Urgent care clinics on rise across region, but state was ‘late to the game’
By Matthew Tota, Correspondent
Posted Oct 7, 2018 at 6:00 AM
When she could no longer bear a nagging ear ache, Schantelle Bouchard
decided she needed to see a doctor. Calling her primary care
physician’s office, though, a mere five-minute drive from her Webster
home, never crossed her mind.
Ms. Bouchard had tried that before, with little luck; she knew from previous attempts to book an appointment that her personal doctor likely could not see her for at least a month. Instead, she went to UrgentCare Express at Harrington, an urgent care center on Sutton Avenue in Oxford.
On Monday, between work and getting home to care for her toddler, Ms. Bouchard arrived at the center with little time to spare. She waited no more than 20 minutes to see a doctor, who diagnosed her with an ear infection, suggested treatment options and quickly sent her on her way.
Her visit, all told, lasted about an hour.
“It’s faster for me to come here and get seen than to actually get a hold of somebody at my doctor’s office to get an appointment,” Ms. Bouchard, 25, said, sitting in one of the center’s exam rooms. “I’ve called them three times to set something up, and they’ve called me back once. At that point, I might as well come here.”
To the rapidly rising number of urgent care centers in the state, Ms. Bouchard is the perfect customer, struggling to navigate what experts call a gap in care: one with an acute condition – an ache, cough, sprain or sore throat – seeking to avoid the long wait for a primary care doctor and high cost of an emergency room trip.
Whether run by hospitals, medical practices or private companies, urgent care centers continue to spring up across the state, having convinced investors that they can both fill and take advantage of this gap, according to interviews with a handful of doctors and health care executives.
And, they say, urgent care, far cheaper than a visit to the emergency room, has the potential to reduce the overall cost of health care – if done correctly.
“I think there is a way to do urgent care right, and that’s to have
it integrated with an overall care platform, so that you have the
information on the patient that’s arriving, there is a quality check on
how good that care is, and there is a follow-up mechanism in place with a
provider,” said Eric Dickson, president and CEO of UMass Memorial
Health Care, which operates five centers with CareWell Urgent Care. “In
that situation, you are getting somebody, sometimes, to a more
convenient, lower cost center for care, and you may be opening up their
primary care doctors to get new patients.”
Still, with such unfettered growth in urgent care, a dangerous perception could take hold, they said: that urgent care can trump primary care altogether. In that case, when preventive care falls behind ease and convenience, health costs could compound, especially if the centers do not make the effort to open lines of communication with a patient’s regular doctor.
“We do see urgent care centers go up in some situations that are disconnected with the rest of the health care environment around them, not sharing the way they need,” Dr. Dickson said. “They are there to make a buck on acute illness.”
In Massachusetts, a late surge in urgent care
In 2012, CareWell Urgent Care opened its first center in South Dennis, joining about 24 other clinics in the state, according to the company’s current CEO, Shaun Ginter. Viewed in a bubble, the number of centers in Massachusetts would seem to indicate that urgent care had not yet taken off.
But beyond the Bay State, urgent care was booming.
Consider a report, released a year later, by the nonpartisan Washington research group Center for Studying Health System Change. The group highlighted a “rapid expansion” of urgent care centers in the country: By July 2013, some 9,000 urgent care centers had opened, an explosion of growth that dates back to the early-1990s.
Still, urgent care had not caught on in Massachusetts, mainly because
insurance companies were hesitant to contract with the centers, Mr.
Ginter said. Near the start of 2012, almost as soon as insurers began
working with urgent care centers, lifting restrictions and agreeing to
contract with them, the flood gates opened, he said.
“Massachusetts, specifically, was late to the game and just had not caught up with the times,” he explained. “The insurance companies and the medical industry here started paying attention to what was going on in the rest of the country. As the high cost of care skyrocketed in the emergency departments, the insurance companies realized they needed an alternative to the emergency rooms.”
In just six years, CareWell expanded to 16 centers in Massachusetts, including five under the UMass Memorial Health Care umbrella, Mr. Ginter said.
Meanwhile, the state started experiencing the rise of urgent care seen by the rest of the country, where there are now about 7,600 centers. Now in the U.S., the $18 billion industry – with more than 89 million people visiting centers each year – is expected to grow nearly 7 percent by the end of 2018, according to the Urgent Care Association of America.
From 2010 to the end of 2017, the number of centers in Massachusetts increased from 18 to 145, according to an August report by the Health Policy Commission. The report also noted an increase in retail clinics, which, unlike urgent care centers, staff mostly nurse practitioners and open in large pharmacy chains.
