The Urgent Care Center as a Method of Alternative Healthcare Delivery

For many people who have a pressing health issue or concern that does not occur when their doctor is in office, the emergency room is their only alternative. An emergency room doctor can’t turn them away, and for the uninsured the ER is often the place where the bulk of their health problems are addressed—including things that are non-emergencies. Now the advent of the urgent care center has changed all that. Research suggests that patients should use utilize urgent care clinics versus an emergency room for non-life threatening medical issues because they are often treated faster, utilize fewer resources, and have less out-of-pocket expenses.
Finding patient accessible care has long been a problem. For example, some workers who have to be at work at 8am, before most doctor’s offices are open, might go to the emergency room to get an ear infection treated. Of course, this is how many people view the ER and is one of the problems that causes overloading, overcrowding and long wait times for the emergency room. “A large portion of ED visits fall into the category of avoidable use resulting from patients seeking non-urgent care or ED care for conditions that could have been treated and/or prevented by prior primary care. Use of the ED for non-urgent (or non-emergency) visits grew from 9.7 percent of all ED visits in 1997 to over 12 percent in 2006…Estimates of total avoidable ED use range as high as 56 percent of all visits” (NEHI, 2010). What this data clearly suggests is that there is a definitive way to make ERs all over the nation more efficient, and more empowered to serve the populations that they are meant for. The ideal part of this issue that is so easily fixed revolves around the fact that ERs everywhere are being misused. Since this problem is so easy to diagnose, it really should be easy to fix. It’s like a long line at an ice cream parlor because that is the only business in the neighborhood that sells bottle of water and juice. Once a convenience store can open up, a store that is stocked full of necessary beverages, then that immediately eliminates the long line in the hypothetical ice cream shop.
While many experts have mixed opinions about the explosion of urgent care centers, they do offer a viable alternative to the emergency room. Urgent care centers have sprung up and have filled a gaping, aggravated need in the realm of professional medicine. They offer patients health assistance when waiting (not even in the ER) is an option. “Urgent care centers and retail clinics have emerged as alternatives to the emergency department for nonemergency care. We estimate that 13.7–27.1 percent of all emergency department visits could take place at one of these alternative sites, with a potential cost savings of approximately $4.4 billion annually. The primary conditions that could be treated at these sites include minor acute illnesses, strains, and fractures” (Weinick, 2010). Fundamentally, an urgent care center can take on the bulk of the load that boggles down an ER waiting room. For example, a urinary tract infection is definitely not an emergency, but getting one late Friday night and having to live with it until you can see your primary care physician on Monday can feel unbearable. It’s just not fair and not the mark of a first world nation to make someone wait three hours in the waiting room of the ER to see a doctor.
For many people, the emergence of the urgent care center has entered society as a godsend. While they aren’t cheap, they are affordable for many and are a safety net for when doctors aren’t in offices and the line at the ER is too long to manage. However, just because urgent care centers play such a useful role in society now, doesn’t mean that everyone uses them or understands their purpose. It takes work to change employee perceptions of urgent care in order to minimize inappropriate ER usage (Saravas, 2012). When ERs are used without discrimination it puts a direct strain on the healthcare system (Saravas, 2012). Once perceptions regarding urgent care centers are transformed, overall healthcare costs can be lowered, as urgent care centers will be utilized more regularly.
As we’ve seen so many times in life, education is key in order to create meaningful change in society. As one author illuminates, there are two main aggravated circumstances that create an unhealthy dependence on the ER. The first is that people have trouble making the distinction about which medical conditions require emergency care and which don’t (Fogarty, 2011). For so many people, going to the ER is a default solution to an unexpected medical issue that occurs when their doctor is not available. They don’t even stop and think that there might be another alternative to waiting for hours in the ER. Moreover, there is the fact that many people feel pressured to use the ER as a result of the way their insurance is set up (Fogarty, 2011). On the other hand, insurance companies have been cracking down on the non-emergency use of ERs and recently experienced some pushback from doctors. Anthem Blue Cross sent out letters last year and made headlines. An excerpt from the letter is as follows: “Save the ER for emergencies — or cover the cost… starting July 1, 2017, you’ll be responsible for ER costs when it’s NOT an emergency. That way, we can all help make sure the ER’s available for people who really are having emergencies” (Fox, 2017). This letter received instant criticism from doctors, accusing health insurance companies of just being out to make money. While that is probably true, the new policy change does represent a primitive attempt to get people to stop using ERs in non-emergency scenarios. Sometimes commanding people to stop using them when there are other facilities available is a productive way to get people to change their behavior. Other tactics that have proven to have a certain level of effectiveness are increasing the emergency room fee (Do, 2014). This was meant to discourage non-emergency clients from visiting and it did have an impact in decreasing the rate of non-emergency patients (Do, 2014). Furthermore, research has shown that a lot of ER users with non-urgent needs tend to be younger and healthier, often without regular access to a primary care doctor (Adesara et al., 2011). Sometimes primary care doctors will tell them to go to the ER for care on the weekends should they need it, surprisingly enough (Adesara et al., 2011). This clearly indicates that there is a lack of clarity in communicating the need to use urgent care centers and that everyone needs to get on the same page.
The bottom line is that shifting patients away from ERs and into retail-centered and urgent care walk-in centers have a markedly positive impact on the bottom line of the healthcare arena as a whole. The benefits are widespread: they lower healthcare costs for everybody, they make care more accessible, and they can minimize the impact of certain chronic diseases (Frederick, 2013). Many experts predict that urgent care facilities are indeed here to stay indefinitely, as they meet a real need in the market. More than ever in today’s fast-paced world, people want a place they can go to receive treatment for their health issues in an immediate fashion. Once people start to understand the unique role that urgent care facilities intend to play, then more people are likely to be in support of them. This is because most urgent care facilities intend to work in cooperation with primary care physicians, and not in competition with them (Ashton, 2017). This is an important distinction to bear in mind, as viewing urgent care facilities as competitors to traditional means of accessing healthcare is how some initially viewed them. “Urgent care is viewed by many as a disruptor in health care, an upstart that is changing the status quo by allowing patients to access care at the time and place they choose. Urgent care centers have definitely rattled some cages, prompting some primary care offices to open on weekends and offer extended evening hours just to compete for patient business” (Kulin, 2015). Competition is precisely what spurs the marketplace forward. Primary care facilities should do everything they can to keep the clients they have, including being open on the weekends. For so long, primary care offices could just do whatever they wanted, because they were the only proverbial game in town. With the emergence of urgent care centers this has all changed. Primary care offices now have to step their game up if they want to survive. Some journalists have argued that the advent of the urgent care center is exactly what has caused the deterioration of the doctor-patient relationship that have long existed (Bonura, 2000). Instead of regular check ups and managed care, people are just going to the urgent care facility for episodic needs and ignoring the need for a consistent relationship with their healthcare provider at all. This isn’t the fault of the urgent care facility. As it remains, urgent care centers fulfill a concrete need and fix a concrete problem in the healthcare delivery system.
Cooperation with urgent care and primary care offices is crucial in order to offer the patient a more comprehensive platform for health. One of the other really crucial needs that urgent care fulfills is that any doctor will agree that it is truly challenging to predict the incidences of episodic care: the itchy eyes, the urinary tract infections, the sore throats. As one doctor claims, just when you think you understand patient health patterns, the trend changes and it disrupts any veil of clarity you though you had (Kulin, 2015). “We all know it is tough to schedule regular patient visits months in advance and still leave enough space for urgent needs. This is exactly why primary care shouldn’t see urgent care as a threat, but as an opportunity to improve the care of the larger population” (Kulin, 2015). Some primary care doctors have been happy to no longer be obligated to keep their practices open on the weekends. Many urgent care centers are often very good at communicating with the patient’s primary care doctor or “homebase” knowing that they do receive follow up care there. This is a definitive way that urgent care can work with primary care to create very nuanced cooperative care.

