When Keyur Sathe, MHA, decided to put his nearly two decades of healthcare leadership and entrepreneurialism to work in a bold new venture—one that would, in his words, help “bend the arc of healthcare” toward greater value—he didn’t have to look far for inspiration. His wife is a pediatric gastroenterologist. Their young children are the loves of their lives. And there are only a handful of places in the U.S. to which stressed parents can turn when a child needs non-emergency medical care during nights, weekends and holidays. 

NiteHawk Pediatric Urgent Care was born this past July with the opening of its flagship facility in the Dallas suburb of Wylie, Texas, with Sathe as president and CEO. That’s a role he filled the previous nine years with Trinity Surgical Worldwide, a developer and manager of ambulatory surgery centers. In the months leading up to the NiteHawk launch, he recruited Dallas pediatrics fixture Claude Prestidge, MD, to serve as chief medical officer and Emmett Moore, JD, CPA, a healthcare executive with 40+ years of clinical-business alignment under his belt, as chairman.

That professional firepower points to NiteHawk’s enterprising aims: Open five to seven facilities in the Dallas-Fort Worth metroplex over the next few years, then take NiteHawk national—all with an uncompromising focus on quality, accessibility and affordability. This Sathe refers to as “the triangle.”

“We’re not just putting up a shingle and opening our doors,” Sathe told imagingBiz. “This is about finding the right corners of the right markets that are most in need for these services. We’re interested in moving into places where we can add the maximum amount of value for the largest number of patients and parents.”

NiteHawk’s in-depth market analysis, already underway in earnest for those five to seven Dallas-Fort Worth sites, involves carefully considering everything from demographics, socioeconomic metrics and population trends—literally asking “Where are the children?”—to technology assessment, parking, exterior lighting and street signage.

“We don’t want to be just a myopic urgent care center company,” Sathe says. “We view what we provide as an infrastructure-level service for the community and the surrounding communities. We are looking to add significant value by partnering with physicians, school districts and other community stakeholders.”

Physician-centric care

NiteHawk’s provider model calls for treating patients exclusively with board-certified or board eligible pediatricians, assisted by pediatric ER nurses and other staff trained in pediatrics. “This further distinguishes us from virtually every type of provider model in the urgent care space,” Sathe says. “Most tend to utilize midlevel providers, meaning nurse practitioners or physician assistants, for care delivery. Our providers are highly qualified physicians, and that is a very important distinction.”

The flagship site in Wylie has been seeing everything from colds and coughs to lumps and bumps to lacerations and dehydration, not to mention rashes, sprains, fractures, pneumonia and all manner of concerns that are urgent but not emergent. The pace started steady this summer and has picked up considerably since schools opened.

“We are not a referral business per se, in that the decision point for care is ultimately up to the parents,” Sathe says. “They can take their child to a children’s hospital ER, a general hospital ER, a freestanding ER, a non-pediatric-specific urgent care center. Or they can choose NiteHawk. We believe we make a compelling case as to why we are the right after-hours urgent care provider for their child.”

The case includes extending the emphases on value and service to how the facility is outfitted.  There’s an onsite lab and state-of-the-art x-ray room. “The x-ray piece of our service line is a microcosm of, and in many ways a metaphor for, our business as a whole,” says Sathe. “For us, the technology we chose made all the sense in the world.”

The technology he refers to is Viztek’s Ultra Straight Arm DR with Pediatric Imaging Package. He says this selection was consistent with the team’s insistence on the best quality for children and value for their parents.

The Viztek system, which is dose-conscious in support of the ACR’s Image Gently program, is proving excellent at imaging not only for sprains, strains and fractures but also for gastrointestinal and breathing issues, says Sathe.

Parents have heightened awareness when it comes to the care they get for their children, he adds. “Increasingly, they are becoming better educated in all aspects of care. That’s where reducing radiation dose without compromising image quality has become a hot button issue among parents.”

The low-dose difference 

To provide the highest quality care, NiteHawk works closely with general pediatricians as well as pediatric specialists, including a radiology group that provides overreads. All are very well attuned to the ALARA concept, and all have been highly satisfied with image quality, Sathe says. As for the patient and the parent, before they leave the building, NiteHawk can hand the parent a CD with the image, as well as a radiologist’s final read. Then, they’re on their way back to their pediatrician for follow-up care or to a coordinated referral to a specialist.

Sathe says the team looked at other options besides Viztek. The name “came highly recommended to us from other providers, including radiologists,” and ease of use was a frequently cited attribute.

The deal-sealer was Viztek’s option to upgrade to a cesium iodide panel with the low-dose feature. “At that point, the choice became a no-brainer for us,” Sathe says. “We are the first urgent care facility in the state of Texas to adopt this technology. It became an opportunity not only to raise awareness for parents, which is very important, but almost as important is raising that awareness for general pediatricians and family practitioners in the community.”

At NiteHawk, all who work with the Viztek system receive training in proper operation. This includes nurses as well as technologists.

Kelly Hogue, RN, NiteHawk’s clinical manager, sent a statement praising the user-friendly nature of the Viztek DR. “Staff are usually apprehensive at first before training, but quickly realize how easy it is to use and how simple the technology is,” she wrote. “They quickly grew at ease using the machine.”

‘Gravy on top’

Sathe says NiteHawk works with physicians who moonlight at other locations or with other providers that have used different types of x-ray machines. “We have almost universally received feedback telling us that the Viztek system is just a fantastic machine to use. It’s easy to use. It produces quick and clear images. And again, [cesium iodide technology offers] the lowest radiation dose available out there. That’s just been the gravy on top not only for the parents, but also for the providers taking the images.”

Doubling back to his triangle equation, Sathe emphasizes the affordability aspect of NiteHawk’s business plan. “We don’t charge like any type of emergency room,” he explains. “We’re able to bill at a more moderately priced level of service because of the setting.”

“It’s all about filling in a very specific gap in availability of care that’s out there,” Sathe concludes, noting that only 2% to 3% of the 9,000 or so urgent-care centers in the U.S. are focused on pediatrics. “We don’t overlap with the pediatricians in the community in days, hours or services. We don’t do well-child visits or immunizations. We strictly treat sick and injured children after hours. There’s just a big void in the marketplace out there for this specific type of service. And we are offering it in a way that is substantially different from any other option out there.”