In a recent Loyale Healthcare article, “Healthcare Costs Continue to Soar as Patients Look for a New Kind of Provider Relationship” we focused on initiatives healthcare providers can pursue to provide more cost-efficient services to patients. One initiative described in that article promises to be a game changer – the emergence of Urgent Care Centers.
The first Urgent Care Centers in the United States opened during the 1970s and were affectionately referred to as “Doc-in-the Boxes.” Since then, this sector has rapidly expanded to approximately 8,000 – 9,000 centers across the United States.
Many of the early centers were started by emergency medicine physicians responding to a public need for convenient access to unscheduled medical care. Today, they represent an increasingly popular low-cost alternative to hospital Emergency Departments (EDs). These care delivery alternatives have grown in relevance as the millennial generation’s preferences for convenience and efficiency have begun to drive big changes in healthcare.
In a recent survey on medical service preferences conducted by WD Partners, the responses of 2,600 healthcare decision makers between the ages of 18 and 80 illustrated a rapidly shifting healthcare landscape:
“…it became evident that there was a significant contrast between the needs of younger versus older respondents. We found that despite consumers longstanding and continual loyalty to Primary Care Physicians (PCPs), urgent care centers are quickly becoming a highly preferred alternative. 42% of consumers considered an urgent care facility for healthcare services in the past 6 months, while 85% considered a PCP; when you look to how many facilities are open for each in the US (7,600 vs. 246,000, respectively), it is evident that there is a growing interest in urgent care as a serious PCP competitor.”
Not surprisingly, this popularity is driving growth in the sector. The number of U.S. urgent-care centers swelled to 8,774 as of November 2018, up 8% from 8,125 in 2017, according to the Urgent Care Association’s Annual Report. Contributing to the growth are the patients whose healthcare is covered by Medicare or Medicaid. This group’s use of urgent-care centers continues to grow, accounting for nearly 27% of all visits in 2018.
In addition to their lower costs and greater convenience, Urgent Care Centers can act as a partial solution to the increasingly acute shortage of medical personnel.
The Association of American Medical Colleges (AAMC) predicts a shortfall between 14,800 and 49,300 primary care physicians by 2030. Urgent care centers can relieve some of the stress created by this shortage by taking on a significant amount of primary care, often with physician assistants, thereby supporting PCP practices with easy access to same-day care and collaboration.
Urgent Care Centers, often offer fixed prices for services ranging from $150 to $250 per visit, compared to an emergency department where costs can run into the thousands. This has the potential to positively affect patient services beyond cost. According to a 2018 report, approximately 64 percent of patients between the ages of 18 and 64 have delayed or not sought needed or necessary care due to cost. The effect of this avoidance on the health of the patient has not been assessed, but it stands to reason that the avoidance of care due to cost is likely to lead to adverse health outcomes.
Additionally, about a third of the patients visiting urgent care centers have no primary care physicians, says Urgent Care Association (UCA) CEO Laurel Stoimenoff. “For that reason, urgent care really is a great connector because the number one referral we make is to primary care or into a medical home.” Thus, urgent care can be viewed as the rst stop for medical services and as a conduit to more advanced medical services as needed by the patient.
While Urgent Care Centers are focused on cost and convenience, they also offer transparency and efficiency in the administration of patient records and billing. Registration is generally highly efficient and costs are generally plainly posted.
Urgent Care Centers affiliated with mainline hospitals and other ambulatory providers can reduce overall costs through operating efficiencies and improved staff and patient satisfaction. Leveraging an enterprise-wide patient engagement platform, both Urgent Care Centers and full-service facilities can collaborate to meet all of a patient’s needs. And because data is gathered at every patient touch-point, system analytics can be mined for business intelligence to drive continual improvement.
Healthcare Networks in particular must establish and reinforce an overall identity – or brand – that promises positive financial experiences to win patient engagement and engender long-term patient loyalty. Today’s Urgent Care customer could be a legitimate ED patient with overnight admission the next time. Satisfied patients may later seek specialty care in areas such as oncology, cardiology or orthopedics. Network-operated Urgent Care Centers should not be isolated islands, but rather components in a well-run health system. A system committed to delivering a holistic patient experience, powered by a high performing patient financial engagement engine.
