Urgent care

Urgent care is a category of walk-in clinic focused on the delivery of ambulatory care in a dedicated medical facility outside of a traditional emergency room. Urgent care centers primarily treat injuries or illnesses requiring immediate care, but not serious enough to require an ER visit. Urgent care centers are distinguished from similar ambulatory healthcare centers such as emergency departments and convenient care clinics by their scope of conditions treated and available facilities on-site. While urgent care centers are usually not open 24-hours a day, 70% of centers in the United States open by 8:00 am or earlier and 95% close after 7:00 pm.[1]

History of urgent care in the United States

The initial urgent care centers opened in the 1970s. Since then, this healthcare industry sector rapidly expanded to approximately 10,000 centers. Many centers were started by emergency medicine physicians, responding to a public need for convenient access to unscheduled medical care. A significant factor for the increase of these centers is significant monetary savings when compared to ERs. Many managed care organizations (MCOs) now encourage or even require customers to utilize urgent care options.[2] As of 2014, the urgent care industry is worth an estimated $14.5 Billion.[3]

Demographic features of urgent care patients and providers

In 2014, US communities with non-hospital-based urgent care centers (UCCs) were mainly urban, located in areas with higher income levels and higher levels of private insurance.[4] Kaissi et al considered local multi-hospital systems in Florida, Maryland, Nevada, Texas, Virginia and Washington. In 2012 50% of 117 hospital-based "clusters" included either UCCs, retail clinics, or both. 57% of systems in Washington operated an UCC, compared to 36% of systems in Washington, while systems in Florida had the largest share of UCCs (17.6%). Authors noted unexplained state-by-state variation in hospital system partnership with UCC and retail clinic models.[5] Corwin et al considered Medicare beneficiaries presenting to an UCC (n=1,426,354) emergency department (ED) (n=334,841) or physicians office (n=8,359,498) with upper respiratory or urinary tract infections, bronchitis, sprains or contusions, and back or arthritic pain, in 2012. Patients who presented to an ED were more likely to be female (67% of ED presentations) compared to those who presented to a UCC or physicians office (65% and 64% respectively). Patients who presented to an UCC were significantly more likely to be aged over 85 (27%, compared to 15% of physicians office presentations, and 13% of ED presentations) or Black (11%, compared to 6% of physicians office presentations, and 4% of ED presentations).[6] In 2014, 3.1% of Family Physicians in the United States worked primarily in UCCs, with a male:female ratio of workforce is 6:7, and an urban:rural ratio of 2:1. This compares to 3.6% of Family Physicians working primarily in Emergency Care, with a male:female ratio of 5:3 and urban:rural ratio approaching 1:2.[7]

Criteria for urgent care centers

Both the Urgent Care Association of America (UCAOA) and the American Academy of Urgent Care Medicine (AAUCM) have established criteria for urgent care centers and the physicians that operate them. Each share similar qualifying criteria including:

The UCAOA program is called Urgent Care Certification[8] and the AAUCM is called Urgent Care Center Accreditation.[9]

Organized medicine and urgent care

The Urgent Care Association of America (UCAOA) holds an annual spring convention and an annual fall conference. Many leaders of organized urgent care anticipate the establishment of urgent care as a fully recognized specialty.

Urgent Care Management Monthly hosts a bi-annual conference, teaching doctors, investors, and owners about the business side of an urgent care center. Urgent Care Management Monthly (UCMM) is the official publication for urgent care management, with discussions on topics such as billing, staffing, marketing, accounting, and logistics.

JUCM, The Journal of Urgent Care Medicine is the Official Publication of the Urgent Care Association of America (UCAOA). Each issue contains peer-reviewed clinical and practice management articles.

Board of Certification in Urgent Care Medicine (BCUCM) provides board certification for physicians with requisite training and experience. Urgent Care College of Physicians (UCCOP)

Postgraduate training

In 2006, the Urgent Care Association of America sponsored the first fellowship training program in urgent care medicine. A collaboration between the Department of Family Medicine University Hospitals of Cleveland / Case School of Medicine, the Urgent Care Association of America (UCAOA), and University Primary and Specialty Care Practices, Inc. in Cleveland, Ohio made this fellowship possible. The program was partially funded by an unrestricted grant from the Urgent Care Association of America. Fellowship physicians receive training in many disciplines, including: adult emergencies, pediatric emergencies, wound & injury evaluation and treatment, occupational medicine, urgent care procedures, and care center business aspects. In 2007, the Urgent Care Association of America (UCAOA) sponsored a second fellowship opportunity through the University of Illinois. The one-year fellowships are open to graduates of accredited Family Medicine and Med/Peds residencies.

Staffing and services

Unlike other walk-in clinics such as retail clinics, urgent care centers are generally staffed by a physician and supported by nurses, physician assistants and medical assistants. Sixty-five percent of urgent care centers have at least one physician on-site at all times.

Of the physicians that staff urgent care centers, 47.8% are family medicine, 30.1% are emergency medicine and 7.6% are internal medicine.

With these licensed physician on-site, urgent care centers are able to offer a wide range of services including broken bones, moderate cuts and lacerations requiring stitches, and most common injuries and illnesses. These services, of course, are made possible with the diagnostic equipment and x-ray machines typically found at an urgent care.