The proliferation of urgent care centers and retail clinics has been “particularly noticeable” in the Springfield and Worcester areas, the HPC said, as well as outside Boston.
With their high number of services for treating patients, flexible hours and reduced wait times, urgent care centers will continue to surge, experts predict. And urgent care will have an even larger role to play for those affected by the shortage of primary care doctors, they said.
The low cost for care, too, will keep the centers an attractive
option, they said. Patients and insurers pay a little less than $900 for
an emergency room visit, the HPC reported, with the copayment averaging
$118. However, at a walk-in urgent care center, the average combined
payment is $149, with a $33 copayment.
As overall health care costs trend up, urgent care centers become even more appealing, Mr. Ginter said, adding that with both the number of centers in the state today and the number of patients seen each day, the centers could lead to more than a billion dollars a year in health care savings in Massachusetts.
“There is no greater savings to the health care system than people being able to seek care through an urgent care center,” he said.
Connected care
At one time, Harrington HealthCare System CEO Edward Moore wanted to avoid the urgent care business.
That changed roughly five years ago, as Mr. Moore watched urgent care center after urgent care center spring up around him, coming ever closer to the market served by his Southbridge hospital.
Mr. Moore began to worry that another center, what he viewed as a competitor, would jump into his market, so he pulled the trigger; in 2015, Harrington opened its first UrgentCare Express in Charlton.
A year later, it opened another in Oxford.
“It was an offensive move and a defensive move,” Mr. Moore said. “If I
waited too long, companies like MedExpress or AFC would have come in.
They’ll get patients that aren’t going to my emergency room. It wasn’t
that hard to figure out that I needed to open first.”
Harrington’s two centers each see about 40 to 50 patients a day, Mr. Moore said, with the numbers increasing to around 70 during cold and flu season. He needed to add two more exam rooms in Charlton to meet the demand. And in Oxford, he hopes to soon have a primary care physician working out of the center.
Urgent care’s expansion in Massachusetts has prompted hospitals like Harrington to get into the game. In 2017 alone, the HPC said, 15 urgent care centers tied to hospitals opened, compared to 11 centers unaffiliated with hospitals.
Dr. Dickson, president of UMass Memorial, believes that that for urgent care to bring real savings to the health care industry, it needs to have a connection with primary care. Fragmented care, he added, can only raise costs.
UMass Memorial decided about four years ago to partner with CareWell, Dr. Dickson said, in large part because it felt “the pressure to reduce the cost of care.” UMass and CareWell can easily share medical records, so there is a constant flow of information between the urgent care doctor and the patient’s primary care physician.
Too many centers, he said, open with no affiliation to a hospital or medical group.
“I really worry about the emergence of standalone doc-in-the-box urgent care,” he said. “You’ve got people getting care, and they can jump from one to another, and there is a total lack of coordination. And I think there is a lack of quality oversight.”
While it’s not necessary for every patient, Dr. Olivier Gherardi,
medical director of Harrington’s Urgent Care Express centers, said he
always tries to circle back with a primary care physician.
“There can be problems when an urgent care center doesn’t really care, and they’re just in there for a profit,” Dr. Gherardi said.
Yet not all experts agree that urgent care should be connected, including CareWell’s CEO, Mr. Ginter.
“A majority of the population does not have a regular relationship with a primary care physician:
They only go to the doctor when there is something episodic,” he said. “If you have a community that doesn’t have a large hospital, there are large members of a community that need care who don’t have need for a medical record to be sent anywhere. There are lots of urgent care centers not affiliated with hospitals, but still providing a great service to a community and filling the need that’s there.”
Where urgent care hasn’t helped – and may hurt
Two urgent care centers sit within a quarter mile of the UMass Memorial HealthAlliance-Clinton emergency department. And though they have been busy since they opened, visits to the nearby emergency department have gone up, not down, said Dr. Dickson, an emergency room physician himself.
The HPC opened its report noting that “alternative care sites” like urgent care centers could, over time, unburden busy hospital emergency rooms by reducing the number of visits.
But that has not been the case, at least so far.
“Urgent care centers haven’t had that kind of impact on the state,” he said. “If you look at the number of emergency department visits in the state, they are on the rise, but if you look at urgent care visits, they are on the rise, too.”
The centers, rather, have taken away visits from primary care doctors, according to Mr. Dickson:
“You’re moving what could be seen by a primary care physician out to an urgent care center.”
This leads to a greater issue, he and other doctors said, of creating the perception that the centers can replace primary care. Worse, they said, ignoring preventive care could end up increasing a patient’s overall cost of care.
