If you’ve paid attention to your neighborhood strip mall over the last few years, chances are at least one new urgent care clinic has moved in. The clinics, which are run by doctors and typically open 7 days a week, 12 hours a day, offer quick and convenient care for a range of non-emergency conditions. Think along the lines of treating a bad flu, a twisted ankle, or a nasty cut that needs stitches — the kind of stuff that may seem too minor for a trip to the emergency room but too serious to wait for an appointment at your doctor’s office.
There are an estimated 7,000 urgent care centers in the U.S. today, according to the Urgent Care Association of America, and the industry is growing at a rapid clip. Since 2011, 600 new urgent care clinics have opened per year, double the rate from 2008 to 2010. And that overall number could be much higher, as there is no federal agency assigned to track openings. The current count is based on a manual tally by the UCAOA, the industry’s main trade group.
Urgent care isn’t an entirely new phenomenon. The practice has been around since the 1970s, but the real boom occurred in the last seven years or so. It’s not hard to see the appeal of quick and efficient medical care in today’s healthcare landscape, especially when it can be done cheaply. More Americans today have health care than ever before, but the proliferation of high deductible health plans, which require patients to often pay thousands of dollars out of pocket before insurance kicks in, can make even a routine doctor’s visit cost prohibitive. The average deductible for a family in the U.S. was $4,522 in 2013, according to the Kaiser Family Foundation. If you’re too sick for a regular doctor but can avoid going to an emergency room, you could potentially save hundreds, if not thousands, of dollars by visiting an urgent care clinic. A 2009 study by the Annals of Internal Medicine found that the average cost of an urgent care visit for three illnesses was $155, compared to $570 at an emergency room.
“From a big picture standpoint, there continues to be a strong movement away from in-patient care and a push to access lower-cost options,” says UCAOA president-elect Steve Sellars. “We fit somewhere between primary care and the ER.”
Although urgent care centers are staffed by doctors and trained medical staff, the majority aren’t mom-and-pop style small businesses. Nearly one-third are run by private corporations and 13% are owned by hospitals. Only 12.5% are owned by a single physician. Concentra, with 300 clinics, and US Healthworks, with 187, are the largest providers in the nation. Urgent care facilities have also begun to expand their foothold through mergers and acquisitions. In 2014, Long Island, N.Y.-based Premier Care and New York City-based CityMD merged under the CityMD umbrella, becoming New York's largest urgent care provider with 42 locations. Concentra, bought by Humana (HUM) in 2010 for $790 million, was recently sold for $1 billion to a private equity firm. The clinics generally have enjoyed an influx of funding from private equity firms, which invested nearly $4 billion in health service companies in 2012, up from less than $1 billion in 2009, most of which went to clinics and urgent care centers, according to Thomson Reuters.
The big draw of urgent care clinics? Convenience. Namely, having access to a facility where you are guaranteed to see a doctor within 30 minutes, which is the average wait time at 97% of these clinics. Wait times at emergency rooms are roughly the same, but the entire visit takes more than two hours, compared to less than an hour at urgent care clinics. The decline of emergency care departments in the U.S. has also fueled the growth of urgent care centers — the number of emergency departments fell from 2,446 to 1,779 from 1990 to 2009. Meanwhile, a shortage of primary care physicians has left 62 million Americans will little or no access to a primary care doctor.
CityMD, which opened its first practice in 2010 in Manhattan, tailors its services to busy workers who have trouble booking appointments with primary care doctors, says Calvin Hwang, chief experience officer. Each clinic aims to get patients in and out in 45 minutes. If a patient arrives five minutes before closing time, they can still be seen.
“[Urgent care] is an answer to an existing problem and the problem is that people, when they need to see a doctor, cannot,” Hwang says. “That is the fundamental reason why urgent care is growing very fast.” By the end of 2015, CityMD will add a dozen additional offices, including their first location in New Jersey.
Regulators playing catch-up
As is the case with many burgeoning industries, urgent care centers are expanding faster than federal and state regulators can keep up with. As of now, there is no federal regulation of urgent care facilities — they don’t have to register with the federal government or obtain accreditation from the Joint Commission, a nonprofit agency that accredits more than 25,000 health care services, including most hospitals. Some states require clinics to have licenses for specific types of treatment, such as lab testing or imaging services, but Arizona is the only U.S. state that has a specific licensure program for urgent care clinics. Illinois and Delaware are among the few states to restrict the way urgent care clinics are branded, banning them from using words like “urgent” or “emergency” in their names so they don’t mislead patients into thinking they’re being treated at an emergency room.
Earlier this year, New York State’s Public Health and Health Planning Council tried and failed to convince state leaders to toughen regulations on urgent care clinics. The Council called for all clinics to have their staff ACLS (advanced cardiovascular life support) and PALS (pediatric advanced life support) certified and required to follow standardized naming guidelines. In July, N.Y. Attorney General Eric T. Schneiderman sent letters to dozens of major urgent care clinics over concerns that the way they explained insurance coverage on their websites was deceptive.
There is a real risk of sticker shock for patients who wander into a clinic for treatment thinking their insurance is accepted only to find out later, in the form of an expensive bill, that it was not. Some clinics can be vague about what types of insurance they accept, so it’s important to ask before you get treated. It’s not enough to simply ask whether your insurance is “accepted” — ask if the clinic is “in network.” If the clinic isn’t in your insurer’s specific network, you may pay more than you had banked on. You can also check on your insurer’s website to see if they have a list of urgent care clinics included under your plan.
Hwang says CityMd is well aware of the potential for miscommunication. It’s their standard practice to review each patient’s insurance information before they are treated to find out if their services are in their insurance network. It also keeps a list of accepted insurers on its website.
“We are very transparent,” he says. “We’re pretty clear on how much they would be charged.”
Urgent care clinics may be convenient and cost-effective, but they’re not meant to be a replacement for primary-care physicians. Only 15% provide ongoing primary care, according to the UCAOA, and you can’t be certain that the clinic will be able to easily share your medical records with your primary doctor. For people who suffer from chronic, long-term conditions it’s even more important to see someone who knows your full medical history and exactly what treatment you’ve received in the past.
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