Top Challenges Urgent Care Centers Face in 2018

There are a number of exciting things happening in the world of urgent care: more geographic diversity means better access for patients, an increased trust in urgent care facilities, etc. However, whether it’s a person or a business, there are usually growing pains that accompany the process of expansion.

In this Q&A, Dr. Alejandro Badia, the founder of OrthoNOW, sheds light on the critical challenges faced by urgent care centers in 2018.

Q: Why do we need urgent care centers?

A: General urgent care centers fill an important niche in terms of availability, access and cost. In the event of a cold, for example, you don’t typically need to see your primary care physician (PCP). These centers should not, however, displace PCPs who know the patient’s history.

Q: Do urgent care centers provide the same level of quality as an ER?

A: Orthopedic and pediatric issues are two of the most common reasons patients seek out an urgent care center. A typical PCP or emergency room (ER) doctor is not trained in subtle pediatric or orthopedic problems. In fact, a 2014 University of Maryland School of Medicine study found that more than 90% of potential pediatric fractures are not splinted correctly in ERs and urgent care centers, something that can result in joint dysfunction, skin issues and poor pain reduction. If someone with such an issue goes to a general urgent care center, the appropriate treatment may actually be delayed. For example, the treating physician may just give someone ibuprofen for a painful foot and tell them to rest…when what is actually needed is an X-ray because the foot is fractured. So, the person doesn’t actually get a confirmatory diagnosis for, say, another 24-48 hours. In such a situation, the urgent care center is just a stepping stone that is adding cost to the system.

The bottom line is you don’t want to go to your local drug store — many of which now have medical clinics — if you have a tumor. Those type of situations are actually what motivated me to launch a full-scale orthopedic urgent care franchise. So many patients who ‘land’ in my office have already been to several other places to no avail. A 2017 article appearing in AAOSNow found that more than one-third of orthopedic assessments in an ER were inaccurate. Or, you may have a practitioner at a general urgent care center telling someone they have a jammed finger, which is actually not a medical diagnosis. In fact, the person has one of many subtle things that require the intervention of a hand specialist.

Q: It’s a competitive medical environment. How are urgent care centers faring?

A: The market is becoming saturated with healthcare providers, among them numerous urgent care centers. In rural or semi-rural areas there is room for expansion. The issue is that some urgent care franchises will have trouble getting contracts with insurance companies. In some areas there are large healthcare systems that have a stranglehold on healthcare, meaning if you are an independent PCP or ER doctor who wants to open an urgent care center, you may have trouble with contracts.

It’s only a matter of time before we shift to a completely value-based system where insurers are pressured to determine whether XYZ treatment represents good value. A busy ER, for example, is not typically a good value. It’s an unusual process, really, as the insurers don’t routinely assess quality or need. The bottom line is that incentives need to be aligned. If insurance companies and providers were properly aligned, the overall system could save a lot of money. In the event of an orthopedic issue if an insurer says, ‘Yes, XYZ treatment makes sense for a given patient,’ then the entire care process is less expensive and better for the patient.

Q: What are the regulatory/legal challenges facing urgent care centers?

A: The laws vary widely from state to state, and are frequently in flux, both of which mean that regulatory issues are a moving target. As a nation we are spending more and more on healthcare laws, but are we really getting quality care? The Health Insurance Portability and Accountability Act compliance and reporting regulations mean that facilities must have a sophisticated electronic medical record system in place — which is very expensive. And with declining reimbursements, this added expense means that you have to increase the volume of patients.”

Administrators of urgent care centers have to be marketers because for many years people have been conditioned to go to the ER. Now, urgent care franchises are deconditioning people to go to the ER. Ideally, insurers would be supporting and working closely with specialty urgent care centers. We need to have these discussions with insurance companies; but thus far they are for the most part not involved in the urgent care dialogue.

Q: Do you think we will see a rise in the use of urgent care centers?

A: Approximately 10 to 15 years ago urgent care centers were a novelty and people were wary of them. Now, the pendulum has swung the other way and urgent care facilities are receiving patients with clinical problems that actually should be treated in a hospital. If someone has chest pain and goes to an urgent care center they won’t be able to start thrombolytic therapy to interrupt a stroke or heart attack. Consumers need to be educated about these issues.

Q: What positive things does the year hold for urgent care centers?

A: I believe we will begin to see more uniformity coming from the federal government as it becomes clear that U.S. healthcare is under pressure. For one thing, we will see a wave of telemedicine options. Some urgent care centers will be hubs; patients will be able to contact a clinician with detailed information in order to determine if it’s really necessary to come there in person. There are 11 states that have parity laws so that treatment providers can get reimbursed the same amount for a telemedicine as an in-office visit.

The future does hold many promises for urgent care franchises, especially when these centers specialize in certain areas and have the resources to support the full spectrum of treatment.