Urgent care

Urgent Care is a new way of accessing medical care when you want it, where you want it without having to wait for an appointment to be seen. It was pioneered by ER physicians as a way to meet the demands of patients seeking an alternative to overcrowded hospital based ER's that were geared mainly to see the trauma and the gunshot wound patient far more expeditiously than the patient with a back-ache. In ER parlance, "Stat" means "Right Away" - this was the most common phrase used by ER providers on the famous TV Show "ER". The care provided at an Urgent Care is typically just that. Most urgent care facilities will provide a high quality of immediate care within a half-hour of the patient showing up at the door. They will also accept patients who do not have health insurance coverage. This 'immediate' and 'on-demand' delivery of ambulatory care in a facility dedicated to the delivery of medical care outside of a hospital emergency department, usually on an unscheduled, walk-in basis defines the urgent care movement in the US. Most Insurance plans will cover an Urgent Care visit as long as the facility is on their roster of approved Urgent Care Centers. Consumers should make sure that they are not walking into a facility that is called an Urgent Care but is only a regular medical practice marketing itself as an Urgent Care. Urgent care centers are primarily used to treat patients who have an injury or illness that requires immediate care but is not serious enough to warrant a visit to an emergency room. Often urgent care centers are not open 24 hours a day, unlike a hospital emergency room which would be open at all times. However most real urgent care centers have extended hours in the evenings and are open on all weekends and holidays. Most true urgent care centers will see children of all ages along with adults. Urgent Care centers are usually staffed by people with a background in either Emergency Medicine or Urgent Care Medicine and are able to treat a wide variety of conditions from suturing a laceration to treating a broken bone. Retail Pharmacies have opened up such centers, although many have had to be closed down in recent years. Retail pharmacy based Urgent Care centers have a limited ability to treat medical urgencies. They are usually staffed by Nurse Practitioners who are remotely supervised by a Physician.

The initial urgent care centers opened in the 1970s. Since then this sector of the health care industry has rapidly expanded to an approximately 10,000 centers until recently when a series of retail pharmacy based centers were closed. Most Urgent Care Centers were started by entrepreneurial ER physicians who have responded to the public need for convenient access to unscheduled medical care. Other centers have been opened by hospital systems, seeking to retain patient flow into their networks. Much of the growth of these centers has been fueled by the significant savings to the health plan and the consumer that urgent care centers provide over the care in a hospital emergency department. Almost all managed care organizations (MCOs) now encourage their customers to utilize the urgent care option over an ER and will direct their members to an approved facility if the member was to call their membership hotline.

Other Ambulatory Healthcare Facilities and 'Urgent Care'
Urgent care centers are distinguished from other similar types of ambulatory healthcare centers by three characteristics - they cater to all age groups, they are purely walk-in centers (never needing appointments to be made for a person to be seen) and they are open after-hours including weekends and most holidays.

Emergency departments and Fast Tracks
Emergency departments are located within hospitals and are prepared to care for patients suffering true emergencies, such as myocardial infarctions ("heart attacks"), serious motor vehicle accidents, suicide attempts, and other such life-threatening conditions. Being located within a hospital, these centers are positioned to provide ready access to major surgeries and critical care units. Emergency departments are usually staffed by physicians with specialized training or board certification in emergency medicine. Most states in the USA require all hospitals to house an emergency department within the hospital building. A few states in the USA allow freestanding emergency departments to be built outside of a hospital building. Many authorities would consider this type of facility to be a high-acuity urgent care center, rather than a true emergency department. Hospitals in the last few years have started to call a section of their triage area a "fast-track' area. Consumers need to be aware that this is no different than the regular ER and that the cost of care, the billing systems used, the codes billed as well as the co-pay in a fast track area are no different than the regular ER. A fast-track is not equivalent to an Urgent Care.

Staff Model HMO's and Multi-speciality Groups and Urgent Care
Also, many multi-speciality groups esp. the Staff Model HMO's and those with capitated contracts with Insurance companies in their attempts to contain costs hired fewer but overworked providers and as a result the appointment schedule would often be fully booked for weeks at a time. Consumers that did not want to wait, would seek care elsewhere in between the regular scheduled visits at such "Centers". Soon, it was discovered that the overall costs sky-rocketed as more and more patients went to other practitioners; many never returning back to their "center based providers". The unpopularity of such Centers led to them evolving intop separate business entities with contractual agreements.

Many such Centers created an 'Urgent Care' area within their facilities. This way, the patients could be seen quickly by either a Nurse Practitioner or a Provider that was covering the area for that shift; much like an ER. The care provided also became more efficient.facility.

Primary Care offices and "Urgent Care"
Many primary care offices are open for some hours in the evenings and weekends. Many call themselves Urgent Care Centers. These centers may be open for walk-in patients of select age groups and may also offer on-site x-ray facilities. However taking care of all age groups and their 'emergent' and 'urgent' care needs such as repairing a laceration, treating a fracture or draining an abscess are beyond their scope of practice since they are not full fledged Urgent Care Centers.

