One Saturday Carol Sprague had the unfortunate mishap of tripping over an item in her house, and coming down hard. When she put out a hand to break her fall, a sudden pain unlike anything she’d ever experienced seared through her shoulder. Something was definitely wrong. After a few minutes of steeling her will to get up in spite of the pain, she went to the phone and called a neighbor for help. Fortunately, there was a walk-in emergency medical facility, EmUrgentCare, just a few minutes away in West Coxsackie.
“Everybody around here says that’s where you go if you get hurt,” Sprague recounts. “When I got there, I gave them my insurance card, answered some questions, and waited maybe 20 minutes. Then I had an exam and x-rays. They found that I had dislocated my shoulder, and had a hairline fracture of the greater tuberosity [a knob for muscle attachment] of the humerus.” The doctor was able to put the shoulder back in alignment, fit her with a sling, and give her a referral for a primary care physician (she was new to the area). “Then I went home and took some Advil,” she says. In the following days Sprague visited the primary care physician and an orthopedic surgeon; the injury gradually healed with patience, care, and physical therapy.
Sprague was glad she didn’t have to travel to the nearest medical facility, in Albany, at the time of the accident. “You need someplace to go that’s not a million miles away,” she says. “I suppose I could have called an ambulance, but I didn’t want to do that. And not everybody has an emergency that needs an ambulance. EmUrgentCare did an excellent job. I have no complaints. And they’re very nice people,” she says of physicians Stephen Hassett and Alison Spear. “They sponsor a lot of things in the area. They are very giving to the community.”
Urgent-Care Centers Emerge
Walk-in medical facilities known as urgent-care centers have been around a long time. First emerging in the US in the late 1970s, the nascent sector of medical services grew slowly at first, and even experienced a backslide in the early 1990s. But the concept took hold again and rallied, and today, there are thousands of centers spread across all but a few states. About half of them are in retail shopping centers; most others are freestanding buildings; a few are in hospitals. Some are multioffice chains, others are single businesses. Many are started by experienced physicians seeking a respite from years of a demanding family practice or the intense schedule of the hospital emergency room.
“Our overall goal is to create a one-stop shop for most minor illness and injuries—whether injured at work, home, or play,” says Todd Martin, executive vice president of Emergency One, which has a facility in Kingston and another in Hyde Park. Emergency One was founded by Dr. Ferdinand Anderson, an emergency room doctor who has served as medical director and chairman of the emergency departments at The Kingston Hospital, Ellenville Hospital, Margaretville Hospital, and Benedictine Hospital. “Our providers are board certified in either emergency medicine, internal medicine, or family practice,” says Martin, “and all of them have previous emergency room or urgent-care experience.”
That makes the center ready and equipped for just about any medical challenge. “We differentiate our services from the emergency room this way: If it’s a matter of life or [losing a] limb, to go the emergency room; otherwise, come to us.”
Vital Stats on the Urgent-Care Model
If you haven’t heard of urgent-care centers, and many people haven’t, here are some reassuring statistics compiled by the National Association for Ambulatory Care (NAAC) about urgent-care centers across the nation:
• 100 percent of centers are licensed to practice medicine by the state in which they are located.
• 97 percent of centers have a fulltime staff of physician(s) and other medical personnel.
• Urgent-care physicians must be licensed to practice medicine, just as other practicing doctors are.
• Nonphysician medical staff include licensed RNs, LPNs, medical assistants, lab technologists, x-ray technologists, physical therapists, and others.
• 95 percent of centers are open seven days each week, typically for 12-14 hours a day.
The American Medical Association has given its nod to the urgent care sector by establishing a code for physicians to self-designate their specialty as “urgent-care medicine,” and a new postgraduate curriculum in urgent care is offered for MDs through collaborations of two medical schools (Case Western Reserve University and the University of Illinois) and practicing urgent care physicians. Professional organizations support the sector: most prominent are the NAAC, birthed in 1973, and the Urgent Care Association of America (UCAA), which together sponsor online networks, accreditation, national conferences, online and printed versions of newsletters and the Journal of Urgent Care Medicine, and more. Clearly, this is a robust arena of medicine that is here to stay.
Being able to see a doctor after work hours (sometimes, until midnight), on weekends, and even on many holidays, is rapidly gaining converts to the urgent-care sector. And the centers are truly a walk-in service: a referral from a primary care physician is not usually necessary (online databases allow access to a patient’s medical records, if the primary care physician’s office participates in such a service).
“The trend we are seeing,” says Martin, “is that individuals are very, very busy, and they want healthcare services available to them on their own time. We serve that niche for the community, and it’s been very well received.” In addition, Martin points out, urgent-care centers make it possible for people to get a problem checked out that they might otherwise ignore. “When you have deadlines at work, and you’re taking the kids to practice, and both parents are working, you wait until you are really in a lot of pain or very ill to seek a physician,” he says of the usual doctor’s office option. And while that office may be willing to fit in a patient’s emergency during office hours, doing so strains both the medical office and the patience of others who have waited weeks or months for their appointment.
