With millions of Americans newly insured under the ACA and an increasing aging population, emergency room volumes are higher than ever. The number of patients visiting emergency departments was 136.3 million in 2011 -- up 10% from 122.67 million in 2008 and 2011, according to CDC.
And the numbers continue to climb. In a 2015 survey of 2,098 ED physicians, about 75% said visits had increased over the past year. The result can mean overstressed emergency staff and long waits for patients.
In contrast, urgent care facilities can promise patients medical care when and where they need it. As people are pushed into high deductible insurance plans, they are becoming more consumer-savvy about where they go for non-emergent care. They are willing to shop around for quality care and service, convenience and affordability.
By routing less serious medical problems to an urgent care center, EDs can reduce wait times and the amount of stress on ED staff and resources, allowing physicians focus on cases that truly need emergency care.
Business is booming
There are currently about 7,100 urgent care centers in the U.S., according to the Urgent Care Association of America. Concentra Urgent is the industry leader, with more than 300 clinics in 38 states. Other top players include U.S. HealthWorks, American Family Care and Doctors Express, MedExpress Urgent Care, and NextCare Holdings.
The global urgent care centers market is expected to reach $30.5 billion by 2020, up from $23.5 billion in 2013, according to a report by IBISWorld, a market research firm. North America is expected to lead the market due to rising demand for walk-in health services, cost-effective care, and more options for care of nonemergency conditions, the report says.
Another factor fueling urgent care’s growth is an unmet demand for primary care physicians. Often when an urgent care facility opens, it creates its own demand, drawing in people who previously rode out an illness rather than visit the ED or lack access to primary care, Shawn Borich, a regional director with ECI Healthcare Partners and board-certified emergency medicine physician, tells Healthcare Dive.
“A patient can go to an urgent care with a sore throat and get one charge … that’s probably 10% to 20% of what they pay when they go to an ED for the same complaint,” he says.
Benefits of urgent care
When an urgent care pops up, they mainly compete for patients with low-acuity issues, like sore throats and sprained ankles. EDs may lose out on those patients, because they can’t compete on convenience and cost.
Much depends on where a hospital is in the transformation from volume-based care to value-based care, said Keith Shah, managing director and chief strategy officer for the Center for Healthcare Economics and Policy at FTI Consulting. “If they’re farther along in that value proposition, they may have already accounted for and worked towards creating some momentum for the use of urgent care,” he tells Healthcare Dive.
But without some alignment of services, urgent care may dip into spaces better served by the ED or primary care, Shah says. For example, a patient who is sicker may be better off going directly to the emergency room, or a patient may be better off having a longer-term relationship with a primary care doctor than habitually using urgent care.
“Figuring out the right balance is key,” says Shah. “Once you have that, there seems to be a real benefit to having urgent care facilities” in a community.
Need for an interface
To ensure the best use of both the ER and urgent care facility, it helps to establish an interface between the two, says Borich. “It’s helpful for hospitals to look at urgent cares almost as another client or service line and to support the urgent cares when a patient needs a higher level of service or care than the urgent care can provide,” he tells Healthcare Dive.
For example, he notes, the hospital and urgent care facility might have an arrangement that allows the urgent care to do outpatient imaging studies. That way, a patient with a head injury can go directly from the urgent care center to the imaging center without having to go the ED. The turnaround for the outpatient study can be just as quick as in the ED without the wait that an ED visit entails.
Similarly, hospitals can set up direct admission guideline so that a patient who is fully worked up in the urgent care and needs to be admitted to the hospital can do so without having to go through the ED, Borich adds. “The emergency room might lose out on a patient and lose out on some revenue, but overall it’s cheaper and it’s a better patient experience,” he says.
Taking it another step, some hospitals are actually teaming up wit urgent cares in one location or in adjacent facilities so that patients who come into the hospital can be triaged to the most appropriate level of care. This drives down the cost the patient and relieves EDs from the burden of seeing nonemergency patients, says Borich.
He cautions, however, that hospitals that open their own urgent cares need to understand the differences between managing an urgent care facility and running an ED.
“I’ve seen a lot of hospitals that have opened up urgent cares and they tend to fail within two to three years because of a lack of volume or a lack of revenue,” Borich says. “And typically there are three main reasons for it to fail: wrong location, haven’t managed it appropriately and didn’t provide customer service to the level of satisfaction of the patients that you’re serving.”
He notes, for example, that state regulations typically require EDs to ask patients questions, such as where they’ve traveled recently and whether there are issues at home, that an urgent care isn’t required to ask. Bringing an emergency room mentality to the urgent care “tends to clog things up” and not allow for the streamlined experience urgent care provides, he says.
The future of urgent care
While urgent cares can be disruptive, that’s becoming less the case as payers and health systems figure out how to work with them. Shah says it helps to see urgent cares as just another piece of the bigger healthcare puzzle. “I think it has a bright future in terms of what it can offer, but there are a lot of things that need to be accounted for and work to be done,” he says.
Hospitals need to look at the urgent care’s governance and leadership and how it aligns with their own, he says. “Is there overlap? Is there inconsistent ideology? How do they work through that, or is that an opportunity to create unique spaces for each other and to make sure patients in their [respective] areas are accounted for and ultimately receiving both coverage of care and higher quality?”
Borich also believes urgent care will continue to grow, driven by demand for more access to care and for more cost-efficient care. But several factors could affect that growth. On the one hand, urgent cares haven’t competed against one another for the customer experience the way that EDs have been competing against each other over the past five or six years, he says.
“I think you’ll see more growth in the market as urgent cares that are hungrier for business move into established areas where there may already be an urgent care, but they don’t provide the service as well,” he says.
On the other hand, as organizations figure out how to use telemedicine, patients will be siphoned off from urgent cares by more convenient and cost-effective telehealth visits. “It hasn’t really made its move and its mark yet, but once it is figured out, it will hurt the urgent care business,” Borich says.