Urgent care is a category of walk-in clinic focused on the delivery of
ambulatory care in a dedicated medical facility outside of a traditional
emergency room. Urgent care centers primarily treat injuries or illnesses
requiring immediate care, but not serious enough to require an ER visit.
Urgent care centers are distinguished from similar ambulatory healthcare
centers such as emergency departments and convenient care clinics by their
scope of conditions treated and available facilities on-site. While
urgent care centers are usually not open 24-hours a day, 70% of centers in the
United States open by 8:00 am or earlier and 95% close after 7:00 pm.
Urgent care outside of the USA Although the urgent care movement began
in the US, urgent care centers are now an important healthcare delivery
component in several other countries, including Canada, England, Ireland,
Australia, New Zealand and Israel. Urgent care in New Zealand
The Royal New Zealand College of Urgent Care runs a 4-year fellowship training
program in urgent care. In 2000, New Zealand became the first country to
recognize urgent care as a medical specialty. A MCNZ report estimated that
urgent care clinics then accounted for 9% of consultations in primary care. In
2007, a New Zealand Medical Journal paper defined these clinics by onsite
X-ray facilities, opening hours, and being community rather than hospital
based. Typically limited liability companies with salaried staff in a
central city location, they were distinct from both the deputizing
services available to general practitioners in the UK, and the
co-operative after hours centers becoming more common in the rest of the
Western world. This paper summarized findings from a 2001 MOH report in which
data was collected from 12 randomly selected clinics. Injury/poisoning,
respiratory and non-specific symptoms were common presentations. Consultations
took, on average, just over 15 minutes with most relating to new or short term
problems. Depending on the time of day, X-rays were ordered on between one fifth
and one sixth of visits. Overall, about half of visits resulted in a
prescription, commonly for antibiotics or analgesics. About a quarter of visits
during normal hours resulted in no treatment. During normal hours, 4.2% of
patients were referred to a hospital emergency department. Like General
Practitioners, but unlike hospital Emergency Departments which are free at
the point of service, NZ Urgent Care Clinics bill patients with a
part-charge, and one third of consultations were subsidized by ACC.
In March 2008, the Accident and Medical Practitioner's Association and the
Australasian Society for Emergency Medicine hosted the first international
urgent care conference in Auckland, New Zealand. Subsequent annual conferences
have been held in partnership with the Goodfellow Symposium.
History of urgent care in the United States
The initial urgent care centers opened in the 1970s. Since then, this
healthcare industry sector rapidly expanded to approximately 10,000
centers. Many centers were started by emergency medicine physicians,
responding to a public need for convenient access to unscheduled medical
care. A significant factor for the increase of these centers is significant
monetary savings when compared to ERs. Many managed care organizations now
encourage customers to utilize urgent care options. 3.1% of Family Physicians
in the United States now work primarily in Urgent Care. The male:female ratio of
this workforce is 6:7, and the urban:rural ratio is 2:1. This compares
to 3.6% of Family Physicians working primarily in Emergency Care, with a
male:female ratio of 5:3 and urban:rural ratio approaching 1:2.
Criteria for urgent care centers Both the Urgent Care Association of
America and the American Academy of Urgent Care Medicine have established
criteria for urgent care centers and the physicians that operate them. Each share
similar qualifying criteria including: Must accept walk-in patients during
business hours Treat a broad spectrum of illnesses and
injuries, as well as perform minor medical procedures
Have a licensed physician operating as the medical director
Be open 7 days a week Have on-site diagnostic equipment,
including phlebotomy and x-ray Contain multiple exam rooms
Various ethical and business standards The UCAOA program is called Urgent Care
Certification and the AAUCM is called Urgent Care Center Accreditation.
Organized medicine and urgent care The Urgent Care Association of America
holds an annual spring convention and an annual fall conference. Many leaders of
organized urgent care anticipate the establishment of urgent care as a fully
recognized specialty. Urgent Care Management Monthly hosts a
bi-annual conference, teaching doctors, investors, and owners about the business
side of an urgent care center. Urgent Care Management Monthly is the official
publication for urgent care management, with discussions on topics such as
billing, staffing, marketing, accounting, and logistics.
JUCM, The Journal of Urgent Care Medicine is the Official Publication of
the Urgent Care Association of America. Each issue contains peer-reviewed
clinical and practice management articles.
Board of Certification in Urgent Care Medicine provides board certification
for physicians with requisite training and experience. Urgent Care College of
Physicians Postgraduate training
In 2006, the Urgent Care Association of America sponsored the first fellowship
training program in urgent care medicine. A collaboration between the
Department of Family Medicine University Hospitals of Cleveland / Case School of
Medicine, the Urgent Care Association of America, and University Primary and
Specialty Care Practices, Inc. in Cleveland, Ohio made this fellowship
possible. The program was partially funded by an unrestricted grant from the
Urgent Care Association of America. Fellowship physicians receive training
in many disciplines, including: adult emergencies, pediatric emergencies,
wound & injury evaluation and treatment, occupational medicine, urgent care
procedures, and care center business aspects. In 2007, the Urgent Care
Association of America sponsored a second fellowship opportunity through
the University of Illinois. The one-year fellowships are open to graduates of
accredited Family Medicine and Med/Peds residencies.
