Urgent care is a category of walk-in clinic focused on the delivery of ambulatory care in a dedicated medical facility outside of a traditional emergency room. Urgent care centers primarily treat injuries or illnesses requiring immediate care, but not serious enough to require an ER visit. Urgent care centers are distinguished from similar ambulatory healthcare centers such as emergency departments and convenient care clinics by their scope of conditions treated and available facilities on-site. While urgent care centers are usually not open 24-hours a day, 70% of centers in the United States open by 8:00 am or earlier and 95% close after 7:00 pm.
Urgent care outside of the USA
Although the urgent care movement began in the US, urgent care centers are now an important healthcare delivery component in several other countries, including Canada, England, Ireland, Australia, New Zealand and Israel.
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Urgent care in New Zealand
The Royal New Zealand College of Urgent Care, chaired by Dr David Gollogly, runs a 4-year Fellowship training programme in Urgent Care. In 2000, New Zealand became the first country to recognize Urgent Care as a medical speciality. A MCNZ report estimated that Urgent Care (also known as Accident and Medical) Clinics then accounted for 9% of consultations in primary care. In 2007 a NZMJ paper defined these clinics by onsite X-ray facilities, opening hours (seven days a week and until at least 8pm), and being community rather than hospital based. Typically limited liability companies with salaried staff in a central city location, they were distinct from both the deputising services available to General Practitioners in the UK, and the co-operative After Hours centres becoming more common in the rest of the Western world. This paper summarised findings from a 2001/2 MOH report in which data was collected from 12 randomly selected Clinics. Injury/poisoning, respiratory and non-specific symptoms were common presentations. Consultations took, on average, just over 15 minutes with most relating to new or short term problems. Depending on the time of day, X-rays were ordered on between one fifth and one sixth of visits. Overall, about half of visits resulted in a prescription, commonly for antibiotics or analgesics. About a quarter of visits during normal hours resulted in no treatment. During normal hours, 4.2% of patients were referred to a hospital emergency department. Like General Practitioners, but unlike hospital Emergency Departments which are free at the point of service, NZ Urgent Care Clinics bill patients with a part-charge, and one third of consultations were subsidised by ACC. An example of an Urgent Care provider is White Cross.
In March 2008, the Accident and Medical Practitioner's Association and the Australasian Society for Emergency Medicine hosted the first international urgent care conference in Auckland, New Zealand. Subsequent annual conferences have been held in partnership with the Goodfellow Symposium.
Urgent care in popular culture
The film What We Do In The Shadows depicts a consultation in a NZ Urgent Care Clinic. This includes the exterior, waiting room and consulting room of the clinic, and a doctor working while the directors were on site filming the scene (see also: Talk).
History of urgent care in the United States
The initial urgent care centers opened in the 1970s. Since then, this healthcare industry sector rapidly expanded to approximately 10,000 centers. Many centers were started by emergency medicine physicians, responding to a public need for convenient access to unscheduled medical care. A significant factor for the increase of these centers is significant monetary savings when compared to ERs. Many managed care organizations (MCOs) now encourage customers to utilize urgent care options. 3.1% of Family Physicians in the United States now work primarily in Urgent Care. The male:female ratio of this workforce is 6:7, and the urban:rural ratio is 2:1. This compares to 3.6% of Family Physicians working primarily in Emergency Care, with a male:female ratio of 5:3 and urban:rural ratio approaching 1:2.
Criteria for urgent care centers
Both the Urgent Care Association of America (UCAOA) and the American Academy of Urgent Care Medicine (AAUCM) have established criteria for urgent care centers and the physicians that operate them. Each share similar qualifying criteria including:
- Must accept walk-in patients during business hours
- Treat a broad spectrum of illnesses and injuries, as well as perform minor medical procedures
- Have a licensed physician operating as the medical director
- Be open 7 days a week
- Have on-site diagnostic equipment, including phlebotomy and x-ray
- Contain multiple exam rooms
- Various ethical and business standards
The UCAOA program is called Urgent Care Certification and the AAUCM is called Urgent Care Center Accreditation.
Organized medicine and urgent care
The Urgent Care Association of America (UCAOA) holds an annual spring convention and an annual fall conference. Many leaders of organized urgent care anticipate the establishment of urgent care as a fully recognized specialty.
Urgent Care Management Monthly hosts a bi-annual conference, teaching doctors, investors, and owners about the business side of an urgent care center. Urgent Care Management Monthly (UCMM) is the official publication for urgent care management, with discussions on topics such as billing, staffing, marketing, accounting, and logistics.
JUCM, The Journal of Urgent Care Medicine is the Official Publication of the Urgent Care Association of America (UCAOA). Each issue contains peer-reviewed clinical and practice management articles.
