UCAOA fields daily inquiries from members, customers, the public, and media; below is a compilation of the most asked questions we receive.
The 2012 Benchmarking Study (2011 data) indicated that, on average, per visit reimbursement decreased slightly. The 2010 Benchmarking Study (2009 data) reported urgent care center per visit reimbursement had hovered only slightly above the national average for primary care.
Urgent care centers generally use the same evaluation and management (E&M) codes as regular physician office visits.
There are nearly 7,100 urgent care centers in the U.S. The urgent care centers that make up this number have been verified manually by UCAOA and provide full-service urgent care medicine (X-ray, lab, extended hours.) There is no other national database, since federal registration is not required. Other cited figures that are higher may include retail centers.
Concentra 300+ centers in 38 states // MedExpress Urgent Care 180 centers in 16 states // U.S. HealthWorks 174 centers in 21 states // American Family Care and Doctors Express 163 centers in 25 states // NextCare Urgent Care 137 centers in 10 states // FastMed Urgent Care 109 centers in 3 states // Patient First 67 centers in 4 states // HCA CareNow 64 centers in 5 states // CityMD/Premier Care 57 centers in 3 states // CareSpot Express Healthcare 54 centers in 4 states // Doctors Care 51 centers in 4 states // MedPost Urgent Care 51 centers in 9 states // GoHealth Urgent Care 45 centers in 3 states // Fast Pace Urgent Care 37 centers in 2 states // Physicians Immediate Care 37 centers in 3 states // Centra Care 36 centers in three states // Aurora Health 34 centers in 2 states // Intermountain Health 32 centers in 1 state // MedSpring Urgent Care 32 centers in 3 states // Premier Health 31 centers in 3 states // Carolinas Health Care 29 centers in 1 state // ProHEALTH Care 29 centers in 1 state // Providence Health & Services 29 centers in 1 state // Urgent Team 29 centers in 2 states // Express Care of MD 28 centers in 3 states // MD Now 28 centers in 1 state // ZoomCare 28 centers in 1 state // Sutter Urgent Care 27 centers in 1 state // Hometown Urgent Care 24 centers in 2 states. With the continued entry of investor dollars into the industry, and therefore likely continued growth and/or consolidation, it is probable that this list will continue to grow in coming years. *HealthData Management, October 27, 2016
There is nothing in the PPACA that refers specifically to urgent care by name. That said, there are aspects of it that could influence the industry, namely some of the requirements and regulations around Accountable Care Organizations and their formation. It is the conventional wisdom that should the PPACA survive to be implemented, the newly-created pool of insured individuals will fuel significant growth (and perhaps changes) to the urgent care industry - primarily because the existing primary care system is too small to absorb these new patients.
The size of the urgent care industry has only been measured in any real way since approximately 2008, and the approximate growth in the 2008-2010 timeframe seemed to be about 300 centers per year. In 2011 it appeared that that growth rate doubled, but given the constraints on the ability to count centers, that number (600/year) should be used with caution. Anecdotally, it does also seem that the growth rate has increased significantly, confirming what the numbers appear to say. There is no indication that this will slow down any time in the near future, but UCAOA does not make predictions on growth as the tracking does not have enough history and the mechanisms for tracking are far from scientific.
Urgent care began, as far as anyone can tell, in the late 1970s and was created to meet a need in a community. The growth from the 70s-80s was slow and steady as the concept of a "doc in a box" that one could see without appointment gained in popularity. Over the next 20 years the industry continued to expand and to gain respect as a viable place to receive healthcare when one could not get into one's "regular" physician. Recent industry growth (last 5 years) seems to be fueled by a confluence of events and awareness - primary care being somewhat hard to come by, emergency room wait times and overcrowding spreading, physicians seeing and acting on these needs in their communities, and patients driving their popularity. Most recently, the private equity community has noticed urgent care as a viable business model and their investments have also fueled growth from within the industry itself.
In general these terms all refer to urgent care, which is differentiated from other healthcare delivery models based on: no appointment necessary to see a medical provider; evening and weekend operating hours; x-ray on site; and capability to perform procedures like suturing and casting. Additionally urgent care centers tend to be positioned in high-visibility, consumer accessible locations, have a strong customer service orientation, and focus on getting patients in and out quickly. Whether a center chooses to call itself “urgent care,” “immediate care,” “walk-in care,” “convenient care”—or to brand itself in such a way that connotes the same concept of on-demand medical care (such as FastMed, CareNow, or MedExpress)—the name chosen is up to the individual practice and should not be inferred as differentiating the center’s scope or quality of services. The use of the term 'urgent care' is generally unregulated with the exception of Delaware where an alternative/interchangeable name is used (e.g., immediate care or convenient care) to connote the delivery model and scope of services offered in compliance with the state's marketing and signage restrictions. Urgent care centers, regardless of their moniker, treat minor or acutely rising medical conditions that patients feel require immediate medical attention but that are not medical emergencies. Non-urgent conditions can generally wait to be treated by scheduled appointment in a primary care office and medical emergencies involving trauma or resuscitation should go straight to a hospital emergency room.
Services offered are generally defined by the practice, but there is a baseline of a broad scope of both "primary care" type services as well as more acute care that is beyond the typical primary care office but below the treatment of life or limb-threatening conditions. Many urgent care centers also provide occupational medicine services, and various other ancillary types of care (physical therapy, weight-loss, etc.)
In some communities, urgent care centers do formally function as the primary care practice for some of their patients, usually driven by patient demand rather than competitive intent.
