After Dwayne Duckenfield banged his right elbow working around the house on a recent Saturday, he grew worried when the swelling didn't go down and the pain worsened.
Concerned he may have broken a bone, the project manager who lives in Washington, D.C., didn't go to the nearest emergency room or wait until Monday to call his physician for an appointment. Like an increasing number of Americans looking for fast and affordable health care, he went to an urgent care facility.
Duckenfield, 41, visited Concentra Urgent Care just inside the Washington Beltway, a center that's part of the nation's largest urgent care chain. Within 75 minutes, he was examined, had an X-ray and was prescribed a pain medication. "This was so convenient, and now I have peace of mind," he said after paying his $25 insurance co-pay.
Across the U.S., an estimated 3million patients visit these centers each week, according to the Urgent Care Association of America, a trade group based in Chicago. To meet demand, the number of facilities has increased from 8,000 in 2008 to more than 9,200 this year, the association said. About 600 urgent centers opened this year.
Fueling that rise are two longstanding trends -- crowded emergency rooms and a lack of primary care doctors. Urgent care operators say another factor is helping to propel business: the drive to lower costs.
Savings draw attention
Urgent care centers' fees are at least half those charged at a hospital emergency department for the same condition, although they are similar to what physicians charge for office visits. Still, the savings in ER costs are a big draw for patients without insurance, as well as insured patients facing higher out-of-pocket costs because of rising deductibles. Those lower fees have also drawn the attention of hospitals and insurers -- both of which increasingly see the facilities as a way to hold down costs and boost bottom lines.
Tom Charland, the CEO of Merchant Medicine, a Minnesota consulting firm specializing in walk-in clinics, said the urgent care centers are poised to attract more patients in 2014 when the Affordable Care Act begins to expand health coverage to 32 million Americans. Finding a primary care doctor could become more difficult then, he said.
Some doctors groups worry that increased reliance on urgent care may hurt efforts to better coordinate care and get patients into "medical homes" where they have a regular physician, strategies promoted by the 2010 health law to improve quality and lower costs.
Urgent care is not as good as having a regular physician, says Glen Stream, president of the American Academy of Family Physicians. He is concerned the surge in urgent care use could lead to fewer patients having a regular physican.
"No one really gets to know them, if they use a different urgent care each time," he said. "One of the best predictors of health outcomes is having a usual source of care where you can go for acute and chronic illnesses and develop a relationship with a doctor."
Urgent care centers typically treat many injuries and illnesses -- including colds, broken bones, cuts and back pain -- and do blood and urine tests, X-rays and drug testing. They see patients without an appointment and often are open evenings and weekends. Unlike small retail clinics that have opened in the past decade in department stores and pharmacies and mainly employ nurse practitioners, urgent care centers usually have physicians on site.
About half of the facilities are owned by doctors, according to the urgent care association, and 28% are hospital-owned, the American Hospital Association reports.
Filling a niche in patient care
Humana last year became the first major insurer to get into the urgent care business when it bought Concentra, which has more than 300 centers in 40 states. "We want to make sure we have access to providers in key areas," said Paul Kusserow, Humana's chief strategy and corporate development officer.
As Humana and other insurers shift to using smaller networks of doctors and hospitals to hold down premiums, urgent care will be a vital outlet when doctors' offices are too busy, he said. Humana and other insurers have expanded the number of urgent care centers in their provider networks to reduce unnecessary ER use.
Hospitals also are adding urgent care centers to increase admissions, and they see it as a way to keep their costs down in treating patients.
"A lot of people don't have regular doctors, and so this is a way of getting them into our system," said John Anderson, chief medical officer at Duke Primary Care in North Carolina. Duke University Health System has five urgent care centers -- including two added in the past two years -- that complement its 27 primary care physician offices.
The growth of urgent care also is changing the way doctors operate, said Stream, a family doctor in Spokane, Wash. More doctors are adding evening and weekend hours and leaving more room on schedules for same-day appointments, he said. "In that sense, the urgent care movement has been a good market pressure on primary care doctors to offer more convenient care."
Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a non-profit, non-partisan health policy research and communication organization not affiliated with Kaiser Permanente
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