Board of Certification in Urgent Care Medicine (BCUCM) provides board certification for physicians with requisite training and experience. Urgent Care College of Physicians (UCCOP)
Postgraduate training
In 2006, the Urgent Care Association of America sponsored the first fellowship training program in urgent care medicine. A collaboration between the Department of Family Medicine University Hospitals of Cleveland / Case School of Medicine, the Urgent Care Association of America (UCAOA), and University Primary and Specialty Care Practices, Inc. in Cleveland, Ohio made this fellowship possible. The program was partially funded by an unrestricted grant from the Urgent Care Association of America. Fellowship physicians receive training in many disciplines, including: adult emergencies, pediatric emergencies, wound & injury evaluation and treatment, occupational medicine, urgent care procedures, and care center business aspects. In 2007, the Urgent Care Association of America (UCAOA) sponsored a second fellowship opportunity through the University of Illinois. The one-year fellowships are open to graduates of accredited Family Medicine and Med/Peds residencies.
Staffing and services
Unlike other walk-in clinics such as retail clinics, urgent care centers are generally staffed by a physician and supported by nurses, physician assistants and medical assistants. Sixty-five percent of urgent care centers have at least one physician on-site at all times.
Of the physicians that staff urgent care centers, 47.8% are family medicine, 30.1% are emergency medicine and 7.6% are internal medicine.
With these licensed physician on-site, urgent care centers are able to offer a wide range of services including broken bones, moderate cuts and lacerations requiring stitches, and most common injuries and illnesses. These services, of course, are made possible with the diagnostic equipment and x-ray machines typically found at an urgent care.
Of course, the urgent care centers are not an emergency room and do not offer surgical services.
That said, an estimated 13.7 to 27.1 percent of all emergency department visits could take place at an urgent care center or a retail clinic, generating a potential cost savings of approximately $4.4 billion annually, according to a 2010 study in Health Affairs.
Hours of operation
Urgent care centers are usually great options for seeing a physician, particularly after traditional office hours, on weekends or even holidays. In fact, 85% of urgent care centers are open 7 days a week. Common hours of operation are 8:00 am to 8:00 pm daily. In fact, 81.1% of urgent care centers are open by 8:00 am and 90.6% are open until at least 7:00 pm.
These extended hours are particularly helpful if patients are looking to avoid the hassle of hospital emergency rooms for less severe conditions. Over 80% of ER visits occur during the most common hours of urgent care centers.
Ownership
The majority of urgent care centers are owned by physicians or physician groups, however, more corporations and investment banks are acquiring urgent care centers and creating regional and national brands in the industry. The following is a breakdown of urgent care ownership following a 2012 study by the UCAOA:
- 35.4 percent of centers owned by physicians or physician groups, down from 50 percent in 2010
- 30.5 percent owned by a corporation, up from 13.5 percent in 2010
- 25.2 percent owned by a hospital
- 4.4 percent owned by a non-physician individual
- 2.2 percent owned by a franchise
Urgent care centers by state
Given the constantly evolving industry and opens and closures of urgent care centers each week - and lack of standardized SIC or NAICS codes - it is impossible to know the exact number in the country, much less by state. However, according to the most accurate, known database of walk-in clinics, the following is a state-by-state breakdown of urgent care centers.
Point-of-care medication dispensing
Point-of-care dispensing enables healthcare practitioners in the urgent care setting to ensure that their patients receive their prescription prior to leaving the clinic. To offer this service to patients, urgent care centers generally contract with a point-of-care dispensing corporation. Point of Care dispensing enables physicians (and in some states, other licensed healthcare practitioners) to dispense at urgent care facilities. Unlike a pharmacy, practitioners may only dispense to their own patients. Regulations regarding state pharmacy law vary from state to state. Dispensing by a healthcare practitioner is not legal or quite limited in certain states, such as Texas and New York.
Group purchasing organization
Group purchasing organizations, focusing on the urgent care industry, have been formed. The concept of these GPOs is that they join hundreds of urgent care centers together to allow the type of price bargaining that previously was only available to hospitals.
Medical malpractice insurance
Malpractice insurance offerings unique to the urgent care industry have begun to be widely discussed in light of the fact that many insurers do not recognize the reduced malpractice risk of urgent care centers. Insurers that recognize this reduced risk do not group urgent care centers with hospital emergency physicians and other high-risk specialties. Features of this type of insurance may include no charge for tail coverage when providers leave ("tail coverage" is coverage for malpractice claims which may arise after termination of a policy), 3-5 day approval of new providers, no additional premium when providers are added to the policy, per visit FTE rating, and lower premiums.
Codes for urgent care
In recent years the American Medical Association approved the code UCM (Urgent Care Medicine). This code allows physicians to self-designate as specializing in urgent care medicine. Services rendered in an urgent care center may be designated, using the place of service code -20 (POS -20) on the CMS-1500 form, as submitted to third-party payers. The Centers for Medicare & Medicaid Services (CMS) have designated two specific codes to apply to urgent care centers: S9083 (global fee for urgent care centers) and S9088 (services rendered in an urgent care center).
Advantages of urgent care over emergency departments
For injuries and illnesses that are urgent but not life-threatening, it is more efficient to use urgent care than an emergency department in terms of both money and time. The typical wait time to be seen at an urgent care center is less than 30 minutes, compared with hours at an emergency department.
As of 2009, urgent care centers cost less than emergency departments and have the potential to provide much more efficient care for nonurgent cases. Reimbursement by insurance companies for urgent care centers is comparable to general/family practice reimbursement ($101-$103), which is well below the average contribution for emergency department visits ($560).
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