Urgent care centers: if we build them, will all patients come?

Urgent care centers are growing across the United States in response to emergency rooms that are standing-room-only for many patients trying to access them. But can urgent care centers play a cost-effective, high quality part in stemming health care costs and inappropriate use of ERs for primary care.

That’s a question asked and answered by The Surge in Urgent Care Centers: Emergency Department Alternative or Costly Convenience? from the Center for Studying Health System Change by Tracy Yee  et. al.

The Research Brief defines urgent care centers (UCCs) as sites that provide care on a walk-in basis, typically during regular business hours, as well as evenigns and weekends, though not 24 hours a day. They treat the kinds of conditions seen in primary care offices and retail clinics – ear infections, strep throat, the flu, and minor injuries, among the most common treatments seen at UCCs.

UCCs are generally found in high-density, high-income areas with heavy foot and vehicle traffic and high proportions of employer-sponsored health care among the people who live in the local communities. UCCs are lower-cost than than emergency rooms, and roughly equal in cost to primary care practices. UCCs’ patients tend to be privately or Medicare-insured. When UCCs serve uninsured people, they generally require up-front payment which, as Yee and her colleagues point out, can be a barrier to access.

When owned and operated by hospital groups, UCCs provide convenient continuity of care within their health systems. One hospital executive quoted in the paper referred to urgent care as a “funnel” or “gateway” to their hospital system.

Health Populi’s Hot Points:  The expansion of insured people in the U.S. in 2014 is expected to strain the already-constrained primary care supply of doctors and other primary care providers (PCPs). UCCs can be viewed as convenient, community-based sources for primary care – although they are staffed by PCPs which diverts those staff people away from more traditional primary care locations (doctors’ offices, ERs, clinics, etc..

But if the cost structure of the UCC is lower, and quality assured, then UCCs can play a key role as an on-ramp to primary care before patients seek care in a more expensive emergency department.

The challenge will be in educating people who currently prefer using the emergency department to seeing physicians in offices to using lower cost sites like UCCs. This will be a critical challenge especially for lower-income people: in research published this week in Health Affairs, the case is made for Understanding Why Patients of Low Socioeconomic Status Prefer Hospitals Over Ambulatory Care. Kangovi et. al. found that patients with low socioeconomic status use more acute hospital care and less primary care than patients with high socioeconomic status.

This pattern of care conflicts with goals toward moving people toward a high-value health system, to channeling people to access health care services in the most appropriate level and cost of care. If lower-income people tend to perceive high-value and quality is gained in the hospital setting, all things being equal, that pattern won’t change unless incentives (payment, personal values, social network pressures) do.

Kangovi and colleagues warn that accountable care organizations shouldn’t assume that patient-centered medical home strategies will automatically be attractive to newly-insured patients. As in all new product designs, the key to success is in building the values and preferences of customers into the offering. Patients have a stake and must play a role in crowdsourcing the design of a more effective U.S. health system.

3 Responses to Urgent care centers: if we build them, will all patients come?

  1. Dr Pullen July 13, 2013 at 12:19 am #

    The idea that urgent care centers can only be associated with hospitals, pharmacies, or be freestanding leaves out the reality that family practice groups like ours have for many years had evening and weekend “walk in” clinic hours for our patients as well as for the community. This concept has been very well received by our patients and has allowed us to capture the “easy” visits that used to go to the ER, or outside freestanding UCCs. If was just poor business to manage the diabetes, hypertension, depression, and chronic illness, and have the sore throat or ear ache on Sunday go elsewhere. A tru win-win situation. There is little reason for any medium sized of larger group not to find a way to capture the profits of this work, save the system money, and provide better continuity of care to their patients.

  2. West Coast Urgent Care Pasadena July 16, 2013 at 12:46 pm #

    The urgent care centers can provide the best and high quality treatments to the patients. This health care is moving towards a high-value system, so the people can access the most appropriate level and cost of care.

  3. LukeGray July 19, 2013 at 5:29 am #

    Well I think urgent care is a better and affordable option for people and because urgent care clinic provide their services 24 hours and they also provide best facilities and affordable emergency treatment. Everyone get the best health treatment at urgent care clinic.

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