The shortage of primary care physicians nationally is one factor contributing to the inappropriate use of hospital emergency rooms. While some primary care physicians have added open access slots to their schedules, others have closed their practice to new patients. Many do not have evening or weekend hours and have limited numbers of same-day appointments. All of these forces drive up emergency department utilization rates, and their impact is likely to increase when an estimated 32 million uninsured persons gain insurance coverage and exacerbate the current shortage of primary care physicians.
Health care organizations across the country are finding that urgent care centers can provide multiple strategic and operational benefits, including meeting consumer demand for quick, convenient, affordable health care services when physician offices are closed or patients are unable to get timely appointments with their primary care provider. A 2010 study by the RAND Corporation found that about 17 percent of all visits to hospital emergency departments across the United States could be treated at retail medical clinics or urgent care centers, often staffed by nurse practitioners and physician assistants, potentially saving $4.4 billion annually in health care costs.
Several urgent care strategies should be considered as options for better serving existing patients and preparing for the effects of health care reform:
Offer hospital-based urgent care services within or adjacent to the existing emergency department. Having the option of urgent care immediately available to patients who arrive at an emergency department, but would be better served by urgent care, promotes a smooth flow of patients to the setting that is best suited to their needs.
Offer or partner with community-based urgent care services. Networks of urgent care centers provide convenient, accessible care to service area residents while establishing a visible presence in the community. In markets where primary care physicians are in short supply or are overwhelmed by after-hours calls from patients, developing urgent care centers that assist local practices can be an opportunity to build or strengthen key referral relationships.
Shift lower acuity emergency visits to urgent care centers. Approximately 40 percent of all emergency department visits are typically Level 1 or Level 2 in severity (e.g., minor infections, strains, fractures, lacerations) and could be treated in alternative, lower-cost care sites such as urgent care centers.
Are urgent care centers an option for patients in your community? Are they being used appropriately? Is your emergency department managing demand for its services well, and, if not, are plans underway to make changes? How is communication among your emergency department, urgent care center(s), acute care services, specialists, and primary care physicians being managed?