Finally one of the things that makes urgent care so successful and so competitive are the hours that they keep. Sure some primary care facilities have a few early or later appointments, but those often get snapped up very quickly. Most clients have jobs that require them to be there at least 9am to 5pm, in addition to travel time. With an urgent care center, the hours are much wider in order to stress patient access. “The emphasis on patient access at UH urgent care centers is reflected in the facilities' open scheduling and business hours—from 9 a.m. to 9 p.m. on weekdays and 9 a.m. to 5 p.m. on weekends” (Cheney, 2015). Some urgent care facilities are open even earlier. This is good because its bringing competition back to this area of the marketplace. Healthcare has too long been viewed as a necessity (though it is) and not a service industry. The sense of competition and the need to bring one’s A-game to patients and clients is good. Urgent care centers have been that spark that have driven competition back into this particular arena of the industry, and patients stand to benefit. This is particularly crucial, as patients haven’t benefited for so long. “"In part, we want to be a place where physicians want to work. We're in a service industry. There are recruiting battles out there in the urgent care and emergency department areas, and in primary care” (Cheney, 2015). Years ago, a statement like this would have been unheard of, though it is a phenomenon that directly benefits the patient. Recruitment battles mean better doctor for patients and a higher standard of care. For so long, doctors have forgotten that they were members of the service industry. Instead doctors were treated as though they were delicate geniuses whose time was more valuable than the patients. It’s honestly no wonder that there were so many tremendous issues with patients looking for care in evenings and weekends. In the past, many primary care doctors wouldn’t deign to have their practice open on the weekends. Now they are finding it to be more and more of a necessity so that they don’t lose their customer base.
As one expert explains, “U.S. healthcare has been a monolith of inefficiency, limited access, and untenable costs for decades, due mainly to a lack of healthy competition. Today’s healthcare landscape, however, spurred by converging market forces, is rapidly evolving into a competitive marketplace, with urgent care being one of the key catalysts for this welcomed and long overdue change” (Ayers, 2017). The most accurate phrase in this excerpt is “monolith of inefficiency”—the healthcare industry was like a slow dinosaur delivering subpar care to patients because they could. With the advent of urgent care centers, a spark of change has been ignited. Now with fresh competition there is finally the possibility for efficiency, and for costs to become competitive as well as the forms of service delivery. Primary care centers shouldn’t bemoan the increased competition, rather it should motivate them to do their jobs in a better fashion, outshining the level of care received at urgent care facilities. One patient who just graduated college explained that as someone who cannot afford health insurance, that urgent care centers gave him “peace of mind” that if anything happened to him, he would be able to take care of it—all in a timely fashion. More over, urgent care centers can act as entry points in to the healthcare arena for people who don’t have primary care doctors. In some cases, the urgent care center has been known to give primary care doctors additional business.
In conclusion, urgent care centers represent efficiency and accessibility, two major gaps that existed in the previous model. The previous model can largely be dismissed as healthcare that benefits doctors and insurance companies, not patients—which is ludicrous as the patients were the ones bankrolling everything. One can safely summarize that urgent care centers represent the dawn of change, however slowly, for a flawed and backwards system.