Walk-in Primary care offices and Urgent Care
There are no rules around preventing the misuse of the Urgent Care label. It is a common marketing method, esp. in New York area Urgent Care marketplace where practitioners will often use the Urgent Care label to get walk-in traffice into their offices (baiting). It is one way of filling up the schedule and building up a medical practice. Primary Care offices can only charge a Primary Care co-pay. Most Insurance plans esp. HMO's require that their member first call in and select the Primary Care physician as the "Primary". Many practices esp. in major Metropolitan areas such as New York City will even ask that an appointment be made before a patient can be seen. Consumers should be extremely wary of using services at such facilities. Real Urgent Care Centers never need an appointment and provide far more service than a regular practice would. When in doubt, consumers should call their Insurance plans' member service hotline and provide them with the facility name or address and confirm whether the facility is actually contracted with their plan as an Urgent Care or not. A common mistake consumers make is that they enquire about the physician being an 'in network' provider. Whereas physicians may be credentialed with a health plan (as a primary care physician for example) it does NOT mean that the practice is also an Urgent Care. Urgent Care visits are all treated as a speciality visit and are often billed using special codes from the AMA CPT Code book. Urgent Care co-pays are usually higher than the regular medical practice co-pay and a lot lower than an ER co-pay. Unsuspecting consumers would be overpaying for an inferior and misrepresented service, shortchanging themselves and potentially be stuck with unpaid claims and collection agency phone calls! Allowing walk-in patients is not a sufficient criterion to define a physician office as an urgent care. If the office does not offer the expanded services and significant after-hours care, then the physician office would not fit the definition of an urgent care center.

Mid-level provider offices in retail stores (Convenient Care Clinics) and Urgent Care Centers
In 2000, medical treatment centers opened in retail stores with an on-site pharmacy raising significant ethical issues surrounding potentially incentive-driven conflict of interest where medications readily available at the retail pharmacy would potentially be prescribed preferentially with no independent oversight of the medical appropriateness or medical necessity of such prescribing habits. Whereas Physician practices are debarred from selling medications in many states, retail pharmacies with such provider offices are readily allowed to do so. These centers are generally staffed with competent nurse practitioners or physician assistants. Prices are generally posted in public view and patients can shop while waiting. These retail clinics are called Convenient Care Clinics but are not true Urgent Care Centers because of the limited level of care that can be provided without a physician or proper equipment on site. Concerns about conflict of interest and incentives to over-prescribe medications in a facility rented from a pharmacy have yet to be fully addressed by organized medicine or governmental agencies, but the American Academy of Family Practice has issued Desired Attributes for Retail Clinics &lt;ref&gt;http://www.aafp.org/online/en/home/policy/policies/r/retailhealthclinics.html&lt;/ref&gt;.

Criteria for Urgent Care Centers
Several groups have tried to define criteria for urgent care centers. There are many business groups but no one group has jurisdiction over all Urgent Care Centers in the US. Urgent Care Centers by far remain a cottage industry just like regular medical practices. There are various criteria around the scope of service, hours of operation, and staffing requirements; however regulation of this sector still remains in its infancy.

Organized medicine and Urgent Care
There is usually an annual convention sponsored by one of the many Urgent Care Associations and their affiliated business groups. Many leaders in organized urgent care medicine anticipate the full establishment of urgent care as a fully-recognized specialty.

CPT Codes for Urgent Care
Real Urgent Care Centers bill Insurance companies through specific CPT Codes approved by the American Medical Association whereas Urgent Care Centers that are otherwise regular medical practices cannot bill using these codes. They would be using CPT Codes developed for Routine and Preventive Primary Care. Services rendered in an urgent care center may be designated, using the place of service code -20 (POS -20) on the CMS-1500 form, as submitted to third-party payors. The Centers for Medicare &amp; Medicaid Services (CMS) have designated two specific codes to apply to urgent care centers: S9083 (global fee for urgent care centers) and S9088 (services rendered in an urgent care center).

Postgraduate fellowship training
In 2006, a fellowship training program in urgent care medicine was begun and now there are more than one such program. Physicians in the urgent care fellowship program receive training in the many disciplines that an urgent care physician needs to master. These disciplines include adult emergencies, pediatric emergencies, wound and injury evaluation and treatment, occupational medicine, urgent care procedures, and business aspects of the urgent care center.

Point-of-care medication dispensing
Point-of-Care dispensing enables healthcare practitioners in the urgent care setting to ensure that their patients receive their prescription prior to leaving the clinic. To offer this service to patients, urgent care centers need to partner with a point-of-care dispensing corporation.

Point of Care dispensing not only enables physicians to dispense at urgent care facilities; but any licensed health care facility with a licensed dispensing practitioner on staff (Not all practitioners are able to dispense). The patient may opt to receive medication at the point of care. Unlike a pharmacy, practitioners may only dispense to their own patients. Regulations regarding state pharmacy law vary from state to state. Dispensing by a healthcare practitioner is not legal in certain states.

Specialized services
One sign that the urgent care industry is truly emerging as an important sector of the healthcare industry has been the development of supporting industries with specialized urgent care products.

EHR
Many vendors have developed EHR just for urgent care. The most economic delivery of EHR for Urgent Care facilities is via the Software-as-a-service (SaaS) paradigm.

Group purchasing
Group purchasing allows members to get product discounts previously available only to hospitals. Internet shopping has reduced overall costs for Urgent Care Centers.

Medical malpractice insurance
Malpractice insurance offerings unique to the urgent care industry have begun to be widely discussed in light of the fact that many insurers do not recognize the reduced malpractice risk of urgent care centers. Insurers that recognize this reduced risk do not group urgent care centers with hospital emergency physicians and other high-risk specialties. Features of this type of insurance may include no charge for tail coverage when providers leave ("tail coverage" is coverage for malpractice claims which may arise after termination of a policy), 3-5 day approval of new providers, no additional premium when providers are added to the policy, per visit FTE rating, and lower premiums.