Urgent care’s niche between primary care and the ED

Why are patients increasingly turning to urgent care centers? With high-deductible plans proliferating, people want access to affordable care. They want clarity on pricing. They want proximity and immediate availability of care, tailored services and, of course, quality. Meanwhile, emergency departments are expensive and inconvenient.

In Boston, for example, patients can wait up to 65 days to see their primary care doctor, explained Evan Berg, M.D., associate medical director, urgent care, Newton-Wellesley Hospital, Waltham, Mass., speaking at the recent National Urgent Care Convention in Chicago, sponsored by the Urgent Care Association of America.

For all these reasons, IDNs – including Newton-Wellesley Hospital – are anxious to open urgent care centers. The IDN operates an urgent care center on the first floor of a satellite campus in Waltham. It is one of four urgent care centers operated by Partners HealthCare, of which Newton-Wellesley is a part.

To more rapidly expand their presence in the urgent care market, in December 2014, Partners and MedSpring Urgent Care formed a joint venture – Partners Urgent Care – with the goal being to roll out a dozen or more facilities in eastern Massachusetts.

The opportunity
The nine-bed unit in Waltham has a staff of front-end personnel (registration, greeting); and back-end personnel, including physicians board-certified in emergency medicine, family medicine and internal medicine, nurses (RNs and LPNs), and medical assistants. The center occupies the bulk of space of the “Waltham campus” of Newton-Wellesley Hospital, approximately three miles from the main campus, Berg explains. Included in this space is X-ray, ultrasound, phlebotomy, a family medicine practice and rotating OB/GYN practices. “We routinely utilize X-ray and ultrasound services during our operating hours, but those services are also available – as is the lab draw/phlebotomy station – for primary care providers and/or specialists in need of outpatient studies.”

The competition in eastern Massachusetts is substantial, said Berg. But so are the opportunities. “There’s a huge opportunity in the market for consumer-directed services,” he said. “Consumer-directed” involves more than convenience and affordability, however.

“People are seeking more meaningful interactions” with healthcare providers, said Berg, who is certified in emergency medicine. Retail clinics can’t provide it. Neither, in most cases, can the emergency department. An extra 15 or 20 minutes with a patient can make the difference, he said, and urgent care centers can deliver it.

It’s true that independent operators of urgent care centers enjoy some advantages over IDN-owned facilities, he said. For example, they tend to have ideal locations and more robust social media and digital marketing programs. In many respects, they tend to be more nimble organizations.

However, when compared to IDN-owned sites, independent centers and retail clinics typically suffer from lean staffing, a narrow scope of service, an inconsistent specialty referral network, inconsistent followup with primary care physicians, disjointed electronic medical records systems, and an absence of a hospital-based credentialing process. Meanwhile, the IDN or hospital that owns and operates an urgent care center benefits by limiting “leakage,” that is, the loss of patients and potential patients to other hospitals, retail clinics or independent urgent care centers.

Spreading the word
Since opening the Waltham urgent care center, Newton-Wellesley has taken care to enlist the support of the hospital’s primary care physicians, said Berg. Initially, some physicians were threatened that the urgent care center would take away patients and income. Berg met with all the primary care doctors to explain the mission of the center. “It has been well-received, because the primary care physicians see they can offload their weekend and evening schedule to us,” he said. “They can spend more time with more challenging, complex patients,” potentially keeping them out of the ED. What’s more, the primary care doctors benefit from the referrals from the Newton-Wellesley Urgent Care Center, as many patients who visit the center lack a primary care doctor.

Likewise, Berg and the urgent care team have met with the hospital’s specialists, who also have come to embrace the urgent care concept. “They are the first ones who said, ‘I don’t want to do I&Ds in my office; I’d rather be in the OR,’” he said.

The urgent care team has ventured into the community, attending community events, such as expos, races and wellness fairs, and visiting local employers. The many colleges in eastern Massachusetts also represent opportunity, as many college students lack a primary care physician, and are at a loss as to who to see when they sustain an injury. Consequently, the Newton-Wellesley urgent care team has formed solid relationships with college health centers and athletic departments.

The urgent care team is also ramping up its marketing efforts, expanding into local TV and social media.

Population health management
Most important for the future, urgent care centers can play a valuable role in population health management, said Berg. That’s particularly true as governmental and commercial payers continue to make the transition to reimbursing for value instead of volume.

Population health management means delivering “the right care at the right place at the right time at the right price,” he said.

“I am an emergency physician, but the ED isn’t always the right place for treatment. The ED is the ideal location for higher-acuity, more complex, critically ill patients – including med/surg and mental health issues – given its staffing mix and necessary resources. However, for lower-acuity conditions not in need of emergent testing, a qualified urgent care venue, where the physician is not being pulled towards the higher-acuity, more critically ill and more complex patients, is a setting where the provider can spend the extra time at the bedside doing an assessment and addressing any concerns/questions, thereby potentially limiting testing that might otherwise occur if you didn’t have the benefit of time and order.”