References

Adesara, R., Spencer, J., & Bost, J. (2011). Office-Based Patient Education Decreases Non-Emergent Emergency Department Visits. Journal of Medical Practice Management, 131-135
Ashton, L. (2017, July). Urgent Care: A growing healthcare landscape. Nursing, 47(7), 21-24. 
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Cheney, C. (2015, November 30). The New Urgent Care Wave | HealthLeaders Media. Retrieved from https://www.healthleadersmedia.com/finance/new-urgent-care-wave?page=0%2C2
Bonura, C. (2000, November 20). ‘Urgent’ care centers cut ER waits. New Orleans Citybusiness, 4-5.
Cheney, C. (2015, November). The New Urgent Care Wave. HealthLeaders, 38-40. 
Do, Y. (2014, October 27). The Impact of an Emergency Room Fee Increase on the Composition of Patients Visiting Emergency Departments. Journal of Preventive Medicine and Public Health, 2014(20), 309-316 
Fogarty, T. (2011, October 15). Reigning in unnecessary emergency room costs – for individuals and employers. Managed Care Outlook, 24(20), 2-5
Frederick, J. (2013, March 11). Insurers turn to retail, urgent care clinics to keep members out of emergency rooms. Drug Store News, 32-37. 
Fox, M. (2017, June 5). Is this new emergency room policy bad medicine? Retrieved from https://www.nbcnews.com/health/health-news/major-insurance-company-s-payment-decision-angers-er-doctors-n767766
Frederick, J. (2013, March 11). Insurers turn to retail, urgent care clinics to keep members out of emergency rooms. Drug Store News, 32-37. 
Kulin, J. (2018, February 16). The Cooperative Model for Urgent Care and Primary Care. Retrieved from https://www.athenahealth.com/blog/2015/04/27/the-cooperative-model-for-urgent-care-and-primary-care
NEHI. (2010, March). A Matter of Urgency:Reducing Emergency Department Overuse. Retrieved from https://www.nehi.net/writable/publication_files/file/nehi_ed_overuse_issue_brief_032610finaledits.pdf
Weinick, R., Burns, R. M., & Mehrota, A. (2017, August 2). Many Emergency Department Visits Could Be Managed At Urgent Care Centers And Retail Clinics | Health Affairs. Retrieved from https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2009.0748

Saravas, P. (2012, January 1). Perception is Reality: Six keys to changing employee perceptions of urgent care and reducing inappropriate ER utilization. Managed Care Outlook, 25(1), 2-7.