Patients have finally become impatient. When they have a simple need—a flu shot, a school sports physical, a strep test—they can choose to forgo a trip to the doctor (often involving a phone call, a several-day wait for an appointment, and more waiting once they arrive) in favor of dropping in at an urgent care center or retail clinic, where they're seen in a half-hour or less, on average. And increasingly, they do just that, according to the Urgent Care Association of America (UCAOA). Its 2018 study1 of the industry estimated that urgent care centers and retail clinics have taken over 18.2 percent of all primary care visits, representing more than 89 million visits per year.
Young people are even more likely to avail themselves of the convenient locations and expanded hours: 28 percent of patients aged 18 to 34 are using these facilities for primary care visits, while only 43 percent go to a physician. The balance get their primary care in the ER, though the UCAOA says there's good evidence that having urgent care or retail clinic care available nearby reduces ER visits by 30 percent. Of note, the organization says 98 percent of visits to urgent care centers and retail clinics require the level of care that's appropriate to those settings: only 2 percent of patients are referred to the ER.2
The total number of “convenient care" sites is approaching 8,800, up 7 percent from 2017 and almost 45 percent since 2013, according to the UCAOA's 2018 figures. Investment is coming from all directions: health systems such as Dignity Health, HCA, Aurora Health, and Intermountain Healthcare, and retailers like Walgreens (working with insurer United Health) and CVS (which recently closed a merger with insurer Aetna).
The merged entity owns more than a thousand retail clinic sites and has announced plans to add services, including managing common chronic and/or complex conditions, adding more primary health services, and guiding discharged hospital patients through their at-home plans and managing complex conditions.
What do these developments mean for academic medical centers? “Looking five or ten years down the road, the outpatient side is going to be a major generator of revenue, and they're going to have to be able to play that game," says Robert Field, professor at Drexel University's Thomas R. Kline School of Law and Dornsife School of Public Health. “I think most hospitals acknowledge that because of the way they have participated in the consolidation frenzy and hedged their bets by being affiliated with a range of providers at all levels. If patients are coming in through urgent care, they want a piece of that action."
The Thomas Jefferson University Hospitals operate seven urgent care centers, open seven days a week, throughout the greater Philadelphia area. “We're just trying to follow the consumer trend of convenience, convenience, convenience," says Steven Gadowski, administrator, Department of Pathology, Anatomy and Cell Biology, Sidney Kimmel Medical College, Thomas Jefferson University.
George Washington University Medical Center is pursuing a similar path with four locations in the Washington, D.C. area. “Our experience has not been highly profitable so far, but it has been moderately profitable," says Donald Karcher, MD, Chair of Pathology and Director of Laboratories. “More importantly, it helps drive more specialty care to our specialists, which is a net gain for us. Patients get convenience, they get great care, and they have access to the specialists they need." Because academic medical centers don't traditionally put a heavy emphasis on primary care, they may be able to benefit more than other types of hospitals from developing synergy with urgent care clinics, without worrying about hurting the health of existing primary care services.
Karcher hopes his laboratories can also play a role in providing consulting services to urgent care settings, whether or not they are affiliated with the medical center. “When they get a result [from point-of-care testing] that doesn't make sense in the context of that patient, we could help them decide what it means and what additional testing the patient needs."