Urgent Care Centers Are Booming, Worrying Some Doctors

Quick in and out with weekend hours, urgent care centers located in shopping centers and big-box stores gaining in popularity.

WEDNESDAY, September 19, 2012 — When Emily Auerswald and her children need care for minor illnesses or injuries, they head to a shopping center near Annapolis that has a starbucks, a Five Guys hamburger joint and an urgent care center.

Such centers treat the most common damages and sickness-- including colds, , cuts and back pain, ear infections -- urine and drug tests in addition to taking X-rays and performing simple blood,.

Doctors Express in Edgewater is open nights and weekends, and accepts walk-ins without an appointment.

Since 2008, the number of facilities has increased from 9,000 to 10,300. That includes about 500 in the District, Maryland and Virginia -- and that's not counting smaller and more limited walk-in clinics in pharmacies and big-box stores such as Target and Wal-Mart.

And they are booming: An estimated 3 million patients visit them each week, according to the Urgent Care Association of America.

Some physicians groups warn that the overreliance on the centers can complicate efforts to develop health through better coordination of care.

If a teenager comes in with slashes, for example, a family doctor might broach the subject of liquor or drug use, he said. Similarly, a series of apparently minor sicknesses might indicate a larger, less obvious problem.

"Family doctors take a more complete view of a person," said Glen Stream, president of the American Academy of Family Physicians.

Next Gold Rush?

Rick Morani, owner of the clinic near Annapolis, said he bought the Doctors Express franchise -- one of seven in the Washington-Baltimore area and 54 nationwide -- because he expects the growth curve to look "like a hockey stick."

But consumers looking for to avoid long waits in emergencies rooms and grateful for more suitable evening and weekend hours are driving a steady growth in urgent care centers.

Growth is expected to growth even faster in 2014, when the Affordable Care Act starts to bring health-care coverage to as many as 40 million Americans, many of whom do not have regular doctors, said Charland.

Many urgent care centers are stand-alone doctor's offices, sometimes called "doc-in-a-box" locations. But much of the recent growth has come from chains, said Tom Charland, chief executive of Merchant Medicine, a Minnesota consulting firm that tracks the industry.

Growth is expected to increase even faster in 2014, when the Affordable Care Act starts to bring health-care coverage to as many as 30 million Americans, many of whom do not have regular doctors, said Charland.

Concentra, the nation's largest chain, has 324 centers, including 14 opened in the last nine months.

In the past, at least some of the patients who now go to urgent care centers would have ended up in hospital emergency rooms. While the typical $110 visit to a center is comparable in price to a visit to a doctor's office, an emergency room visit can cost more than twice as much. A 2011 Rand Corp. study found that almost one in five visits to hospital emergency rooms could be treated at urgent care centers, potentially saving $4.4 billion annually in health-care costs. Several local hospitals have also opened facilities. Inova Health System, for instance, has four urgent care centers in Northern Virginia and is looking to add a fifth.

Even hospitals have jumped in, adding their own urgent care centers. In July, for example, Dignity Health, the nation's fifth-largest hospital system, bought U.S. HealthWorks, the second-largest urgent care chain, with 147 centers.

While urgent care centers typically offer hundreds of medical services, they do not perform surgery and are not equipped to deal with life-threatening emergencies. In most cases, a doctor is on site, although care may be provided by a nurse or physician assistant who is also on staff. Many centers are busiest in the evenings and on weekends, when most doctors' offices are closed.

The lower costs have drawn the attention of insurers. Many have added urgent care centers to their provider networks, and one has gone a step further. Humana, in 2010, purchased Concentra.

Even hospitals have jumped in, adding their own urgent care centers. In July, for example, Dignity Health, the nation's fifth-largest hospital system, bought U.S. HealthWorks, the second-largest urgent care chain, with 147 centers.

Selling Efficiency

For patients, convenience and lower costs seem paramount.

Diantrey Thompson, 26, of Glen Burnie, recently had a cyst removed from his head at Righttime's location in Gambrills. Although the restaurant manager has insurance and a regular doctor, he says, "I've been coming here for years because they are just so efficient."

From a command center in Crofton, Md., an employee tracks all Righttime centers via cameras set up at front desks and in hallways.

Urgent care center executives clearly understand that saving time is a major selling point. Righttime, for example, has a goal of getting patients in and out within an hour.

A computer system monitors how long people have been waiting.

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