Walk-in urgent care at Emergent Care Plus.

The Case for Urgent Care

Abstract: Urgent care centers have been open in the US for over thirty years and see between 71 and 160 million patient visits each year. As the US healthcare system faces issues with access to care, increasing patient needs, growing demands on the primary and emergency care systems and rising costs, it is striking that urgent care centers are rarely included in solution development at the legislative level. Independent studies have shown that urgent care can improve access, while lowering costs, but no global review has been done. To help address this absence, the authors performed an environmental scan of the recent literature with the ultimate goal of educating the public and policymakers about the current and possible future roles of urgent care centers in healthcare delivery.

Since the early 1980s, urgent care centers have been operating in the US. Since the mid 1990s the industry has grown rapidly1 to between 4,000 and 9,000 facilities according to the Urgent Care Association of America, the industry's trade association.2 There have been studies of the industry by established research institutions such as the California Health Care Foundation, the Institute for Health Policy at Massachusetts General Hospital and RAND. There are articles supporting the benefits of urgent care found in publications ranging from the Wall Street Journal to The New York Times to HealthLeaders. Yet there appears to be no inclusion of urgent care in any of the recent federal healthcare legislation.

The current dialogue around healthcare delivery reform emphasizes use of the Patient Centered Medical Home (PCMH, also called Advanced Primary Care) and the primary care physician as the solution for lowering the costs of care.3 Urgent care has significant existing potential to participate in this model, yet its role has not been examined. Urgent care has been noted in studies to reduce overcrowding in the Emergency Department in several local programs4,5, yet there is not yet a national discussion about that success.

This paper attempts to bring together the results of the many national and regional studies and articles of recent years to illustrate the role urgent care centers are currently playing in improving access to and lowering costs of healthcare. In addition, it will review both current and future potential roles for urgent care centers, and highlight the need to include urgent care centers in healthcare delivery reform solutions at all levels.

Overview of Urgent Care

The broadest definition of urgent care, as defined by the Urgent Care Association of America, is healthcare provided on a walk‐in, no‐appointment basis for acute illness or injury that is not life or limb threatening, and is either beyond the scope or availability of the typical primary care practice or retail clinic. There are approximately 9,000 facilities in the US that meet this definition.

The majority of urgent care centers provide services in episodic primary care, occupational medicine, routine immunizations and school physicals, and at least half of them (4,000+) also provide lab tests, x‐rays, fracture and laceration care, and intravenous fluids. They are typically open significantly beyond standard nine‐to‐five office hours, including nights and weekends. Urgent care centers are owned by physicians, groups of physicians, hospitals and corporations, and are typically staffed with physicians, with approximately half also employing physician assistants and nurse practitioners as additional providers.

Urgent care centers see, on average, 342 patient visits per week. Therefore these 4‐9,000 centers are seeing between 71,136,000 and 160,056,000 patient visits each year.

Access To Care

According to the Department of Health and Human Services (HHS), as of June 2011, there are 66,615,059 people living in a primary care Health Professional Shortage Area in the United States.10 A 2009 study by the National Association of Community Health Centers (NACHC) placed the number of individuals "lacking access to primary care" at 60 million. Only 2 years earlier that number was 56 million. That increase occurred despite the fact that community health centers added two million people to their patient rolls over the same period.

For Americans who do have a regular physician, only fifty‐seven percent (57%) of Americans report having access to same or next‐day appointments with that physician and sixty‐three percent (63%) report difficulty getting access to care on nights, weekends or holidays without going to the emergency room. Twenty percent (20%) of adults waited six (6) days or more to see a doctor when they were sick in 2010.

Whether or not patients have a formal relationship with a primary care or "regular" physician, there is a current national challenge in accessing care, especially on an "urgent" basis: with no appointment, evenings, weekends and holidays. In contrast to traditional physician offices, urgent care centers are by design already open evenings, weekends and holidays and do not require appointments to see patients.