several companies, or pilot programs, in Western New York have launched in recent years, primarily through the home health industry, and far-flung hospitals have used telemedicine to connect to specialists at larger hospitals in Buffalo and Rochester for expert opinions.

Radford and others believe it has potential to serve people who don't want, or need, to go to an emergency room or urgent care clinic for treatment of an ailment and who can be more efficiently, and inexpensively, served by interacting with a physician through a video-conferencing "visit" over their smartphones. It's not for stroke symptoms, or heart attacks, but for mild respiratory infections and to answer whether a cut needs stitches, Radford said.

Dr. Thomas Madejski, whose practice in rural Medina includes geriatrics and internal medicine, said he and his partners are trying to figure out the right model to experiment with telemedicine with their existing patients.

To work with new patients raises difficult questions about continuity of care, he said, and about not being able to perform a clinical exam.

"You're not going to get their full sense of anxiety, whether they may be not telling you something or there's something you need to ask them," said Madejski, who is treasurer of the New York State Medical Society.

There are a number of national players already in the market, with names such as Doctor on Demand and American Well, and all can serve patients in New York State. At least one other New York-based company is up and running, DocChat, which grew out of a chain of urgent care clinics in New York City, said Michael Okhravi, its chief executive officer.

Radford said his telemedicine company, 247 Online Care, for now will rely on the same doctors, physician assistants and nurse practitioners who work at Five Star Urgent Care. Patients using the 247 Online Care app, available through the Android and Apple app marketplaces, will log in and say they need to talk to a medical professional about a problem.

How it works

When that call comes in, Radford said, it will come into a central portal, and everyone working at that time -- or the people on call overnight when the clinics are closed -- will be notified of the call. Whoever has time to take the call will accept it and sit down in front of a computer with a webcam and begin to interact with the patient.

There is no time limit on the visit, Radford said. The clinics' doctors only are licensed to take calls from patients in New York, but Radford said he eventually would look to expand the operation.

The company charges $49 out-of-pocket for a visit, or $249 for a yearly membership that allows unlimited visits. For comparison, the self-pay rate ranges from $130 to $195 for a basic visit to a Five Star Urgent Care clinic.

The state did pass a law that took effect Jan. 1 that requires health insurers and Medicaid to reimburse for telemedicine visits on par with in-person visits, said Justin Jolls, associate director of strategic planning for JCR Medical Services.

That law should be a boon for providers such as 247 Online Care, though the company is waiting for guidance from the state Health Department on how the law will work, Jolls and Radford said.

The company began offering the telemedicine services earlier this month but has not yet begun advertising in the Buffalo, Rochester and Albany markets, so use of the service has been limited. They expect most patients to come through memberships with employers, who would pay a per-member, per-month cost of a couple of dollars or less per patient.

"I think it's very much a barrier to entry, just because it's new. There's a lot of education," Jolls said. "When urgent care first started up, it wasn't very popular, people were unsure about it. And now, people will say, oh yeah, that's my urgent care that I go to. They speak to it as if they have ownership. So really with this, it's an education. And once people use it, they come back and use it more."

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