Urgent Care Clinics on the Rise

Patients suffering from small problems - such as a persistent rash - often avoid emergency rooms and instead choose urgent care clinics or retail clinics inside pharmacies.

Figures on the number of urgent care clinics nationwide range from 12,000 to 20,000. Industry observers say after declining during the 1990s, the number of urgent care clinics is growing at about two a week.

In the Triangle, Duke University Medical Center has plans to open urgent care centers in Morrisville and Knightdale. Triangle Orthopaedic Associates is opening two more ortho urgent care centers to add to its Durham location.

Retail clinics, designed to take care of minor illnesses, are springing up even faster. Eight MinuteClinics have opened in the Triangle in the past year in CVS stores, and another five are planned. Other pharmacy chains, including Walgreens, are also warming to the concept.
"Urgent care clinics serve a necessary niche," says Paula Bickley of Raleigh-based Ad Hoc Consulting, which counts urgent care centers as clients.

Many facilities started as nothing more than a physician during evening hours. They have since expanded their menu of services - from providing digital X-rays to re-hydration and even advanced life support to stabilize a sick patient for transport to a hospital emergency department.

RESURGENCE OF URGENT CARE FACILITIES

The urgent care center concept dates to the late 1970s. A California HealthCare Foundation study found that the number of centers declined in the 1990s, mostly because independent clinics got gobbled up by local hospitals. The study said that implementing a hospital-style cost structure made these centers unprofitable - or the hospitals closed the centers down to avoid competition.

Also, in their early years, urgent care centers didn't do a good job of marketing their services, according to the study.

In recent years, entrepreneurs and hospitals have refocused urgent care clinics on providing minimal wait, episodic care for people who cannot see a doctor, don't have one, or become ill outside normal business hours. Many hospitals have embraced the idea of opening urgent care centers to eliminate overcrowding in their own EDs

"Clinics are focusing on the patient experience, offering more customer service training and treating the facilities more like a retail business," says Lou Ellen Horwitz of the Urgent Care Association of America. Horwitz says hospitals such as Duke University Medical Center, which has two urgent care centers in Durham, and Rex Hospitals, which has two centers in Wake County, see these units not only as a way to relieve overcrowding in emergency rooms but as a way to draw patients.

HIGHER TRAFFIC

Dr. Kevin Broyles, medical director for Duke's urgent care clinics, says the clinics helped reduce crowding at the hospital emergency department. "People didn't have access to care in Durham outside normal business hours," says Broyles.

In fact, ED admissions at Duke have been stable at about 58,000 a year since the clinics opened in 1998 and 2002 respectively. The first clinic saw 6,000 visits the first year, and the two are now up to about 70,000 visits a year.

Urgent care centers also see plenty of traffic from patients without family physicians. Ultimately, says Horwitz, the center encourages patients to find a doctor, especially if they suffer from any chronic conditions. "Urgent care should not replace the family physician," Horwitz says.

Yet in a rapidly growing area like the Triangle, where newcomers may not have had time to find a physician, urgent care centers fill the gap.

"We've got frequent flyers,'' says Thomas Haugh, practice administrator for Accent Urgent Care and After Hours Pediatrics, referring to patients who visit frequently.

The company has centers in Cary and Raleigh. Haugh says his staff also sees patients who find visiting a doctor during the daytime too inconvenient. Since 2001, the centers have seen visits increase by close to 10 percent a year.

PEERS AND RIVALS

Convenience is a driving force behind urgent care centers' popularity. Bickley, who helps centers connect with insurers, notes a Center for Studying Health System Change report showed patients wait times, and how quickly lab results were turned around.

Convenience is also the driving force behind the retail clinics that have surfaced nationwide. "Individuals are seeking greater access to health care services with a more patient-centric approach that matches today's busy lifestyle," says Kristen Broom, manager of operations for MinuteClinic. "We meet that demand by offering services seven days a week in convenient locations close to where patients live and work. No appointment is necessary," Administrators of urgent care centers say they are not concerned that retail clinics will take a bite out of their centers' business.

The clinics, frequently found in pharmacies, typically employ just one nurse practitioner and are focused on treating the simplest illnesses - like swimmer's ear, strep throat, pink eye and bladder infections. Anything more complicated is referred out. "We actually get a lot of referrals from them," Haugh notes. "Their protocols (illnesses that will or won't be treated) are pretty stringent.''

The retail clinic administrators agree. "We are not an urgent care center," says Broom. "We don't treat fractures or sprains, abdominal illnesses, lacerations and other conditions treated at urgent care clinics."

"I think the urgent care centers were worried initially, but they've developed positive relationships with the (retail) clinics,'' Bickley says.

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