Urgent care is a category of walk-in clinic focused on the delivery of ambulatory care in a dedicated medical facility outside of a traditional emergency room. Urgent care centers primarily treat injuries or illnesses requiring immediate care, but not serious enough to require an ER visit. Urgent care centers are distinguished from similar ambulatory healthcare centers such as emergency departments and convenient care clinics by their scope of conditions treated and available facilities on-site. While urgent care centers are usually not open 24-hours a day, 70% of centers in the United States open by 8:00 am or earlier and 95% close after 7:00 pm.[1]
Urgent care outside of the USA Although the urgent care movement began in the US, urgent care centers are now an important healthcare delivery component in several other countries, including Canada, England, Ireland, Australia, New Zealand and Israel.
Urgent care in New Zealand
Urgent Care Trainee studyingThe College of Urgent Care Physicians, chaired by Dr David Gollogly, runs a 4 year Fellowship training programme in Urgent Care. In 2000, New Zealand became the first country to recognize Urgent Care as a medical speciality. A MCNZ report estimated that Urgent Care (also known as Accident and Medical) Clinics then accounted for 9% of consultations in primary care. In 2007 a NZMJ paper defined these clinics by onsite X-ray facilities, opening hours (seven days a week and until at least 8pm), and being community rather than hospital based. Typically limited liability companies with salaried staff in a central city location, they were distinct from both the deputising services available to General Practitioners in the UK, and the co-operative After Hours centres becoming more common in the rest of the Western world. This paper summarised findings from a 2001/2 MOH report in which data was collected from 12 randomly selected Clinics. Injury/poisoning, respiratory and non-specific symptoms were common presentations. Consultations took, on average, just over 15 minutes with most relating to new or short term problems. Depending on the time of day, X-rays were ordered on between one fifth and one sixth of visits. Overall, about half of visits resulted in a prescription, commonly for antibiotics or analgesics. About a quarter of visits during normal hours resulted in no treatment. During normal hours, 4.2% of patients were referred to a hospital emergency department. Like General Practitioners, but unlike hospital Emergency Departments which are free at the point of service, NZ Urgent Care Clinics bill patients with a part-charge, and one third of consultations were subsidised by ACC. An example of an Urgent Care provider is White Cross. In March 2008 the Accident and Medical Practitioner's Association and the Australasian Society for Emergency Medicine hosted the first international urgent care conference in Auckland, New Zealand. Subsequent annual conferences have been held in partnership with the Goodfellow Symposium History of Urgent Care in the United States The initial urgent care centers opened in the 1970s. Since then, this healthcare industry sector rapidly expanded to approximately 10,000 centers. Many centers were started by emergency medicine physicians, responding to a public need for convenient access to unscheduled medical care. A significant factor for the increase of these centers is significant monetary savings when compared to ERs. Many managed care organizations (MCOs) now encourage customers to utilize urgent care options.[2] Criteria for Urgent Care Centers Both the Urgent Care Association of America (UCAOA) and the American Academy of Urgent Care Medicine (AAUCM) have established criteria for urgent care centers and the physicians that operate them. Each share similar qualifying criteria including: Must accept walk-in patients during business hours
Treat a broad spectrum of illnesses and injuries, as well as perform minor medical procedures Have a licensed physician operating as the medical director Be open 7 days a week Have on-site diagnostic equipment, including phlebotomy and x-ray Contain multiple exam rooms Various ethical and business standards The UCAOA program is call Urgent Care Certification[3] and the AAUCM is called Urgent Care Center Accreditation.[4] Organized Medicine and Urgent Care The Urgent Care Association of America (UCAOA) holds an annual spring convention and an annual fall conference. Many leaders of organized urgent care anticipate the establishment of urgent care as a fully recognized specialty.
Urgent Care Management Monthly hosts a bi-annual conference, teaching doctors, investors, and owners about the business side of an urgent care center. Urgent Care Management Monthly (UCMM) is the official publication for urgent care management, with discussions on topics such as billing, staffing, marketing, accounting, and logistics.
JUCM, The Journal of Urgent Care Medicine is the Official Publication of the Urgent Care Association of America (UCAOA). Each issue contains peer-reviewed clinical and practice management articles.[citation needed]
Postgraduate training In 2006, the Urgent Care Association of America sponsored the first fellowship training program in urgent care medicine. A collaboration between the Department of Family Medicine University Hospitals of Cleveland / Case School of Medicine, the Urgent Care Association of America (UCAOA), and University Primary and Specialty Care Practices, Inc. in Cleveland, Ohio made this fellowship possible. The program was partially funded by an unrestricted grant from the Urgent Care Association of America. Fellowship physicians receive training in many disciplines, including: adult emergencies, pediatric emergencies, wound & injury evaluation and treatment, occupational medicine, urgent care procedures, and care center business aspects. In 2007, the Urgent Care Association of America (UCAOA) sponsored a second fellowship opportunity through the University of Illinois. The one-year fellowships are open to graduates of accredited Family Medicine and Med/Peds residencies.
Staffing and services Unlike other walk-in clinics such as retail clinics, urgent care centers are generally staffed by a physician and supported by nurses, physician assistants and medical assistants. Sixty-five percent of urgent care centers have at least one physician on-site at all times.
Of the physicians that staff urgent care centers, 47.8% are family medicine, 30.1% are emergency medicine and 7.6% are internal medicine.
With these licensed physician on-site, urgent care centers are able to offer a wide range of services including broken bones, moderate cuts and lacerations requiring stitches, and most common injuries and illnesses. These services, of course, are made possible with the diagnostic equipment and x-ray machines typically found at an urgent care.
