Because urgent care centers are popping up everywhere

New York

If you drive past a busy suburban mall or walk down a street in a major city, chances are you won’t go long without locating a Concentra, MedExpress, CityMD, or other urgent care center.

Demand in urgent care centers increased during the Covid-19 pandemic as people sought tests and treatment. Patient volume has increased 60% since 2019, according to the Urgent Care Association, an industry trade group.

This has fueled the growth of new urgent care centers. A record 11,150 urgent care centers have popped up in the United States and are growing 7 percent annually, the trade group says. (This does not include clinics within retail stores such as CVS’s MinuteClinic or independent emergency departments.)

Urgent care centers are designed to treat non-emergency conditions such as a common cold, sprained ankle, ear infection, or rash. They are recommended if patients cannot get an immediate appointment with their primary care physician or if patients do not have one. Primary care practices should always be the first call in these situations because they have access to patients’ medical records and all of their health history, while urgent care centers are meant to provide episodic care.

Urgent care sites are often staffed by physician assistants and nurse practitioners. Many also have on-site doctors. (An urgent care industry magazine says that, in 2009, 70 percent of its providers were physicians, but that percentage had dropped to 16 percent by last year.) Urgent care usually offers medical care outside of than normal doctor’s office hours, and a visit costs significantly less than a trip to the emergency room.

Urgent care has grown rapidly due to affordability, gaps in primary care, high costs of emergency department visits, and increased investment by health systems and private equity groups. The urgent care market will reach about $48 billion in revenue this year, a 21% increase from 2019, IBISWorld estimates.

The growth highlights the crisis in the US primary care system. According to the Association of American Medical Colleges, a shortage of 55,000 primary care physicians is expected over the next decade.

But many doctors, health care advocates and researchers are raising concerns about the proliferation of urgent care sites and say there may be downsides.

Frequent visits to urgent care sites can weaken established relationships with primary care physicians. They can also lead to more fragmented care and increase overall health care spending, research shows.

And there are questions about the quality of care in urgent care centers and whether they adequately serve low-income communities. A 2018 study by the Pew Charitable Trusts and the Centers for Disease Control and Prevention found that antibiotics are overprescribed in urgent care centers, particularly for common colds, flu and bronchitis.

“It’s a reasonable solution for people with minor conditions who can’t wait for primary care providers,” said Vivian Ho, a health economist at Rice University. “When you need ongoing management of a chronic illness, you shouldn’t go there.”

Urgent care centers have existed in the United States since the 1970s, but they have long been derided as “papers in a box” and grew slowly during their first few years.

They have become more popular over the past two decades, in part due to pressures on the primary care system. People’s expectations about wait times have changed, and it can be difficult, and at times nearly impossible, to schedule an immediate visit with a GP.

Urgent care sites are typically open for longer hours during weekdays and weekends, making it easier to get an appointment or walk-in visit. According to the Industry Trade Group, approximately 80 percent of the U.S. population is within a 10-minute drive of an urgent care center.

“There is a need to keep up with society’s demand for rapid, on-demand services that can’t be supported by underfunded primary care,” said Susan Kressly, a retired pediatrician and fellow at the American Academy of Pediatrics.

Health insurers and hospitals have also focused more on keeping people out of the emergency room. Emergency department visits are about ten times more expensive than visits to an urgent care center. During the early 2000s, hospital systems and health insurers began opening their own urgent care centers and introduced strategies to discourage emergency room visits.

Additionally, passage of the Affordable Care Act in 2010 spurred an increase in urgent care providers as millions of newly insured Americans sought health care. Private equity and venture capital funds have also poured billions into urgent care center deals, according to data from PitchBook.

Urgent care centers can be attractive to investors. Unlike emergency rooms, which are legally required to treat everyone, urgent care centers can essentially choose their patients and the conditions they treat. Many urgent care centers do not accept Medicaid and may turn away uninsured patients unless they pay a fee.

Like other health care options, urgent care centers make money by billing insurance companies for the cost of the visit, additional services, or the patient pays out of pocket. In 2016, the average cost for a 30-minute visit to a newly insured patient was $242 at an urgent care center, compared with $294 at a primary care office and $109 at a retail clinic, according to one study by FAIR Health, a nonprofit that collects health insurance data.

“If they can make it a more affordable option, there’s a lot of revenue here,” said Ateev Mehrotra, a professor of health policy and medicine at Harvard Medical School who has researched urgent care clinics. “It’s not where the money is in health care, but there are substantial numbers of patients.”

Mehrotra’s research found that between 2008 and 2015, urgent care visits increased by 119 percent. They have become the dominant location for people seeking treatment for low-severity conditions such as acute respiratory infections, urinary tract infections, skin rashes, and muscle strains.

Some doctors and researchers worry that patients with primary care physicians – and those without – are substituting urgent care visits in place of a primary care provider.

“What you don’t want to see is people are seeking a lot of care outside of their pediatrician and decreasing their visits to their primary care provider,” said Rebecca Burns, medical director of urgent care at Lurie Children’s Hospital of Chicago.

Burns’ research found that high dependency on urgent care fills a need for children with acute problems, but has the potential to disrupt primary care relationships.

The National Health Law Program, a health care advocacy group for low-income families and communities, has demanded that state regulations require coordination between urgent care sites, retail clinics, primary services and hospitals to ensure continuity of patient care.

And while the presence of urgent care centers prevents people from costly emergency room visits for low-severity problems, Harvard’s Mehrotra found that, paradoxically, they increase healthcare spending on the net.

Each $1,646 emergency room visit for a prevented low-severity condition was offset by a $6,327 increase in urgent care center costs, its research found. This is partly because people may go to urgent care for minor illnesses they would have previously treated with chicken soup.

There are also concerns about oversaturation of urgent care centers in high-income areas that have more consumers with private health care and limited access in medically underserved areas.

Urgent care centers selectively tend not to serve rural areas, areas with a high concentration of low-income patients, and areas with a low concentration of privately insured patients, University of California San Francisco researchers found in a 2016 study. They said this “uneven distribution could potentially exacerbate health disparities.”

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