“Urgent care shouldn’t be a replacement for all primary care services,” said Dr. Thad Schilling, who oversees Reliant Medical Group’s ReadyMED urgent care centers. “Preventive care is important — having touch points on a regular basis for blood pressure checks, cancer screening, behavioral health assessments. That’s generally not the focus of urgent care; it’s addressing the primary issue that the patient has that day.”
If not for needing to see her doctor for a new prescription for anxiety medication, Ms. Bouchard, a frequent urgent care center patient, said she likely would never go to her primary care doctor.
“The doctor here doesn’t do anything that my primary care physician doesn’t do,” she said, adding, “It’s convenient, especially when I have a baby at home. I just want to come in and out, get my problem looked at and call it a day.”
Asked what, if any health issue would force Ms. Bouchard – now that she’s experienced the ease of urgent care – to choose an emergency room or a hospital, she offered an extreme.
“I’d have to be dying. I already don’t go to the doctor as much, and I especially don’t go to the emergency room as much,” she said. “Unless I’m on the floor not OK, I would come here.”
Ms. Bouchard had tried that before, with little luck; she knew from previous attempts to book an appointment that her personal doctor likely could not see her for at least a month. Instead, she went to UrgentCare Express at Harrington, an urgent care center on Sutton Avenue in Oxford.
On Monday, between work and getting home to care for her toddler, Ms. Bouchard arrived at the center with little time to spare. She waited no more than 20 minutes to see a doctor, who diagnosed her with an ear infection, suggested treatment options and quickly sent her on her way.
Her visit, all told, lasted about an hour.
“It’s faster for me to come here and get seen than to actually get a hold of somebody at my doctor’s office to get an appointment,” Ms. Bouchard, 25, said, sitting in one of the center’s exam rooms. “I’ve called them three times to set something up, and they’ve called me back once. At that point, I might as well come here.”
To the rapidly rising number of urgent care centers in the state, Ms. Bouchard is the perfect customer, struggling to navigate what experts call a gap in care: one with an acute condition – an ache, cough, sprain or sore throat – seeking to avoid the long wait for a primary care doctor and high cost of an emergency room trip.
Whether run by hospitals, medical practices or private companies, urgent care centers continue to spring up across the state, having convinced investors that they can both fill and take advantage of this gap, according to interviews with a handful of doctors and health care executives.
And, they say, urgent care, far cheaper than a visit to the emergency room, has the potential to reduce the overall cost of health care – if done correctly.
Still, with such unfettered growth in urgent care, a dangerous perception could take hold, they said: that urgent care can trump primary care altogether. In that case, when preventive care falls behind ease and convenience, health costs could compound, especially if the centers do not make the effort to open lines of communication with a patient’s regular doctor.
“We do see urgent care centers go up in some situations that are disconnected with the rest of the health care environment around them, not sharing the way they need,” Dr. Dickson said. “They are there to make a buck on acute illness.”
In Massachusetts, a late surge in urgent care
In 2012, CareWell Urgent Care opened its first center in South Dennis, joining about 24 other clinics in the state, according to the company’s current CEO, Shaun Ginter. Viewed in a bubble, the number of centers in Massachusetts would seem to indicate that urgent care had not yet taken off.
But beyond the Bay State, urgent care was booming.
Consider a report, released a year later, by the nonpartisan Washington research group Center for Studying Health System Change. The group highlighted a “rapid expansion” of urgent care centers in the country: By July 2013, some 9,000 urgent care centers had opened, an explosion of growth that dates back to the early-1990s.
“Massachusetts, specifically, was late to the game and just had not caught up with the times,” he explained. “The insurance companies and the medical industry here started paying attention to what was going on in the rest of the country. As the high cost of care skyrocketed in the emergency departments, the insurance companies realized they needed an alternative to the emergency rooms.”
In just six years, CareWell expanded to 16 centers in Massachusetts, including five under the UMass Memorial Health Care umbrella, Mr. Ginter said.
Meanwhile, the state started experiencing the rise of urgent care seen by the rest of the country, where there are now about 7,600 centers. Now in the U.S., the $18 billion industry – with more than 89 million people visiting centers each year – is expected to grow nearly 7 percent by the end of 2018, according to the Urgent Care Association of America.
From 2010 to the end of 2017, the number of centers in Massachusetts increased from 18 to 145, according to an August report by the Health Policy Commission. The report also noted an increase in retail clinics, which, unlike urgent care centers, staff mostly nurse practitioners and open in large pharmacy chains.
The proliferation of urgent care centers and retail clinics has been “particularly noticeable” in the Springfield and Worcester areas, the HPC said, as well as outside Boston.
With their high number of services for treating patients, flexible hours and reduced wait times, urgent care centers will continue to surge, experts predict. And urgent care will have an even larger role to play for those affected by the shortage of primary care doctors, they said.