The majority of urgent care centers use a "physician-based" model, typically utilizing family practice physicians and emergency physicians. In addition to these primary providers, centers often staff with medical assistants, sometimes registered nurses, and sometimes x-ray technicians. More and more, urgent care centers also staff with physician assistants and nurse practitioners. There is no "recommended" or "standard" or “perfect” staffing model. This is determined individually by each center and varies depending on the philosophy of the center, the local labor market, scope of practice, state practice laws, and the like.
This number is impossible to provide because it depends on location, staffing model, services offered, contracts, rent/buy choices, etc. Each owner will need to do the due diligence to determine operating costs for his/her own center.
Most states do not have any criteria specific to urgent care centers. In those states, centers follow the rules that are in place for opening any regular medical office - business licenses, medical licenses, and applicable registration of x-ray or lab. A few states do have specific regulations.
UCAOA provides Certified and Accredited Urgent Care designation programs to help centers differentiate themselves and to help the industry overall establish a baseline definition for urgent care centers. Currently, certification and accreditation are not a requirement for opening in any state; however, payers are increasingly requiring certification and/or accreditation as part of their contracting process.
The Corporate Practice of Medicine Doctrine basically states that corporations cannot practice medicine, that that should be left up to physicians. Therefore, in the states where it applies (California, Ohio, Texas, Colorado, Iowa, Illinois, New York, and New Jersey) centers must be owned directly by physicians rather than a corporate ownership with physician employees. A quick review of the landscape in these states makes it clear that there are legal structures that make it possible to "get around" that doctrine. Corporations interested in owning centers in those states should work with an attorney to examine this issue.
Primary care offices are often looking to add urgent care to their existing practices, the assumption being that they will be able to charge additional fees for these visits, which is not always the case. The main question for practices interested in doing this is what their current payer contracts say, and what the payer would require to make this addition. Potential requirements are: separate contract, separate providers, separate entrance and waiting area and exam rooms, new Tax IDs, requirement to close and then re-open at later time, etc. There are no laws about this other than what is above in Opening Criteria.
The current conventional wisdom says about $800,000 if you are starting from nothing. That should cover startup costs as well as three months of operating expenses until you start receiving reimbursements from payers. Obviously, every situation is a little different, and you can make some big mistakes and spend a lot more than that. We recommend that everyone considering opening a center either attends live or listens to the recordings of our Comprehensive Clinic Startup Course.
As a non-profit, UCAOA does not do consulting but we offer a Virtual Exhibit Hall containing a listing of consultants. These individuals are experienced in urgent care, but are not formally affiliated with UCAOA.
UCAOA has a policy of not endorsing particular vendors. That is not to say that there are not excellent vendors in the urgent care space – in fact, there are many, which is part of why we do not endorse anyone specifically. In each category, there are several excellent organizations and we would not want to pick one over the other. Each owner needs to evaluate the different vendors individually for their own practice.
Real estate agents can reach out to us to fulfill a classified ad listing, promoting the availability of a certain property or parcel of land for sale. These ads are listed on our web site.
UCAOA maintains a cordial, informal relationship with our colleagues at the American College of Emergency Physicians. We acknowledge that our country’s payment and incentive systems, and requirements of EDs to act as the nation’s healthcare safety net often puts EDs in a very challenging position. We encourage urgent care centers to work cooperatively with their local emergency departments to best meet the needs of their communities in an open-access, low-cost manner. For more information read "Helping Health Care Work Best – The Role of Urgent Care in Today’s Healthcare System."
UCAOA maintains a cordial, informal relationship with our colleagues at the American Academy of Family Physicians. We acknowledge that in some communities there is a “physician shortage” and in some communities that’s not the case, so the strategies for PCPs and urgent cares working together will vary by community. We encourage urgent care centers to work cooperatively with their local primary care to best meet the needs of their communities for no-appointment, non-emergency care.
UCAOA does not offer a sample business plan. We do provide for members several templates, including an empty Excel workbook that helps ensure you have all your bases covered, but we intentionally do not provide amounts in that workbook or a business plan. Experience of hundreds of consultant hours and owners have told us that the prospective owner needs to do the work of developing that on their own if they are truly to be ready to open and run a center.
Currently, urgent care medicine is not recognized as a specialty (or sub-specialty) by the American Board of Medical Specialties (ABMS) and it is unlikely this will change in the near future because there are some basic criteria the field has yet to meet (primarily a unique body of knowledge AND a critical mass of training programs). That said, there are a couple of existing board exams available. The one we are able to speak a bit about is from the American Board of Physician Specialties (ABPS), because the physicians who put that exam together are all UCAOA members and known personally to the leadership of our organization. Information on that exam can be found at the ABPS web site: www.abpsus.org. UCAOA does not currently have any plans to create its own exam, and if that were to even be considered it would be the purview of our affiliated organization, the Urgent Care College of Physicians (www.uccop.org)
Most urgent care centers bill very similarly to the typical primary care office, using E&M (evaluation & management) codes. In addition, many centers bill urgent care-specific codes such as S-codes and other after hours codes. Note that these must be pre-negotiated in your contracts to be paid, so it is important to get that in up front. Medicare does not recognize the S-codes. For place of service, urgent care does have its own number, POS 20. Use of this place of service should also be in your contract. Medicare automatically crosswalks POS 20 to POS 10 (primary care) so do not be surprised at this.Billing in urgent care is a complex topic that cannot be covered in full here. We recommend that centers either hire a coder and/or billing company with urgent care experience, use an EMR that is written for urgent care, or at the very least, send a "normal" coder to educational programs to get up to speed in this area. Caution: there are many billing companies soliciting (and working with) urgent care practices today that do not have experience in urgent care. Try to find an experienced billing company.
It is a common misconception that all urgent care patients are 'new' patients and can therefore always be billed with 'new' E&M codes at a slightly higher rate. Urgent care centers are subject to the same rules for new vs. established patients as every other practice.