Urgent Care Everywhere

Why centers are opening around town

CRAIG MULCAHY PHOTOGRAPH

Say you’re doing a little gardening on a Saturday afternoon when you take a step off the beaten path and – ouch! – a roofing nail pokes through your sandal puncturing the bottom of your foot.

What to do? According to many health care administrators, too often the response is a rush to the nearest emergency room, not because a true medical emergency exists, but because better treatment options aren’t available.

Getting medical care when you need it isn’t simple these days. Even for the individual or family who regularly visits a primary care physician, when a need arises outside of the doctor’s normal office hours it can be hard to get help. As for people who don’t have a “family doctor,” an emergency room nearly always seems the only choice.

But a glance around the New Orleans area shows the picture is changing. No, house calls aren’t making a comeback. But in high-traffic areas throughout the region – positioned near banks or grocery stores or tucked into small shopping centers – neighborhood clinics are sprouting up. They commonly wear names such as Urgent Care or Doctors After Hours and, unlike most traditional health care facilities, these little offices welcome walk-in clients.

“Urgent-care centers fill a space between emergency rooms and primary care physicians,” says Adam Winger, a lawyer who specializes in health care industry transactions at the Baker Donelson law firm. “They allow people who don’t have real emergencies to come in and see someone on a walk-in basis when they can’t get an appointment with their primary care physicians or maybe don’t even have one.”

Winger, who has advised corporations that make investments in urgent-care centers, says the concept is a hot draw for private investors. He says that large health care corporations, such as Dallas-based Concentra, can’t seem to open urgent-care centers fast enough. “For the big players, it’s a race to saturate markets and establish a presence that would keep out other competitors,” he says.

That race is under way throughout the country. About 300 new centers have opened annually during the past few years, with a total of about 9,000 facilities now operating in the United States, according to the Urgent Care Association of America.

The association defines urgent care as health care “provided on a walk-in, no-appointment basis for acute illness or injury that is not life or limb threatening” and is beyond the scope or availability of a typical primary care practice.

Most such centers provide “episodic” primary care, occupational medicine, routine immunizations and school physicals, according to the association, which says that about half of the centers also provide lab tests, X-rays, fracture and laceration care and intravenous fluids.

Typically, urgent care centers are open on a 12-hour daily schedule, including nights and weekends, and are owned by doctors or physician groups, hospitals or corporations. Many employ physician assistants and nurse practitioners in addition to primary care doctors.

Winger says that, along with the obvious appeal such centers hold for people in need of quick medical attention, they score big with government reimbursement programs and insurers. The average visit to an emergency room costs insurers $400 to $600, he says, while a visit to an urgent-care center might run half that amount.

Many hospitals have embraced the concept because it helps unclog their overused emergency departments and some, including Ochsner and East Jefferson locally, have opened their own versions of the centers.

While big institutions own about 30 percent of the urgent-care centers in America, small companies and physician groups have shown increasing interest. New Orleans-based Millennium Health Care Management Inc., for instance, has opened six centers during the past several years and manages another six in south Louisiana and Mississippi. Co-founder and CEO Keith LeBlanc says he and his partners saw opportunity in the changing dynamics of health care delivery.

LeBlanc says the choice between waiting four hours for care in a hospital emergency room and being treated in less than an hour in an urgent-care setting is a no-brainer for consumers. People also feel the difference in their wallets, he says.

As employers have felt the pinch of rising health care costs, many have pushed more of the burden for employee health plans onto workers in the form of higher premiums, deductibles and co-pays. But some insurers are encouraging their clients to use less expensive outpatient options by reducing co-pays for care in an urgent-care center while increasing the out-of-pocket requirement for an emergency room visit.

LeBlanc says his company, which recently opened Lakeview Urgent Care, is building market share by signing contracts with large employers to provide outpatient services, including drug-testing and pre-employment physicals, and by expanding geographically. “We anticipate having 12 to 14 centers in the general area” within the next few years, he says.

The rapid proliferation of urgent care could mean that some centers, particularly those located close to other clinics, won’t survive over the long term. Factors that will affect their survival include quality of care they deliver, convenience of location and their ability to maintain contracts with insurers, experts say.


Facts About Urgent Care
While urgent-care centers are bringing welcome relief to an overburdened segment of the health care marketplace, experts say they aren’t designed to replace the traditional role of the primary care physician, whose mission is to build a trusting relationship with patients and provide comprehensive care on a continuing basis.

Freestanding clinics also aren’t the place to seek treatment for a clearly serious injury or condition. “No urgent care center in the country will see you for chest pains,” says attorney Adam Winger, of the Baker Donelson law firm.

But for people with non-life-threatening injuries or ailments, urgent-care centers are filling a growing demand.

Here are a few facts about the market, provided by the Urgent Care Association of America.

Number of urgent-care centers in the United States: about 9,000

Average number of visits, per center, per week: 342

Wait times: 57 percent of patients wait 15 minutes or less to be seen.

Time in operation:
5+ years: 53 percent
3-5 years: 26 percent
1-2 years: 12 percent
Less than 1 year: 9 percent

Ownership:
Corporation: 13.5 percent
Physician or physician group: 50 percent

Non-physician individual: 7.7 percent
Hospital: 27.9 percent
Franchise: 1 percent

Some centers seek accreditation from the Joint Commission on Urgent Care Accreditation. For a list of centers that have met the accreditation standards, visit ucaoa.org.

Many centers have signed agreements with private insurers, as well as Medicare and Medicaid, but it’s a good idea to check with a center to verify coverage before seeking care.
 

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