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Urgent Care Trends and Opportunities

Dec 06, 2018
Posted by: Stearns Bank

Here are urgent care facts and trends from the white paper “The Essential Role of the Urgent Care Center in Population Health”, published in 2018 by the Urgent Care Association:

Definition: Urgent care center is a medical clinic with expanded hours that is specially equipped to diagnose and treat a broad spectrum of non-life or limb-threatening illnesses and injuries. Urgent care centers are enhanced by onsite radiology and laboratory services and operate in a location distinct from a freestanding or hospital-based emergency department. Care is rendered under the medical direction of an allopathic or osteopathic physician. Urgent care centers accept unscheduled, walk-in patients seeking medical attention during all posted hours of operation.

Industry Trends and Growth Drivers

Health care spending has climbed to 17.8 percent of U.S. gross domestic product, and growing at an unsustainable rate.

Urgent care centers have high patient satisfaction, due to convenient locations and hours, ability to walk in without an appointment and receive diagnosis and prescription (if needed) within an hour.

Staffing: Most urgent care centers have a physician covering shifts. But the staffing model often is a hybrid of physicians and advanced-practice clinicians or nurse practitioners and physician assistants. Nurse practitioners have become increasingly independent in their scope of practice, as states respond to primary care shortages and health care access issues in rural and other under-served areas.

Growth drivers:

  • Consumerism and high-deductible health plans. Individuals and families are paying out-of-pocket for more of their health care, so they are seeking cost-effective treatment options
  • Shortage of primary care physicians
  • Positive clinical outcomes in urgent care centers
  • Consistently high-patient satisfaction
  • Convenience, ease of access.
  • Lower cost than other care settings, especially hospital emergency rooms.

Urgent Care Market

Urgent care is an $18 billion industry, expected to grow 5.8 percent annually through 2018.

In mid-2017, there were 7,639 urgent care centers in the United States.

Communities with urgent care centers were more frequently in and around metropolitan areas and had higher income levels and higher percentage of privately insured patients.

Urgent care volume can be seasonal, typically spiking during late fall and winter. Patient volume often correlates to the intensity of the flu season where urgent care centers play a significant role as part of the safety net in caring for afflicted patients in communities they serve.

Urgent Care Role in Health Care Delivery

Urgent care centers are access points into the health care system, collaborating with the patient’s primary care physician and providing early diagnosis.

Urgent care represents more than 18.2 percent of all primary care visits and 9.7 percent of all outpatient physician visits. This illustrates the significant role urgent care centers are playing in the delivery of primary and ambulatory patient care.

Occupational health: Urgent care centers offer pre-placement physicals, urinary drug screening and post-injury testing, annual physicals, flu immunizations and workforce health education on injury/illness prevention. The opportunity for seven-days-per-week access for treating immediate injuries and continuing the medical care until returning patients to full duty is a significant benefit for many employers.

Cost Effectiveness and Payer Mix

Private commercial health insurance is the dominant payer type. Due to low reimbursement in public programs, Medicaid is lowest payer category. However, 61 percent of urgent care clinics accept straight Medicaid in their state and 70 percent accept managed Medicaid.

Urgent care clinics can reduce costs for state Medicaid programs when patients are diverted from hospital emergency rooms. Urgent care is a more cost-effective gateway to the health care system.

2015 Cost Trends Report indicates 40 percent of emergency department visits could be treated effectively at a lower level of care. Emergency department visits were reduced by 30 percent in communities where there was access to walk-in, no-appointment medical care.

Based on claims studies across similar diagnoses, the cost of care in emergency rooms was 10 times higher compared with urgent care centers.

Value-based payment models are emerging as urgent care centers integrate with hospital networks. Health systems and payers are seeking to off-load overcrowded emergency departments and overburdened primary care providers.

Ownership and Investment

Ownership of urgent care centers is held mainly by physicians and physician groups. However, since 2008, hospital ownership has increased (to 37 percent), while physician ownership has declined (from 54 to 40 percent).

Health care systems such as Dignity Health, HCA, Aurora Health, Intermountain Health, and Carolinas Healthcare have made significant commitments to urgent care in their communities and beyond. Urgent care aligns with many health care systems’ objectives of providing cost effective, accessible care, particularly when integrated with other ancillary, specialty and primary care strategies.

Many multi-site urgent care centers have taken on private equity partners to finance growth and enter new markets. Payers have accelerated ownership in the on-demand health care delivery sector. Payers announcing investments in urgent care include Optum (UnitedHealth Group), Humana and Aetna.

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