• Scope of services:  minor, non-emergency illnesses and  injuries plus immunizations, allergy shots, physical exams, and work-related injuries
• Extended hours:  evenings, weekends, and holidays
• No appointments required:  services are provided on a walk-in-basis
• Staff:  physicians are frequently board certified in family practice or emergency medicine; mid-level providers also see patients
• Visit duration:  typically 60 to 90 minutes
  

Why Hospitals and Systems Should Have an Urgent Care Strategy

Overcrowding in the ED, where patients with minor injuries and illnesses frequently experience delays while sicker patients are treated first, is often the catalyst for the decision to offer urgent care.  In many hospitals, rising visit volumes are compounded by capacity constraints on inpatient units that create a backlog in the ED.

For some hospitals and health systems, including many freestanding children's hospitals, an urgent care strategy is a response to one of several market needs.  Networks of UCCs 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 simply 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. 

One Approach to Urgent Care

Covenant Healthcare's new St. Joseph Outpatient Center in suburban Milwaukee houses an 18-room urgent care center that includes specialty rooms for pediatric, orthopedic, and cardiac patients and also has its own x-ray unit.  The freestanding facility replaces a community hospital ED and a walk-in clinic at an affiliated medical practice that were located three miles apart. 

The UCC, which is the only one in the area that is open 24 hours a day, 365 days a year, is staffed by board certified physicians employed by the Covenant Medical Group who only work in urgent care.  Alicia Modjeska, president of Ambulatory Care Services for Covenant Health states that "the urgent care center is on track to see 25,000 patients in its second year of operations, and approximately 25 percent of those patients are new to Covenant." 

Approximately 50 percent of the St. Joseph Outpatient Center UCC volumes are more complex Level 3 and Level 4 patients, while most UCCs typically see only less complex Level 1 and Level 2 patients.  With this more complex patient mix, overall patient treatment times exceed the center's 60-minute benchmark.

The decision to operate the UCC under hospital-based reimbursement guidelines means patient copays are higher than those for a physician office visit.  Covenant has developed a pamphlet, which is distributed to patients as they leave, to educate patients about the unique characteristics of the center and the higher level of care that it provides and to respond to the most common questions. 

Key Considerations for UCC Development

•  No call or hospital coverage and a less stressful practice environment appeals to an increasing number of physicians.
• Currently, no certification or accreditation is required other than a license to practice medicine in the state where the center is located.
• An urgent care strategy should be positioned as complementary to initiatives of physicians and other providers in the marketplace since it is likely to be perceived as a competitive threat.
•  Participation in managed care plans is common, so reimbursement is typically straightforward.
• Dedicated staff and space is critical for UCCs in or near a hospital ED. 
• Urgent care should be operated as a separate service line with its own nursing and medical directors who have an outpatient service and management orientation; UCCs should not be part of the ED.
•  It may be difficult to change the behavior of patients who have always gone to the ED when their physician was not available.

For more information on urgent care centers, contact Maria Finarelli or Alan Zuckerman, or call 215-636-3500.