Urgent Care Centres – USA Perspective

According to SA Emed :  “Urgent care did not exist in Australia until 2011 but is a very strong industry in the USA which has 3700 Emergency Units but 8700 Urgent Care Centres. Urgent Care centres are basically free standing emergency clinic’s not attached directly to a hospital. They can see over 95% of the standard case mix of a hospital emergency centre. No heart attacks, strokes or car crashes but almost everything else. They are aimed at speed for the walking wounded and sick as an alternative to hanging around the waiting room of a public or private hospital.” Note – SA Emed & Ekera Urgent Care merged to form Ekera Urgent Care SA Pty Ltd to cover the Adelaide Market. Ekera is also linked to Urgent Care Australia.

For a good overviews of Urgent Care Centres in the USA

1.  Wayne T Price’s article “Urgent Care Centres Carve Out a Key Health Care Niche” October 14 2010 : “In a growing trend, consumers increasingly turning to walk-in clinics and urgent care centers for treatment of minor ailments and injuries instead of trying to squeeze in an appointment with a primary care provider or waiting at a crowded emergency room…. Jason Shafrin, a Burlingame, Calif.-based economist specializing in health care, said the changes in health care delivery come as more and more people worry about time constraints and rising medical expenses. 

“For patients, lower cost and more convenience play a larger role,” he said…. By 2007, the Urgent Care Association of America said there were about 8,100 urgent care centers in the United States. That has grown more than 7% since then to about 8,700 today… Urgent care center operators like to stress the differences between their facilities and the walk-in clinics like those found at Walmart and other retail settings. The latter typically are staffed with nurse practitioners or physician assistants, not doctors, and they tend to focus on treating minor illnesses such as upset stomachs, allergies or the flu… Nationally, many hospitals and physician groups are guarded in their comments about urgent care centers and walk-in clinics, though they do see urgent-care centers filling a void.”

2. Results of a 2009 Survey of USA Urgent Care Centres can be found here  “With long waits for appointments with primary care providers, difficulty with same-day access for sick care, limited access to after-hours care, and extended emergency department waiting times, this decade has seen the growth of newer sites for the provision of episodic primary care services in the U.S.” The survey concluded : “While their hours and scope of services reflect some characteristics of emergency departments, urgent care centers are in many ways similar to family medicine practices.

3. A more detailed perspective is given in a 2007 California Healthcare Foundation Report – they first opened in the USA in 1980’s – often as independents not attached to existing hospitals. They then declined with many closing in the early 1990’s and then expanded in the mid 1990’s and have grown rapidly since.  Closures in the 1980’s  were attributed to a number of causes including hospitals were buying the UCC’s & running them with large overheads like licensed nurses, triage processes & union wages making them unprofitable. Like in Australia, there is no universally accepted definition of a UCC – anyone can call their centre an Urgent Care Centre. Although typically they are walk-in, unscheduled, episodic care facilities offering extended hours and weekend hours – with an expanded array of services compared with a primary care physician, including minor trauma. Waiting times to see family physicians are cited as being as long as 6 weeks or more and this has helped to drive Urgent Care Centres and Retail Medical Centres… Many Emergency Departments now operate minor care areas that focus on low acuity patients – known as Fast Track which may be staffed by physicians, nurse practitioners or physicians assistants.

In California the prevalence of Managed Care impacts Urgent Care Centres – which may be run more like an Emergency Department and hence lossmaking – however they save the Health Fund the cost of the more expensive Emergency Department visits & avoid unnecessary testing as their is on-line access to health records.

In the USA at the time of the 2007 report Urgent Care Centres were generally not owned by large multi-state chains – mostly they operated over an average of 2.7 sites with the largest operating 23 sites over 4 states. However there is potentially a move to larger chains to consolidate costs. They may also be part of multi-specialty practices or hospitals

4. A 2011 USA Today Report on Urgent Care Centres : “To meet demand, the number of facilities has increased from 8,000 in 2008 to more than 9,200 this year, the association said. About 600 urgent centers opened this year. Fueling that rise are two longstanding trends — crowded emergency rooms and a lack of primary care doctors. Urgent care operators say another factor is helping to propel business: the drive to lower costs. …Humana last year became the first major insurer to get into the urgent care business when it bought Concentra, which has more than 300 centers in 40 states. “We want to make sure we have access to providers in key areas,” said Paul Kusserow, Humana’s chief strategy and corporate development officer. As Humana and other insurers shift to using smaller networks of doctors and hospitals to hold down premiums, urgent care will be a vital outlet when doctors’ offices are too busy, he said. Humana and other insurers have expanded the number of urgent care centers in their provider networks to reduce unnecessary ER use. Hospitals also are adding urgent care centers to increase admissions, and in the future they see it as a way to keep their costs down in treating patients…Urgent care is not as good as having a regular physician, says Glen Stream, president of the American Academy of Family Physicians. He is concerned the surge in urgent care use could lead to fewer patients having a regular physican. “No one really gets to know them, if they use a different urgent care each time,” he said. “One of the best predictors of health outcomes is having a usual source of care where you can go for acute and chronic illnesses and develop a relationship with a doctor.” ”

Some USA Urgent Care Centre examples

  • Emergency USA– Virginia (2)
    • 8am-6pm x 5 days – accept walk-ins
    • seems more like a Medical Centre ie covers normal GP / Superclinic services (?) for minor illnesses & injuries but not more serious conditions
  • Maryland Urgent Care (1)
    • 7am-6pm x 5 days
    • seems more like a Medical Centre ie covers normal GP / Superclinic services (?) for minor illnesses & injuries but not more serious conditions
  • Medics USA– based in Washington DC (1)  & Virginia (4)
    • may be open up till 9pm – but some only till 7pm – some, but not all, open weekends
    • medical problems that are urgent, but not life threatening in nature.
    • Urgent care is the treatment for a condition that requires prompt attention, but does not pose an immediate, serious health threat. A sprain, minor cut, sore throat or rising temperatures are some examples of conditions which our urgent care staff can treat
    • Fees are due and payable at the time of service – We are a participating Medicare provider.
    • Reviews on Washington DC facility
  • Multicare  – Washington State (9)
    • 9am-9pm x 5 days & open weekends
    • Allergies, Cold or flu symptoms, Cough or bronchitis, Earache, Minor burns or bruises, Rash, poison ivy, allergic reaction, Fevers, Scrapes or minor cuts, Sore throat, Sprain, Minor fracture, Foreign object in eye or nose
  • Urgent Care USA– Florida (2)
    • 9am – 9pm x 365 days per year
    •  Immediate medical attention for simple or mildly complicated health issues (if life or limb is at risk, please call 911 immediately!)
    •  Onsite X-rays, EKG or lab tests while you wait
    • Much shorter wait  and lower insurance co-pay than at a hospital Emergency Room
  • UPMC– Philadelphia (7)
    • 9am-9pm – 7 days per week
    • seems more like a Medical Centre ie covers normal GP / Superclinic services (?) for minor illnesses & injuries but not more serious conditions – ie minor fractures, sprains & strains
  • University of  South Alabama Urgent Care Centre
    • open 8am-5pm x 5 days to Campus Faculty & Staff plus neighbours near the Campus
    • seems more like a Medical Centre ie covers normal GP / Superclinic services (?) for minor illnesses & injuries but not more serious conditions for ages 2 and up
  • WeCareUrgentCare – Arizona (1)
    • 9am-8pm 5 days & 9am-5pm weekends
    • seems more like a Medical Centre ie covers normal GP / Superclinic services (?) for acute illness & injury but not more serious conditions – however information suggests for more minor conditions
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