Of course, they urgent care centers are not an emergency room and do not offer surgical services. If you are experiencing severe trauma or have a life-threatening injury or illness, call 9-1-1 or head to your closest emergency room.
That said, an estimated 13.7 to 27.1 percent of all emergency department visits could take place at an urgent care center or a retail clinic, generating a potential cost savings of approximately $4.4 billion annually, according to a 2010 study in Health Affairs.[5]
Hours of operation Urgent care centers are usually great options for seeing a physician, particularly after traditional office hours, on weekends or even holidays.[citation needed] In fact, 85% of urgent care centers are open 7 days a week.[citation needed] Common hours of operation are 8:00 am to 8:00 pm daily.[citation needed] In fact, 81.1% of urgent care centers are open by 8:00 am and 90.6% are open until at least 7:00 pm.[citation needed]
These extended hours are particularly helpful if patients are looking to avoid the hassle of hospital emergency rooms for less severe conditions. Over 80% of ER visits occur during the most common hours of urgent care centers.
Ownership The majority of urgent care centers are owned by physicians or physician groups, however, more corporations and investment banks are acquiring urgent care centers and creating regional and national brands in the industry. The following is a breakdown of urgent care ownership following a 2012 study by the UCAOA:
35.4 percent of centers owned by physicians or physician groups, down from 50 percent in 2010[6]
30.5 percent owned by a corporation, up from 13.5 percent in 2010 25.2 percent owned by a hospital 4.4 percent owned by a non-physician individual 2.2 percent owned by a franchise Leading companies in the United States While most are clinics are independently owned and operated, there are several large regional and national urgent care brands including the following: Concentra (330 locations in 40 states) [7]
AFC Doctors Express (140 locations in 26 states) [8] MedExpress Urgent Care (114 locations in 9 states) [9] Urgent care centers by state Given the constantly evolving industry and opens and closures of urgent care centers each week – and lack of standardized SIC or NAICS codes – it is impossible to know the exact number in the country, much less by state. However, according to the most accurate,[citation needed] known database of walk-in clinics, the following is a state-by-state breakdown of urgent care centers:[10][when?] State Urgent Care Centers
Alabama 82 Alaska 9 Arizona 127 Arkansas 19 California 226 Colorado 83 Connecticut 52 Delaware 13 Florida 328 Georgia 135 Hawaii 5 Idaho 29 Illinois 112 Indiana 80 Iowa 32 Kansas 19 Kentucky 49 Louisiana 56 Maine 11 Maryland 85 Massachusetts 33 Michigan 150 Minnesota 44 Mississippi 25 Missouri 86 Montana 13 Nebraska 39 Nevada 39 New Hampshire 13 New Jersey 64 New Mexico 28 New York 143 North Carolina 175 North Dakota 8 Ohio 150 Oklahoma 57 Oregon 44 Pennsylvania 98 Rhode Island 18 South Carolina 95 South Dakota 9 Tennessee 101 Texas 283 Utah 39 Vermont 3 Virginia 109 Washington 49 West Virginia 17 Wisconsin 57 Wyoming 11 Point-of-care medication dispensing Point-of-care dispensing enables healthcare practitioners in the urgent care setting to ensure that their patients receive their prescription prior to leaving the clinic. To offer this service to patients, urgent care centers generally contract with a point-of-care dispensing corporation. Point of Care dispensing enables physicians (and in some states, other licensed healthcare practitioners) to dispense at urgent care facilities. Unlike a pharmacy, practitioners may only dispense to their own patients. Regulations regarding state pharmacy law vary from state to state. Dispensing by a healthcare practitioner is not legal or quite limited in certain states, such as Texas and New York.[citation needed] Group purchasing organization Group purchasing organizations, focusing on the urgent care industry, have been formed. The concept of these GPOs is that they join hundreds of urgent care centers together to allow the type of price bargaining that previously was only available to hospitals.[citation needed]
Medical malpractice insurance Malpractice insurance offerings unique to the urgent care industry have begun to be widely discussed in light of the fact that many insurers do not recognize the reduced malpractice risk of urgent care centers. Insurers that recognize this reduced risk do not group urgent care centers with hospital emergency physicians and other high-risk specialties. Features of this type of insurance may include no charge for tail coverage when providers leave ("tail coverage" is coverage for malpractice claims which may arise after termination of a policy), 3-5 day approval of new providers, no additional premium when providers are added to the policy, per visit FTE rating, and lower premiums.[citation needed]
Codes for urgent care In recent years the American Medical Association approved the code UCM (Urgent Care Medicine). This code allows physicians to self-designate as specializing in urgent care medicine. Services rendered in an urgent care center may be designated, using the place of service code -20 (POS -20) on the CMS-1500 form, as submitted to third-party payers. The Centers for Medicare & Medicaid Services (CMS) have designated two specific codes to apply to urgent care centers: S9083 (global fee for urgent care centers) and S9088 (services rendered in an urgent care center).
Advantages of urgent care over emergency departments For injuries and illnesses that are urgent but not life threatening, it is more efficient to use urgent care than an emergency department in terms of both money and time. The typical wait time to be seen at an urgent care center is less than 30 minutes, compared with hours at an emergency department.[11]
As of 2009, urgent care centers cost less than emergency departments and have the potential to provide much more efficient care for nonurgent cases. Reimbursement by insurance companies for urgent care centers is comparable to general/family practice reimbursement ($101–$103), which is well below the average contribution for emergency department visits ($560).[12]
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