Staffing and services Unlike other walk-in clinics such as
retail clinics, urgent care centers are generally staffed by a physician and
supported by nurses, physician assistants and medical assistants.
Sixty-five percent of urgent care centers have at least one physician
on-site at all times. Of the physicians that staff urgent care
centers, 47.8% are family medicine, 30.1% are emergency medicine and 7.6%
are internal medicine. With these licensed physician on-site,
urgent care centers are able to offer a wide range of services including broken
bones, moderate cuts and lacerations requiring stitches, and most common
injuries and illnesses. These services, of course, are made possible with the
diagnostic equipment and x-ray machines typically found at an urgent care.
Of course, the urgent care centers are not an emergency room and do not offer
surgical services. That said, an estimated 13.7 to 27.1
percent of all emergency department visits could take place at an urgent
care center or a retail clinic, generating a potential cost savings of
approximately $4.4 billion annually, according to a 2010 study in Health
Affairs. Hours of operation
Urgent care centers are usually great options for seeing a physician,
particularly after traditional office hours, on weekends or even holidays. In
fact, 85% of urgent care centers are open 7 days a week. Common hours of
operation are 8:00 am to 8:00 pm daily. In fact, 81.1% of urgent care centers
are open by 8:00 am and 90.6% are open until at least 7:00 pm.
These extended hours are particularly helpful if patients are looking to avoid
the hassle of hospital emergency rooms for less severe conditions. Over 80% of
ER visits occur during the most common hours of urgent care centers.
Ownership The majority of urgent care centers are
owned by physicians or physician groups, however, more corporations and
investment banks are acquiring urgent care centers and creating regional and
national brands in the industry. The following is a breakdown of urgent care
ownership following a 2012 study by the UCAOA:
35.4 percent of centers owned by physicians or physician groups, down
from 50 percent in 2010 30.5 percent owned by a corporation, up
from 13.5 percent in 2010 25.2 percent owned by a hospital
4.4 percent owned by a non-physician individual
2.2 percent owned by a franchise Urgent care centers by state
Given the constantly evolving industry and opens and closures of urgent care
centers each week – and lack of standardized SIC or NAICS codes – it is
impossible to know the exact number in the country, much less by state.
However, according to the most accurate, known database of walk-in clinics, the
following is a state-by-state breakdown of urgent care centers.
Point-of-care medication dispensing Point-of-care dispensing enables
healthcare practitioners in the urgent care setting to ensure that their
patients receive their prescription prior to leaving the clinic. To offer
this service to patients, urgent care centers generally contract with a
point-of-care dispensing corporation. Point of Care dispensing enables
physicians to dispense at urgent care facilities. Unlike a pharmacy,
practitioners may only dispense to their own patients. Regulations regarding
state pharmacy law vary from state to state. Dispensing by a healthcare
practitioner is not legal or quite limited in certain states, such as Texas
and New York. Group purchasing organization
Group purchasing organizations, focusing on the urgent care industry, have been
formed. The concept of these GPOs is that they join hundreds of urgent care
centers together to allow the type of price bargaining that previously was
only available to hospitals. Medical malpractice insurance
Malpractice insurance offerings unique to the urgent care industry have begun
to be widely discussed in light of the fact that many insurers do not recognize
the reduced malpractice risk of urgent care centers. Insurers that recognize
this reduced risk do not group urgent care centers with hospital emergency
physicians and other high-risk specialties. Features of this type of
insurance may include no charge for tail coverage when providers leave, 3-5 day
approval of new providers, no additional premium when providers are added to the
policy, per visit FTE rating, and lower premiums.
Codes for urgent care In recent years the American Medical
Association approved the code UCM. This code allows physicians to self-designate
as specializing in urgent care medicine. Services rendered in an urgent care
center may be designated, using the place of service code -20 on the
CMS-1500 form, as submitted to third-party payers. The Centers for
Medicare & Medicaid Services have designated two specific codes to apply
to urgent care centers: S9083 and S9088. Advantages of urgent care over emergency
departments For injuries and illnesses that are
urgent but not life-threatening, it is more efficient to use urgent care than
an emergency department in terms of both money and time. The typical wait time to
be seen at an urgent care center is less than 30 minutes, compared with hours at
an emergency department. As of 2009, urgent care centers cost
less than emergency departments and have the potential to provide much more
efficient care for nonurgent cases. Reimbursement by insurance companies for
urgent care centers is comparable to general/family practice reimbursement,
which is well below the average contribution for emergency department
visits. References
External links Urgent Care Association of America
American Academy of Urgent Care Medicine Journal of Urgent Care Medicine