Of course, the urgent care centers are not an emergency room. They do not offer surgical services, as a rule- particularly invasive surgical procedures (more than cutaneous or subcutaneous procedures- those involving body organs and organ parts, and/or deep penetration of deep fascia, tendons, ligaments, bursae, joints, muscles, or bones), any procedures requiring the use of regional or general anesthesia (more than topical local anesthesia), those procedures requiring a full operating room or suite, having lengthy recovery times, or requiring more than the level of imaging or specialists available at the center.

That said, an estimated 13.7 to 27.1 percent of all emergency department visits could take place at an urgent care center or a retail clinic, generating a potential cost savings of approximately $4.4 billion annually, according to a 2010 study in Health Affairs.[10]

Price

If you are facing a non-life-threatening sickness or injury, a difficult decision that needs to be made is whether you should go to the ER or an urgent care center. Considering that you have limited time and money. A visit to the ER may cost up to seven times more than a trip to an urgent care center. Costs vary regarding the treatment, however on average a trip to the ER costs around $1400, whereas a trip to urgent care around $200. The following estimated costs were prepared by Medica Choice Network for nine of the most common reasons people visit the ER.

Condition Emergency Room Cost Urgent Care Cost
Allergies $345 $97
Acute Bronchitis $595 $127
Earache $400 $110
Sore Throat $525 $94
Pink Eye $370 $102
Sinusitis $617 $112
Strep Throat $531 $111
Upper Respiratory Infection $486 $111
Urinary Tract Infection $665 $112

Ownership

The majority of urgent care centers are owned by physicians or physician groups, however, more corporations and investment banks are acquiring urgent care centers and creating regional and national brands in the industry. The following is a breakdown of urgent care ownership following a 2012 study by the UCAOA:

Urgent care centers by state

Given the constantly evolving industry and opens and closures of urgent care centers each week – and lack of standardized SIC or NAICS codes – it is impossible to know the exact number in the country, much less by state. However, according to the most accurate, known database of walk-in clinics, the following is a state-by-state breakdown of urgent care centers.

State Urgent Care Centers
Alabama 82
Alaska 9
Arizona 127
Arkansas 19
California 226
Colorado 83
Connecticut 52
Delaware 13
Florida 328
Georgia 135
Hawaii 5
Idaho 29
Illinois 112
Indiana 80
Iowa 32
Kansas 19
Kentucky 49
Louisiana 56
Maine 11
Maryland 85
Massachusetts 33
Michigan 150
Minnesota 44
Mississippi 25
Missouri 86
Montana 13
Nebraska 39
Nevada 39
New Hampshire 13
New Jersey 64
New Mexico 28
New York 143
North Carolina 175
North Dakota 8
Ohio 150
Oklahoma 57
Oregon 44
Pennsylvania 98
Rhode Island 18
South Carolina 95
South Dakota 9
Tennessee 101
Texas 283
Utah 39
Vermont 3
Virginia 109
Washington 49
West Virginia 17
Wisconsin 57
Wyoming 11

Codes for urgent care

In recent years the American Medical Association approved the code UCM (Urgent Care Medicine). This code allows physicians to self-designate as specializing in urgent care medicine. Services rendered in an urgent care center may be designated, using the place of service code -20 (POS -20) on the CMS-1500 form, as submitted to third-party payers. The Centers for Medicare & Medicaid Services (CMS) have designated two specific codes to apply to urgent care centers: S9083 (global fee for urgent care centers) and S9088 (services rendered in an urgent care center).

References

  1. ↑ ""2012 Urgent Care Benchmarking Survey Results." Urgent Care Industry Information Kit. 2013" (PDF). Urgent Care Association of America. Retrieved 2015-06-26.
  2. ↑ "Blue Cross of GA Uses Google Maps to Encourage Use of Urgent Care". Urgentcarenews.com. Retrieved 22 June 2015.
  3. ↑ "Race Is On to Profit From Rise of Urgent Care". The New York Times. 2014-07-09. Retrieved 2015-12-18.
  4. ↑ Le, S T; Hsia, Renee Y (7 April 2016). "Community characteristics associated with where UCCs are located: a cross-sectional analysis". BMJ Open. 6 (4): e010663. doi:10.1136/bmjopen-2015-010663.
  5. ↑ Kaissi A, Shay P, Roscoe C. Hospital Systems, Convenient Care Strategies, and Healthcare Reform. Journal of Healthcare Management 61:2 March/April 2016
  6. ↑ Corwin GS, Parker DM, Brown JR, Site of Treatment for Non-Urgent Conditions by Medicare Beneficiaries: Is there a role for Urgent Care Centres?, The American Journal of Medicine (2016), doi: 10.1016/j.amjmed.2016.03.013.
  7. ↑ "One in Fifteen Family Physicians Principally Provide Emergency or Urgent Care" (PDF). Jabfm.org. 2014-07-01. Retrieved 2015-06-26.
  8. ↑ Archived August 26, 2013, at the Wayback Machine.
  9. ↑ "What is Urgent Care Accreditation?". Aaucm.org. Retrieved 22 June 2015.
  10. ↑ Weinick, R. M.; Burns., R. M.; Mehrotra, A (September 2010). "Many Emergency Department Visits Could Be Managed At Urgent Care Centers and Retail Clinics". Content.healthaffairs.org. Retrieved 2015-06-26.
  11. ↑ "The Journal of Urgent Care Medicine". Jucm.com. Retrieved 2015-06-26.
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