As overall health care costs trend up, urgent care centers become even more appealing, Mr. Ginter said, adding that with both the number of centers in the state today and the number of patients seen each day, the centers could lead to more than a billion dollars a year in health care savings in Massachusetts.
“There is no greater savings to the health care system than people being able to seek care through an urgent care center,” he said.
Connected care
At one time, Harrington HealthCare System CEO Edward Moore wanted to avoid the urgent care business.
That changed roughly five years ago, as Mr. Moore watched urgent care center after urgent care center spring up around him, coming ever closer to the market served by his Southbridge hospital.
Mr. Moore began to worry that another center, what he viewed as a competitor, would jump into his market, so he pulled the trigger; in 2015, Harrington opened its first UrgentCare Express in Charlton.
A year later, it opened another in Oxford.
Harrington’s two centers each see about 40 to 50 patients a day, Mr. Moore said, with the numbers increasing to around 70 during cold and flu season. He needed to add two more exam rooms in Charlton to meet the demand. And in Oxford, he hopes to soon have a primary care physician working out of the center.
Urgent care’s expansion in Massachusetts has prompted hospitals like Harrington to get into the game. In 2017 alone, the HPC said, 15 urgent care centers tied to hospitals opened, compared to 11 centers unaffiliated with hospitals.
Dr. Dickson, president of UMass Memorial, believes that that for urgent care to bring real savings to the health care industry, it needs to have a connection with primary care. Fragmented care, he added, can only raise costs.
UMass Memorial decided about four years ago to partner with CareWell, Dr. Dickson said, in large part because it felt “the pressure to reduce the cost of care.” UMass and CareWell can easily share medical records, so there is a constant flow of information between the urgent care doctor and the patient’s primary care physician.
Too many centers, he said, open with no affiliation to a hospital or medical group.
“I really worry about the emergence of standalone doc-in-the-box urgent care,” he said. “You’ve got people getting care, and they can jump from one to another, and there is a total lack of coordination. And I think there is a lack of quality oversight.”
“There can be problems when an urgent care center doesn’t really care, and they’re just in there for a profit,” Dr. Gherardi said.
Yet not all experts agree that urgent care should be connected, including CareWell’s CEO, Mr. Ginter.
“A majority of the population does not have a regular relationship with a primary care physician:
They only go to the doctor when there is something episodic,” he said. “If you have a community that doesn’t have a large hospital, there are large members of a community that need care who don’t have need for a medical record to be sent anywhere. There are lots of urgent care centers not affiliated with hospitals, but still providing a great service to a community and filling the need that’s there.”
Where urgent care hasn’t helped – and may hurt
Two urgent care centers sit within a quarter mile of the UMass Memorial HealthAlliance-Clinton emergency department. And though they have been busy since they opened, visits to the nearby emergency department have gone up, not down, said Dr. Dickson, an emergency room physician himself.
The HPC opened its report noting that “alternative care sites” like urgent care centers could, over time, unburden busy hospital emergency rooms by reducing the number of visits.
“Urgent care centers haven’t had that kind of impact on the state,” he said. “If you look at the number of emergency department visits in the state, they are on the rise, but if you look at urgent care visits, they are on the rise, too.”
The centers, rather, have taken away visits from primary care doctors, according to Mr. Dickson:
“You’re moving what could be seen by a primary care physician out to an urgent care center.”
This leads to a greater issue, he and other doctors said, of creating the perception that the centers can replace primary care. Worse, they said, ignoring preventive care could end up increasing a patient’s overall cost of care.
“Urgent care shouldn’t be a replacement for all primary care services,” said Dr. Thad Schilling, who oversees Reliant Medical Group’s ReadyMED urgent care centers. “Preventive care is important — having touch points on a regular basis for blood pressure checks, cancer screening, behavioral health assessments. That’s generally not the focus of urgent care; it’s addressing the primary issue that the patient has that day.”
If not for needing to see her doctor for a new prescription for anxiety medication, Ms. Bouchard, a frequent urgent care center patient, said she likely would never go to her primary care doctor.
“The doctor here doesn’t do anything that my primary care physician doesn’t do,” she said, adding, “It’s convenient, especially when I have a baby at home. I just want to come in and out, get my problem looked at and call it a day.”
Asked what, if any health issue would force Ms. Bouchard – now that she’s experienced the ease of urgent care – to choose an emergency room or a hospital, she offered an extreme.
“I’d have to be dying. I already don’t go to the doctor as much, and I especially don’t go to the emergency room as much,” she said. “Unless I’m on the floor not OK, I would come here.”
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