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Urgent care centers hold tight to niche for fast, efficient care

urgent-care_mainIn the 1970s, enterprising physicians began opening their practices after-hours to patients suffering minor ailments without an appointment. Patients avoided expensive emergency rooms, and they didn’t have to endure long waits to see their family doctors.

The idea stuck. Shifting work patterns in a growing population have heightened expectations of medical service at all hours and have led to a thriving industry known as urgent care medicine, said Dr. Franz Ritucci, an Orlando, Florida, physician and president the American Academy of Urgent Care Medicine.

Designed to address temporary, non-emergency health issues when regular clinics are closed or inconvenient, urgent care centers have spread to about 7,400 locations throughout the U.S., according to an industry group, the Urgent Care Association of America.

The result: A study released in 2015 by the Massachusetts Health Policy Commission found that emergency-room use fell by about 30 percent when an urgent care center or retail clinic was within 5 miles of a patient’s home.

In Minnesota, several health services such as Allina and Fairview offer urgent care clinics, and the practices are spreading. For example, MedExpress, a national for-profit urgent care provider with local roots, plans 19 urgent care clinics across Minnesota.

MedExpress, with administrative offices in West Virginia and Pennsylvania, was founded in 2001. Eden Prairie-based Optum, a division of Minnetonka-based UnitedHealth Group, acquired MedExpress in 2015. The company wrapped up 2016 with 197 clinics in 15 states.

Another clinic, operated by St. Francis Regional Medical Center, opened recently in Shakopee.

Urgent care operators have embraced efficiency boosters like using technology to achieve 30-minute average wait times as well as online appointment scheduling and iPad-style sign-in and registration, Ritucci said. They give X-rays and do suturing and minor orthopedic procedures.

“Technology is developing quicker and our outreach is becoming more sophisticated,” he said.

Today, urgent care doctors can see 80 to 90 patients a day, with an average wait time of 30 minutes, much faster than a typical family practice or pediatrician, he said.

Most of the patients who visit an urgent care center can be treated there. Only a small proportion of patients need to be transferred to an emergency room.

The idea behind urgent care is not to replace primary-care doctors, who are better suited to manage and treat chronic illnesses and other maladies.

A different model

Indeed, ChoiceOne Urgent Care, which has eight facilities in Maryland and two in Georgia, fills in as a backup partner for primary care offices that are closed for holidays and on the weekends, said Butch Marino, co-owner. The urgent care centers then refer patients back to their primary-care doctors with discharge notes within 24 hours.

Urgent care clinics may also help alleviate a shortage of physicians. Over the next decade, there will be more than 60,000 fewer physicians than needed, according to the most recent projections from the Association of American Medical Colleges. By 2025, the shortage of primary care physicians is estimated to be up to 35,000.

Having a subset of doctors equipped to treat more patients per hour increases their overall productivity, Ritucci said. “Urgent care centers address that, they’re the reliever airports of the health care system.”

The facilities also offer an attractive alternative for family doctors, pediatricians and other physicians who grow tired of the hassle involved with managing their own practices, he said.

Roughly 80 percent of urgent care centers use a combination of physicians, physicians’ assistants and nurse practitioners to provide care, while the rest use physicians only. Moreover, the centers essentially operate as doctors’ practices and follow their regulations, according to the Urgent Care Association of America.

The average cost of a visit is about $150, compared with the average ER visit cost of $1,354, the industry’s trade group said.

Most people who visit urgent care centers pay a copay fee as part of their insurance coverage, but urgent care centers also see many patients — roughly 20 percent — who cover their visit fees with cash, Ritucci said. That’s good for those who have difficulty finding primary care doctors who accept cash-only patients.

Growing market

The demand for urgent care centers has been growing, and venture capitalists are buying up clinics throughout the country, Ritucci said.  Hospital systems are, too, as it helps them expand their footprint in local markets and serves as an added revenue stream.

The University of Maryland Medical System is partnering with ChoiceOne Urgent Care, and the business model works as hospitals have become highly incentivized to improve the productivity of their emergency departments and focus more on big-ticket items like specialty services, ChoiceOne Urgent Care’s Marino said.

Urgent care centers can more efficiently deal with strep throat cases or sew up minor cuts, and then refer patients who need more specialized treatment, such as orthopedic surgeries, back to the hospital systems.

The fate of the Affordable Care Act will not likely have much impact on the continued growth of the urgent care center market over the next three to five years, Marino said. But while their rise has been impressive, the increase will likely reach a saturation point when new centers will stop opening up and may drop away.

Marino estimates the ideal proportion of urgent care centers at one per 17,000 to 20,000 people. Already in some places in Florida, the ratio is one per 5,000, he said.

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