Urgent care administrators know that customer satisfaction is their bread and butter. At Emergency One, says Martin, “we track the total patient duration time—the time from when they check in to check out—and modulate our staffing patterns accordingly. And we constantly solicit feedback through surveys. (When is the last time you were asked to fill out a satisfaction survey at your doctor’s office or emergency room?) A recent national survey, conducted by the National Headache Foundation, asked people who sought help for migraine headaches about their experiences at emergency rooms and urgent-care centers. At the centers, two-thirds of people waited less than an hour for treatment, 58 percent said their diagnosis was clearly explained, and 43 percent were given a clear home-care plan before leaving. By comparison, two-thirds of people visiting emergency rooms waited more than an hour, 38 percent received a well-explained diagnosis, and 17 percent were given a home-care plan. In addition, 67 percent of urgent-care visitors said they were treated politely and respectfully, compared to only 38 percent who said so about their emergency room experience.
Another angle to consumer appeal is ambiance. The founders of FirstCare Walk-In Medical Center in Highland intentionally designed their center so that customers would feel relaxed from the moment they walk in, says Dr. Stephen Weinman. He and his father, also a doctor, and Weinman’s sister, an emergency room assistant, created a spa-like setting to banish any sense of a typical emergency room. “It’s difficult to begin the healing process in the ER because it’s noisy, busy, and people are uptight,” Weinman says, speaking from 15 years’ experience as an ER doctor. “There are a thousand details that went into giving our center a completely different feel, from the open airy spaces, to the waterfall, the artwork, the colors—it took us two months just to find chairs that are beautiful, functional, and comfortable.” The center has a children’s room where decorations of tropical fish hang from the ceiling and large-screen TVs in every room that show tropical fish or birds. There’s WiFi, and a coffee/tea bar in the waiting area. And Weinman refused to install those sliding glass windows that separate nurses from patients in most medical offices (to meet patient privacy laws). “They form a barrier,” says Weinman. “Instead, we’ve trained our staff not to talk about patients and their problems where others can hear.” Weinman also selected and trained his staff to be warm and caring, because “customers are sick, they don’t want to be there. So we want to be sure our staff are smiling and happy. We have a good time.” That’s not a comment most folks laud on their emergency room visits.
As monthly health insurance premiums range into a staggering four-digit payout, people who once had medical coverage are increasingly opting out. When they need care, tapping into the conventional medical network is a high-priced, out-of-pocket luxury. So walk-in centers are a godsend. They aren’t necessarily cheap: a typical consultation with a doctor runs $130 to $180; tests or procedures are additional. But it’s cheaper than an emergency room. And urgent-care centers are an option for people who are visiting from out of the area, and whose insurance doesn’t cover them.
For local folks, urgent-care centers offer affordable memberships or payment plans—another facet of customer appeal. For instance, Emergency One offers the Wellness Access Card, a membership plan with a one-time registration fee of $10 and monthly fee of $21.95 for an individual, $39.95 for a family, which can be deducted from a checking account or credit card. Patients can sign up at their first visit if they have a permanent New York state address (it’s not for seasonal visitors). The benefits of membership are discounted services: $69 for a doctor visit and 20 percent discount on laboratory services or procedures. Members can also get sports or school physicals for $25, flu shots for $20, and physical therapy visits for $45. What’s more, the Wellness Access Card is accepted nationwide by thousands of doctors, specialists, hospitals, pharmacies, dentists, vision care providers, hearing services, and more, which offer a 10-60 percent discount off their services. (An online search page allows you to find participating businesses by zip code.)
Then, there are folks who have medical insurance already. Many insurance plans (but not all) now cover urgent care visits, and consider them an office setting. So the patient pays a doctor’s office copay—typically a third to quarter of the price of an emergency room copay. Tests and other services are also covered as one’s existing health plan stipulates.
Community and Workplace Services
Urgent-care centers also provide nonemergency, ongoing medical services for companies, unions, and public agencies, from schools and fire departments to major corporations. This occupational health niche amounts to a significant portion of a center’s workload—35 percent at Emergency One, for instance. These services are things like employee physicals, workers compensation injury management, drug testing, DOT and OSHA medical screenings, physical therapy, injury prevention programs and other educational trainings, and much more. With a unique position in a community, urgent-care centers proactively court collaborative relationships with employers to design customized programs and services. Emergency One tailors employee assistance programs to provide health-related training, and even offers counseling for stress, grief, substance abuse, marital and family issues—whatever a business or agency needs to best support its workers. Emergency One’s Sports and Industrial Physical Therapy Center was developed in response to an identified need for sports and occupational health services in the Hudson Valley, and offers comprehensive programs such as evaluations of the musculo-skeletal system, gait analysis, return-to-work programs, and ergonomics education. The center usually can schedule patients for evaluation within 24 hours, or even the same day.
It’s no secret that the urgent-care sector, as it continues to flourish, stands to impact more than individual patients’ pocketbooks. The health insurance industry recognizes that most of the populace—roughly 85 percent—is healthy most of the time, according to its analysis of medical insurance usage patterns. Yet it is those same people (and sometimes their employers) who are funding the current medical insurance system. Their monthly premiums create a billion-dollar pool, which is paid out mostly to cover the skyrocketing costs of care for the chronically and seriously ill. The healthy group, by contrast, needs only episodic medical care, which is just what urgent-care centers are designed for. As the standard paradigm of health insurance or managed care gets ever more expensive, healthy people are pulling their dollars from the pool and choosing new approaches like the centers. It remains to be seen just how what’s best for the individual will have a hand in reshaping a beleaguered health insurance industry, but the transition is underway.