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How Urgent Care Clinics are Evolving

   October 06, 2015

Besides relying on walk-in traffic from patients, clinic leaders are also exploring new medical services to differentiate themselves and to better coordinate care.

This article appears in the September 2015 issue of HealthLeaders magazine.

It is hard to get a firm count on the number of urgent care centers in the United States. The Urgent Care Association of America says there are more than 6,400, while the American Academy of Urgent Care Medicine puts the number as high as 9,300. What is clear, though, is the growth of this care model. As hospitals and health system leaders evaluate the risks and rewards of urgent care, there are strategic considerations that may seem unimportant on the surface, but can lead to complications later on.

Robert Rankins, MD

Take, for example, the difficulty in determining the number of urgent care centers. It stems from the lack of standardization in states' regulation of urgent care facilities. Generally, most states view urgent care centers as a physician office with extended hours. A few states, such as Arizona, attempt to regulate urgent care clinics through licensure. And some states require a certificate of need for urgent care centers. The differences in state regulations are an important issue, especially if a healthcare organization's footprint extends across state lines.

Another issue to consider is whether an urgent care center perpetuates the fragmented nature of healthcare. Hospital and health system leaders have repeatedly said that care coordination is imperative to achieve better quality, cost, and outcomes. Will patients, who are in a hurry, especially when seeking an urgent care center, get so used to the easy access and quick service that they forgo seeing or keeping their primary care physician in the loop?

"We tell patients that we do not want to be their primary care doctor," says Robert Rankins, MD, founder of E-Care Emergency Centers, a McKinney, Texas–based network of four for-profit freestanding emergency and urgent care centers that also provide urgent care services in the Dallas suburbs. "I don't want to see them for their high blood pressure and diabetes. We try to get patients who come in here for a primary care reason hooked up with a primary care physician. If they come in with a sore throat and they couldn't get in to see their regular doctor, we tell them to follow up with their primary care doctor because that is not what we want to compete with. We try to make that very clear."

Success key No. 1: Understand regulatory environment

The urgent care business model that Rankins developed—a facility that can treat urgent care and emergency patients—is both a cautionary tale and success story. Rankins says early on he learned that to minimize patient confusion and maximize volume, he needed to deliver what patients wanted and needed.

"What we're doing is a cost-savings for the consumer," says Rankins, who is a board-certified emergency physician. "Our facility is a one-stop shop," he says, noting that patients should be able to come here, receive the care they need, and not worry if they should have gone to an ER or an urgent care center. "We're trying to bring them both under one roof."

Rankins originally opened up E-Care as an urgent care center, but in 2010 when Texas began licensing freestanding emergency departments (FED), the state treated E-Care as a FED only, so Rankins switched gears to offer just emergency care. He says the effect was confusing for patients, payers, and even for him.

Jacqueline Fellows is a contributing writer at HealthLeaders Media.

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