One such solution enabling common identity, transparency and high performance at Urgent Care Centers and traditional hospital systems and physicians groups alike is Loyale Healthcare’s Patient Financial Manager; the healthcare industry’s most widely deployed patient financial engagement solution. By combining Urgent Care Center financial records with the enterprise system’s patient clinical portal, Loyale’s platform-enabled solutions give patients and providers the tools they require, so patients can get the care they need – the way they prefer. All while helping providers achieve their goals for cost containment, growth and patient satisfaction.
What Urgent Care Centers Provide and Don’t Provide
Urgent Care Centers ll an important gap in the delivery of healthcare services, but they are not a cure-all. Operating with a limited scope of services, lower costs and greater convenience, they represent a critical steppingstone to more comprehensive care. 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:
1. Must accept walk-in patients during business hours
2. Treat a broad spectrum of illnesses and injuries, as well as perform minor medical procedures
3. Have a licensed physician operating as the medical director
4. Be open 7 days a week
5. Have on-site diagnostic equipment, including phlebotomy and x-ray
6. Contain multiple exam rooms
7. Various ethical and business standards
8. Contain a procedure room where stitches could be placed, a cast be put on a leg, or even a minor surgical procedure if it is not too risky and can be done under a local anesthetic (numbs a small portion of the body; however,will not put the patient into a medically induced coma).
9. Contain communication lines with local hospitals so that patients who need to transfer to an emergency room have easy access.
Americans go to a hospital 100 million times each year, and over 40% of these visits entail a trip to the emergency room. Many of these visits could be effectively covered by low cost, urgent care centers such as those operated by Providence Health & Services’ Urgent Care Division, and other low cost care delivery providers.
Urgent Care Centers are not for all patients or all patients’ medical issues but they do offer a solution to high ED costs, long ED waits and high patient co-pays and deductibles when Urgent Care services are appropriate to treat the patient.
The Critical Role for Traditional Healthcare Providers
Privately owned and run Urgent Care Centers could be viewed as competition to traditional hospitals and Primary Care Physicians. However, in what we believe is a best-case scenario for patients and providers, many forward thinking traditional healthcare providers are beginning to embrace the market’s new reality with strategies to build or acquire Urgent Care Centers.
“Urgent care centers emerged largely as a physician or physician-group strategy,” UCA says in its 2018 industry report. In 2008, physicians owned 54.1% of urgent care centers and hospitals had 24.8% of the total. Six years later, the two owned about an equal share of the market with physicians at 40% and hospitals at 37%.
A leader in Urgent Care Center expansion has been the HCA Healthcare Group, which recently purchased 24 MedSpring urgent-care centers from Fresenius Medical Care. The urgent-care centers will operate under HCA’s Medical City Healthcare division and be rebranded as CareNow Urgent Care.
The Future of Urgent Care Centers
According to the WD Partners survey, consumers consider urgent care facilities to be quick, easy places to get appointments and care. 28% of consumers have used this platform in the past 6 months (compared to 12% who used retail clinics), with 37% being repeat guests who have made three or more visits. Urgent Care is Quickly becoming a preferred provider over Primary Care Physicians, and has the potential to make a significant impact on the problem of rising healthcare costs.
For traditional hospital systems, the trend of building, buying or affiliating with Urgent Care Centers will need to accelerate to improve accessibility and convenience and to address rapidly evolving consumer preferences. By doing so, health systems will minimize the financial obstacles to care, and assure patients with a superior, seamless experience when referred for more advanced medical services.
Kevin Fleming is the CEO of Loyale Healthcare
Loyale Patient Financial Manager™ is a comprehensive patient Financial engagement technology platform leveraging a suite of configurable solution components including predictive analytics, intelligent workflows, multiple patient financing vehicles, communications, payments, digital front doors and other key capabilities. Loyale Healthcare is committed to a mission of turning patient responsibility into lasting loyalty for its healthcare provider customers.
Based in Lafayette, California, Loyale and its leadership team bring 28 years of expertise delivering leading nancial engagement solutions for complex business environments. Loyale recently announced an enterprise level strategic partnership with Parallon and has completed deployment of its industry leading technology to all HCA hospitals and Physician Practices.