In the 1970s, a group of enterprising physicians began opening up their practices after-hours to visits from patients with minor ailments, without an appointment. Patients didn’t want to go the emergency room, and they couldn’t wait a couple weeks to see their family doctors.
The idea stuck. Aided by shifting work patterns in a growing population has heightened expectations of episodic medical service at all hours and led to a thriving industry in the U.S. known as urgent care medicine, said Dr. Franz Ritucci, a physician associated with the American Academy of Urgent Care Medicine (AAUCM).
Designed to address what are essentially episodic, non-emergency related health issues without the lengthy wait times to schedule a visit with a family doctor or the hefty price tag of visiting an emergency room, urgent care centers have spread to about 7,400 locations throughout the U.S., according to industry group Urgent Care Association of America (UCAOA).
The result: Emergency department use in 2014 fell by about 30% when an urgent care center or retail clinic was located within five miles of a patient’s home, according to the Massachusetts Health Policy Commission.
Urgent care operators have embraced efficiency boosters like using technology to achieve 30-minute average wait times as well as online appointment scheduling and iPad-style sign in and registration, Ritucci said. They give x-rays and do suturing and minor orthopedic procedures. “Technology is developing quicker and our outreach is becoming more sophisticated.”
Today, urgent care doctors can see 80 to 90 patients a day, with an average wait time of 30 minutes, much faster than a typical family practice or pediatrician, he said. Most of the patients who visit an urgent care center wind up in the right treatment space— only a fractional proportion of patients who visit urgent care facilities need to be transferred to an ER. The idea isn’t to replace a primary care or internal medicine doctors, who are better suited to manage and treat chronic illnesses and other maladies.
A different model
Indeed, ChoiceOne Urgent Care, which has eight facilities in Maryland and two more in Georgia, fills in as a backup partner for primary care offices that are closed for holidays and on the weekends, said Butch Marino, co-owner. The urgent care centers then refer patients back to their primary care doctors with discharge notes within 24 hours.
There’s also shortage of physicians and the prospects for reinforcements don’t look good. Over the next decade, there will be more than 60,000 fewer physicians than needed, according to the most recent projections from the Association of American Medical Colleges. By 2025, the shortage of primary care physicians is estimated to be up to 35,000.
Having a subset of doctors equipped to treat more patients per hour increases their overall productivity, Ritucci said. “Urgent care centers address that, they’re the reliever airports of the health care system.”
The facilities also offer an attractive alternative for family doctors, pediatricians and other physicians who grow tired of the hassle involved with managing their own practices, he said.
Roughly 80% of urgent care centers use a combination of physicians, physicians’ assistants and nurse practitioners to provide care, while the rest use physicians only. Moreover, the centers essentially operate as doctors’ practices and follow their regulations, the UCAOA said.
The average cost of a visit is about $150, compared to the average ER visit cost of $1,354, the industry’s trade group said.
Most people who visit urgent care centers pay a copay fee as part of their insurance coverage, but urgent care centers also see many patients—roughly 20%—who cover their visit fees with cash, Ritucci said. That’s good for those who have difficulty finding primary care doctors who accept cash-only patients.
The demand for urgent care centers has been growing, and venture capitalists are buying up clinics throughout the country, Ritucci said. Hospital systems are, too, as it helps them expand their footprint in local markets and serves as an added revenue stream.
The University of Maryland Medical System is partnering with ChoiceOne Urgent Care, and the business model works as hospitals have become highly incentivized to improve the productivity of their emergency departments and focus more on big ticket items like specialty services, Marino said. Urgent care centers can more efficiently deal with strep throat cases or sew up minor cuts, and then refer patients who need more specialized treatment, such as orthopedic surgeries, back to the hospital systems.
The fate of the Affordable Care Act will not likely have much impact on the continued growth for the urgent care center market over the next three to five years, Marino said. But while their rise has been impressive, the increase will likely reach a saturation point when new centers will stop opening up and may drop away. Marino estimates the ideal proportion of urgent care centers at one per 17,000 to 20,000 people. Already in some places in Florida, the ratio is one per 5,000, he said.