In our era of Amazon Prime, fast food and high-speed internet, consumers’ demands for convenience and speed have unsurprisingly permeated the health care market. The past decade has seen the significant growth of urgent care facilities across the country. Since moving to the Richmond area 12 years ago, the number of urgent care facilities within my home’s fifteen-minute radius has grown from 1 to 4, filling empty areas in shopping centers as if restaurants or convenience stores. This growth does not even include the many additional retail clinics in my close vicinity that have sprung up in pharmacies, grocery stores and Walmarts offering walk-in care that can be utilized in between running errands. The Urgent Care Association of America estimates that 300-600 new urgent care clinics are popping up each year contributing to what is more than a $16 billion a year industry and providing a needed intermediary between the ER and the primary care physician. As of June 2017, more than 7,639 urgent care centers are reported to be in operation.What specific role has this booming industry come to fill in our ever-evolving healthcare landscape in providing care, and what risk exists with such convenience?
Low cost care: The demand for urgent care facilities has risen in part with the increasing costs of ER visits. Urgent care facilities operate on a low-margin, high-volume care business model. As a result, while an average ER visit costs about $1,354 the average visit to an urgent care facility costs about $150. Although the difference of the severity in health problems addressed at these two levels may help to explain this cost disparity, this significant difference is also observed when comparing the cost of care for specific ailments. On average, a patient coming in for a strep throat will pay $531 at the ER while paying $112 at an urgent care facility. For a urinary tract infection, the difference will be $665 compared to $112. For a sore throat, it is $525 as opposed to $94 with urgent care. Urgent care facilities typically allow for significantly cheaper care for the treatment of common ailments than that offered in the setting of the ER, keeping insurance copays similar (and sometimes even lower) to that resulting from a visit to the doctor’s office.The financial appeal to patients is evident.
Convenient care: Beyond just our cultural transition to a more fast-paced society, the growth of the urgent care industry also stems from an increasing shortage in primary care providers and the corresponding challenge of scheduling a doctor’s appointment. One in 5 patients report that in the last two years they experienced a time when their regular doctor did not have an available appointment for them when care was needed. In polls conducted by the Robert Wood Johnson Foundation, most people reported choosing to go to Urgent Care for this reason or citing that they found Urgent Care to be more convenient with its extended hours and that it takes less time out of their day. Indeed visits to urgent care providers avoid the long wait times found in emergency rooms while cutting out the delay period that is associated with primary care between a patient’s ailment and their often far-off appointment.
Appropriate care: Urgent care facilities prove a better venue for the many non-emergent cases that consistently overcrowd and slow ERs. An estimated 13.7-27.1 percent could be better treated at urgent care centers and retail clinics, saving about $4.4 billion dollars annually, allowing for greater concentration to be placed on life-threatening emergencies and ensuring that discouraged patients do not leave the ER. Minor acute illnesses, strains and fractures are examples of conditions more appropriate for this intermediary health provider that are too often seen in the ER. While research analyzing the success of available urgent care providers on lowering ER congestion in the U.S has been mixed, 2014 research on similarly-modeled urgent care clinics in the UK on reducing ER overcrowding has demonstrated their effectiveness.
Routine care? Maybe not: Although urgent care usage may be convenient and helpful when medical symptoms are pressing, it is important for patients to avoid making urgent care their source of primary care for all ailments. In 2015, urgent care and retail clinics handled an estimated 20% of all primary care visits according to Accenture yet physicians continue to argue the importance of having a primary physician who knows a patient well- their family history, their lifestyle choices, their diet and exercise pattern- for the purpose of diagnosing and treating. These primary doctors can trace different symptoms across a longer time period to detect underlying conditions in patients, track medication usage (an important role in limiting addiction to painkillers and prescribing antibiotics appropriately) and work to coordinate care. They also provide vital preventative and monitoring care that can limit future emergency health problems that may require costly trips to the ER. Sole crisis-responsive care in the long-term is unsustainable. While primary care may not always be as “convenient” as our contemporary society may like, its wis-reaching benefits cannot be overlooked. Urgent care has a needed place in our evolving healthcare field, however, this place is not all encompassing.
Urgent Care continues to grow as an industry offering affordable, convenient and appropriate care. Urgent care chains such as MedExpress, Patient First and BetterMed continue to cite successful expansion in Virginia. Additionally, many hospitals have created their own urgent care branches or in engaged in partnerships with pre-existing urgent care clinics to minimize their ER visitors and also to reach different communities.We now have an easy and consistent third option to primary and hospital care and patients’ are taking full use of it!
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