October 14, 2015

Meet the new urgent care: bigger, more integrated, and with more services

Daily Briefing

The urgent care market is growing and changing rapidly, forcing providers to rethink their strategies to capitalize on the trend, Jacqueline Fellows reports for HealthLeaders Media.

The American Academy of Urgent Care Medicine estimates there are more than 9,000 urgent care centers in the United States. And according to the Urgent Care Association of America, 60% of urgent care providers expanded in some form to meet rising patient demand in 2013.

But the urgent care market care market isn't just growing—it's maturing, Fellows writes. Providers are learning how urgent care fits into the broader health care market and are adopting new strategies to deal with increased competition.

Network integration

For instance, St. Louis-based St. Anthony's Medical Center has changed its organizational structure to better integrate its four urgent care clinics with its ED. In 2014, the hospital reorganized its ED and moved urgent care centers, occupational medicine, and community health and wellness all under ambulatory care.

For hospitals and insurers, urgent care has become a lucrative investment

The hospital has also taken several steps to ease patient transfers between its ED and urgent care centers. If patients are referred from one of its urgent care centers to its ED:

  • They have their urgent care copay applied to the ED visit;
  • The EHR system—shared between the urgent care center and the hospital—automatically alerts the ED doctor so they can check for labs and tests that have already been completed; and
  • The hospital will hold a bed for 30 minutes under its direct-to-ED bed policy.

Beverly Bokovitz, CNO at the hospital, says the direct-to-ED bed policy has dramatically reduced the average ED wait time for such patients—from 125 minutes in 2013 to 19 minutes in 2014.

Expanding services

As the urgent care market becomes more crowded, health systems are also rethinking what type of services to provide in the urgent care context. Pigeonholing your clinics as just providing urgent care is a mistake, Bokovitz says. "The best strategy is to think about what other types of services you can offer if you have multiple locations."

For example, California–based HealthCare Partners, a division of DaVita HealthCare Partners—which runs medical groups and urgent care centers in California, Florida, Arizona, Nevada, and New Mexico—is actively diversifying its urgent care services and added a cardiology department last year.

Claudia Pfeil, one of two lead physicians at the Pasadena clinic, says bringing in specialty services was a response to patient needs and helped drive the clinic to move to a larger facility in June that is open 24-hours a day, 365 days a year.

"Prior to going 24/7, by 10 or 11 o'clock at night, we were scrambling to try to transfer patients out," Pfeil says. Now, with nine observation rooms and expanded hours, the clinic has "more time to really provide better care and get them directly admitted to the hospital or into a skilled nursing facility."

Pfeil says that it takes a dedicated effort to educate patients and referring are providers about urgent care clinics. Plus, Fellows notes, ensuring that urgent care centers serve as an aid—and not an impediment—to care coordination is also an ongoing challenge.

Challenges ahead

Robert Rankins, founder of E-Care Emergency Centers, says the network tells patients that, "we do not want to be their primary care doctor," and instead aims to connect patients with PCPs. Rankins also notes that the uneven regulatory environment for urgent care clinics among different states can also be difficult to deal with.

But even with the challenges, urgent care has a big role to play in the new health care landscape, says Steve Sellars, CEO of Premier Health Urgent Care.

"We have an aging population, a looming shortage of primary care physicians, and more insured people in the marketplace," Sellars notes. "When you lump all that together with what urgent care provides, it's safe to say that urgent care will play an important role in the healthcare system going forward" (Fellows, HealthLeaders Media, 10/6).

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