A New Hampshire-based company with plans to build five urgent care centers in Vermont is encountering resistance from hospitals in the communities in which they hope to locate.

ClearChoiceMD of New London, New Hampshire, intends to open facilities in Rutland, Burlington, Brattleboro, St. Albans and Barre.

The centers would provide an alternative for people with non-life-threatening injuries or illnesses who can't get in to see their primary care doctor and don't want to seek care in an emergency room, according to owner Marcus Hampers, an emergency medicine doctor at Dartmouth-Hitchcock Medical Center.

"I've been practicing emergency medicine for the past 20 years in both New Hampshire and Vermont," Hampers said, "In that time I've watched emergency departments become increasingly overburdened with patients, who through no fault of their own, present with non-emergencies."

Treatment in emergency departments is far more expensive than in a primary care setting or an urgent care clinic. For example, a chest X-ray in Vermont's emergency departments can cost from $300 to $600, while the same X-ray at a ClearChoiceMD facility would cost $50.

Both Northwestern Medical Center in St. Albans and Central Vermont Medical Center in Berlin have plans to build their own urgent care facilities.

"Any concern I have with a new urgent care provider in town is surrounding the potential duplication of services," Northwestern CEO Jill Berry Bowen said.

Judy Tartaglia, CEO of CVMC, expressed concern that as a for-profit company ClearChoice might not provide care to Medicaid patients, the uninsured or people who are underinsured and can't afford care.

ClearChoiceMD accepts Medicaid patients as well as payments from all public payers, according to Hampers. It also has a discounted fee structure for the uninsured. The company does require payment up-front, unlike Vermont's nonprofit hospitals, which will treat patients and then seek payment.

ClearChoiceMD has asked the Green Mountain Care Board to determine if its plans trigger the certificate of need process, which appears unlikely because current law has an exemption for physician's offices.

However, the board has yet to make its determination, and has several times requested that the company provide more information.

Last week, Rep. Mike Fisher, D-Lincoln, introduced a proposal that would change the statute governing certificates of need to require that urgent care facilities go through the process.

Michael Porembski, ClearChoice COO, said the company is optimistic their request to avoid a certificate of need process will be granted by the board but added, "we will pursue any and all legal remedies available to us so that we can commence operations."

ClearChoice received approval from New Hampshire's Health Services Planning and Review Board to build seven urgent care centers in the Granite State.