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What’s behind the growth of urgent care clinics?

Medical Economics JournalSeptember 10, 2018 edition
Volume 95
Issue 17

Urgent care isn’t booming only because of physicians seeking a better work-life balance. Other factors driving the industry’s growth include patient demand, convenience, and costs.

For Sean McNeeley, MD, patient care was what drew him to medicine. But the challenges of running his own private practice, with its growing administrative burden, made it hard to stay there. So he decided to limit his work to urgent care.

“I loved being in private practice, but it was a challenge in family medicine to be able to do it all well and balance time with my family,” says McNeeley, the medical director of University Hospitals Urgent Care Network based in Cleveland. 

Board certified in both family and urgent care medicine, McNeeley ran his private practice from 1999-2004 while also working at an urgent care clinic for extra income. Ultimately, he closed his practice to work solely as an urgent care physician. Today he oversees healthcare providers at ten University Hospitals Urgent Care Network facilities, while still seeing patients every week.

“Working in urgent care gives physicians the ability to balance work and life, which has no on-call schedule, no nights, and limited weekends,” says McNeeley, who is also the president of the board of directors of the Urgent Care Association.

While urgent cares typically are open longer hours than practices, he notes that patients don’t expect to see a particular provider when they seek care at an urgent care clinic, so when a physician is off work, they are truly off. “I can feel good about what I’ve done during the day and I can go home and have some personal time,” McNeeley says.

Interest in, and demand for, urgent care clinics is growing rapidly. The number of clinics has ballooned from 6,946 in 2015 to 8,285 as of June 2018, according to Laurel Stoimenoff, CEO of the Urgent Care Association (UCA) and co-author of “The Essential Role of the Urgent Care Center in Population Health,” a 2018 association report. Behind those figures lies an $18 billion industry ex- perts predict will grow 5.8 percent this year.

Urgent care clinics handle about 89 million patient visits each year, or more than 29 percent of all primary care visits in the country, and nearly 15 percent of all outpatient physician visits, says Stoimenoff.

Urgent care isn’t booming only because of physicians seeking a better work-life balance. Other factors driving the industry’s growth include patient demand, convenience, and costs.

Meeting public demand

Patients seeking medical care don’t want to wait. Urgent care clinics, with their longer hours and walk-in appointments, fulfill that need in a way traditional physicians’ offices can’t always accomplish.

“This is the age of the patient as a consumer, where fast and convenient is never fast and convenient enough,” says Richard Park, MD, CEO and co-founder of CityMD, a group of urgent care clinics in New Jersey, New York, and Washington state, and president-elect of the UCA.

Urgent care clinics blend retail elements such as ground-floor locations that provide easier access, and the ability to schedule same-day appointments using an online calendar program. A customer-first approach, oriented to service and technology, is fueling growth, says Stoimenoff.

However, urgent care clinics could become victims of their own success, writes Len Schlesinger, DBA, Baker Foundation Professor at Harvard Business School, in a column for athenaInsight: “The tension that I see now is that as these urgent care clinics compete for patients, they might lose the focus that made them successful in the first place.”

Reducing healthcare costs

Urgent care centers save money compared to emergency departments, where many patients go, even though they are not experiencing a true emergency.

A 2017 Annals of Emergency Medicine study compared the average price-per-visit for Texas-based urgent care clinics, free-standing emergency departments, and hospital-based emergency departments in 2012 and 2015. Researchers found that urgent care clinics charged $168 in 2015.

At hospital-based emergency department visits, the average price per visit in 2015 was $2,259 and $2,199 at a freestanding emergency care clinic. Most of the visits, regardless of facility, were for 20 of the most common diagnoses, and prices for patients with the same diagnosis were, on average, almost 10 times higher at freestanding and hospital-based EDs when compared to similar services received at urgent care centers, the study said.

McNeeley says the cost of an urgent care visit is typically similar to a primary care physician visit, and much less than an ED visit. In addition, urgent care clinics offer more services than most primary care offices. “We can do more, such as run IVs, splint a fracture, or sew wounds,” he says.

Faster, easier, cheaper

Millennials are considered relatively healthy and have only one or two episodic health emergencies a year, says Stoimenoff. This demographic makes up a quarter of all visits to urgent care clinics, according to a 2015 PNC Healthcare consumer survey. “I think it’s very appealing to that generation,” she says.

Other patient groups also report not always turning to a primary care physician for care. A UCA study of patients over age 65 found that 11 percent said they had no primary care physician. A Kaiser study from 2014-2016 reported that, on average, 17 percent of women in the United States didn’t use a primary care provider. For men it was 28 percent.

The growing number of older patients is also a factor, says Park, who oversees more than 100 CityMD clinics. An aging population is taking up the resources of primary care and emergency care departments, according to the same 2015 PNC Healthcare consumer survey. It found that 85 percent of seniors choose to see primary care physicians first. Only 11 percent of that population goes first to an urgent care center. This trend “is making other patients choose to go to urgent care clinics for faster, easier and cheaper service,” Park says.

Rural areas in particular are benefiting from the rise in urgent care clinics. A report by FAIR Health, a nonprofit that studies insurance claims, found that from 2007 to 2017 there was a 2,308 percent increase in insurance claims for procedures done in rural urgent care facilities compared to a 1,675 percent increase in urban areas.

And with more patients paying out-of-pocket for healthcare services, more are turning to urgent care because costs are lower, says Park.

“About 35 percent of employees are on high-deductible health insurance plans, and that number is growing,” he says. Many of those patients pay from $6,000 to $8,000 out-of-pocket before insurance pays anything. About 80 percent of them never meet their deductible, so they are essentially self-paying and want to pay the lowest fees.

“Urgent care is one service that checks both boxes,” says Park. “It is faster, better, and less expensive, and relative to primary care physicians, urgent care centers provide better access and an extended scope of practice.”


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