Urgent care is on the fast track for growth in the U.S., for reasons that are economic, as well as related to consumer cost and access to care. Urgent care makes sense in a system transitioning to value-based care.
The niche is attracting attention from integrated delivery systems, hospitals and physician offices. Recent activity in the market underscores the growing role that provider organizations see for urgent care in building a cost-effective continuum of care.
A case in point is the decision by HCA, a Nashville, Tenn.-based hospital chain, to acquire Urgent Care Extra's Nevada operations, which includes 14 centers in the Las Vegas area and six that are being developed elsewhere in the state. HCA also operates four hospitals and four surgery centers in the Las Vegas metro area.
But many in the urgent care segment acknowledge that it needs to improve IT capabilities, which will be necessary for centers to be fully integrated into the continuum of patient care.
The centers will need to boost their IT capabilities, particularly in using electronic health records, and the provider community will increasingly need to be able to exchange patient information with centers as more patients choose them for care.
Urgent care centers need to advance their electronic capabilities if they are to flourish in a value-based reimbursement system, says Steven Berkowitz, MD, principal at SMB Healthcare Consulting, which specializes in strategic planning.
Urgent care centers will need to demonstrate value for their outcomes and they'll need to be able to analyze their data to improve. "It's important for centers to implement a state of the art information system," he says. "The ability of centers to communicate with other providers and insurance companies will make a big difference for them."
To that end, some urgent care center chains are setting the pace for capturing, sharing and analyzing patient records, aiming to improve care for the patients they are seeing,
Experts see the Affordable Care Act as one of the driving forces behind the growth of urgent care centers. The ACA is forcing provider organizations to find alternative ways to deliver higher-quality care while lowering costs.
Increasingly, delivery systems see urgent care centers as one strategy for filling gaps in care delivery. These centers offer both convenience and lower cost for consumers; in addition, they're open for longer hours than physician offices and usually treat a wide range of conditions.
The nation has about 6,900 urgent care centers, according to the Urgent Care Association of America (UCAOA). These centers are expected to play a major role in reducing healthcare costs, serving as an alternative to hospital emergency departments, an expensive alternative to which consumers sometimes turn for routine care. In fact, urgent care centers are becoming the primary care providers for rising numbers of consumers.
While there are some major players in the urgent care market, the market is fragmented and, as such, it's difficult to determine the extent of annual growth for the centers. UCAOA estimates that the nation is experiencing about 5 percent annual growth in the number of centers.
Urgent care centers provide a more ER-type of experience at a much lower price, industry observers note. Urgent care centers also offer treatment for more acute needs, such as taking X-rays, setting broken bones, draining wounds and running tests. The centers also tyically have a full-time physician and nurse on site, and may also have nurse practitioners or physician assistants; some multisite operations have a physician who rotates among and supervises several sites.
"Emergency departments are overwhelmed, and urgent care can take care of 30 percent of patients who could have been seen in an ER setting," says John Kulin, D.O., CEO and chief medical officer at Urgent Care Group in Manahawkin, N.J., with four sites in greater Philadelphia. He also is a UCAOA board member.
Retail clinic and urgent care prices compare very favorably with charges in other venues. A recent study for the American Institute of Certified Public Accountants, conducted by financial evaluation and advisory firm VMG Health, pegged the average cost of a retail clinic visit at about $80; the average cost for both a visit to a primary care physician and an urgent care center is about $130; while care at a hospital emergency department averages about $650. UCAOA estimates that the average cost of a treatment episode at its members' sites is $155.
As the nation's healthcare industry starts to reorganize to match the challenges of value-based care and new economic incentives, providers are paying more attention to how patient information is collected and shared. The increasing use of urgent care centers raises some concerns, because in general, this segment of the industry has lagged in implementing more advanced clinical records systems, says Berkowitz, the consultant.
The vast majority of urgent care center companies are very small, operating one to a handful of sites. However, some companies operate a chain of locations that range from several dozen to hundreds.
Most urgent care centers use basic IT systems, says Sean McNeeley, MD, network medical director for UHMP Urgent Care in Cleveland, which is operated by University Hospitals, a Cleveland-based integrated delivery system. McNeeley, a UCAOA board member, says the organization's research found that 94 percent of urgent care centers use some degree of IT, such as electronic records, electronic prescriptions or lab reporting systems.
A significant "digital divide" exists between large and small players in the urgent care market. Nearly all larger urgent care chains have EHRs and practice management systems, says Kulin of Urgent Care Group. Many also share information with local physicians and use data analytics to support local population health management.
As many as 80 percent of centers send information to a patient's primary care physician. Some use digital approaches, such as secure messaging, but most still send patient encounter information via fax. However, Kulin says, he expects the use of secure messaging will grow as time goes on.
However, many smaller urgent care centers lag far behind in health information technology adoption, says Bruce Irwin, MD, founder and CEO at American Family Care and Doctors Express, a Birmingham, Ala.-based urgent care center chain. His company is always looking to buy smaller chains. "Less than 40 percent of them have any EHR at all; they're all still on pen and paper," he says, adding that most have only a practice management system for insurance billing purposes.
McNeeley says the use of electronic systems for many centers is still relatively basic and often remains detached and unable to be electronically transferred to other provider organizations. "Interoperability is just not there yet," he says. "It's difficult getting records back to the patient's primary provider or to a specialist."
Urgent Care Group is fortunate that Meridian Health System, which serves the region, offers a health information exchange for the community; Kulin says that the availability of health information exchange services that is increasingly likely in other areas of the country, and that those services will help improve the exchange of information between urgent care centers and other providers.
Irwin, a pioneer in the urgent care field, opened his first center in June 1982 and a second a year later. Early on, he linked centers via DEC computers.. He expects to end 2015 with about 168 sites, all linked to a central database.
American Family Care started using electronic health records in 2006. Now, the chain recently implemented its third generation of EHRs and is completely paperless, he says.
Today, American Family Care is exchanging health information when it can with regional providers, and it wants to do more. The company uses various types of interfaces to link with hospitals, labs and radiology facilities, and also uses secure messaging. Without a uniform platform, exchange is difficult, Irwin says. "It is a one-by-one thing, and it's quite arduous."
Another barrier to information exchange is educating patients on the benefits of sharing their records with other providers, says Anthony Williams, CIO of American Family Care.
The bottom line is there is great interest among urgent care centers in sharing information, but it remains a hit-or-miss process because of existing challenges in information exchange. The company continues to look at more information technology, and Williams says that it is particularly interested in using patient portals and kiosks.
For 2016, the UCAOA forecasts a 20 percent increase in hospital acquisitions of urgent care centers or partnerships with independent centers. The hospital buys, Kulin says, are driven by the Affordable Care Act and its emphasis on an integrated system of provider sites coordinating care across the continuum.
Hospitals and integrated delivery systems that partner with independent centers may be more likely to succeed than those that decide to acquire centers and assimilate them into their systems, Kulin says. "We know the urgent care industry, our markets and our product," he asserts.
The need for more data
Larger urgent care center companies increasingly are turning to data analytics.
Urgent Care Group has 134,000 patients in its database, CEO Kulin says. It's using that information to support preventive medicine, such as reminding patients with elevated blood pressure to follow up with their primary care provider.
Urgent Care Group is joining primary care physicians, specialists, hospitals and long-term care facilities in the region by submitting data to a warehouse to better assess trends and improve access to care, such as identifying patients who don't have their own transportation and don't have access to public transportation that they can use to travel to primary care providers.
American Family Care was an early adopter of predictive analytics, starting about five years ago to assess such business factors as demographics, provider scheduling, revenue cycle, provider and practice productivity, and where to build new clinics, says CIO Williams.
Now, the company is using predictive analytics to support population health management. Williams says this use of analytics is still in its infancy, but it's yielding intelligence that helps the chain get patients to return to its clinics for check-ups, as well as conducting preventive and maintenance medicine audits to ensure they are following care regimens that they've been prescribed.
That's increasingly important because, for many people, urgent care has become their primary care resource.
"We see tremendous opportunity in analytics to determine how to reach patients, monitor their health, improve outcomes, and research what works and what doesn't," Williams says. "We want to be full participants in the changes and revolution in healthcare. We want to be in accountable care organizations."
Top 10 U.S. Urgent Care Chains
CONCENTRA URGENT CARE
300+ clinics across the nation
190 sites in 20 states
AMERICAN FAMILY CARE AND DOCTORS EXPRESS
168 sites in 26 states
165 sites in 14 states
FASTMED URGENT CARE
93 sites in AZ & NC
60 Sites in NJ, PA, MD & VA
CARE SPOT EXPRESS HEALTHCARE
52 sites in FL, KS & TN
More than 50 sites in KY, TN, NC & SC
PHYSICIANS URGENT CARE
35 sites in IL, IN, NE
28 sites serving San Antonio, Austin, Round
Rock & New Braunfels
Source: Urgent Care Association of America
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