Industry FAQs
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Industry FAQs

UCAOA receives many inquiries about the urgent care industry and below are the frequently asked questions along with their answers.

 

Table of Contents

 

Average Reimbursement
Range of Visit Levels
Size of Industry
Big Urgent Care Players
Healthcare Reform
Prediction of Industry Growth
Start of UC & Growth
Difference Between Urgent Care, Walk-in Care, Immediate Care, and Convenient Care?
Services Offered
Do Urgent Care Centers Do Primary Care?
Staffing Models
Average Cost of Operating/Annual Revenue/Etc.
Rules/Criteria for Opening
Certification Standards vs. Rules/Criteria for Opening
Can a Non-Physician Own?
How to "Add" Urgent Care to Primary Care
How Much Does It Cost to Start an Urgent Care?
Does UCAOA Do Consulting/Recommend Consultants?
Does UCAOA Recommend/Endorse/Prefer Vendors?
Does UCAOA Help Sell or Fill Real Estate Space?
Relationship with ACEP/Emergency Departments
Relationship with the American Academy of Family Physicians

Do you provide a sample business plan?

Do You Have Board Certification for Urgent Care?
How to Bill?
New vs. Established


Average Reimbursement
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. More information may be found in the 2012 Benchmarking Study.

Range of Visit Levels

Urgent care centers generally use the same evaluation and management (E&M) codes as regular physician office visits. The 2012 Benchmarking Study queried the distribution of visits across E&M codes for the first time.

Size of Industry

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. Another cited figure is 9,000 urgent care centers in the U.S., however, this figure most likely includes retail medical clinics along with urgent care centers. 

14 Top Urgent Care Center Chains in the U.S.*

  1. Concentra Urgent Care (300+ clinics in 38 states)
  2. U.S. HealthWorks (190 sites in 20 states)
  3. American Family Care and Doctors Express (168 sites in 26 states)
  4. MedExpress Urgent Care (165 sites in 14 states)
  5. NextCare Holdings (123 sites in 11 states)
  6. FastMed Urgent Care (93 sites in Arizona and North Carolina)
  7. Patient First (60 sites in Maryland, New Jersey, Pennsylvania, and Virginia
  8. CareSpot Express Healthcare (52 sites in Florida, Kansas and Tennessee)
  9. Doctors Care (more than 50 sites in Kentucky, North and South Carolina, and Tennessee)
  10. Physicians Immediate Care (35 sites in Illinois, Indiana and Nebraska)
  11. Texas MedClinic (28 sites serving San Antonio, Austin, Round Rock, and New Braunfels)
  12. CareNow (24 sites in the greater Dallas-Fort Worth region)
  13. Hometown Urgent Care (24 sites in Michigan and Ohio)
  14. MD Now (22 sites serving South Florida)

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, November 19, 2015

Healthcare Reform

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.

Prediction of Industry Growth

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.

Start of UC & Growth

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.

Difference Between Urgent Care, Walk-in Care, Immediate Care, and Convenient Care?

In general these terms all refer to “urgent care,” which is differentiated from other health care 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 Illinois and Delaware.  In those states, urgent care centers adopt alternative, interchangeable names such as “immediate care” or “convenient care” that connote the delivery model and scope of services offered in compliance with the states’ 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

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.)

Do Urgent Care Centers Do Primary Care?

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.  These practices do handle ongoing chronic conditions and serve as a formal “medical home” for their patients. The 2012 urgent care benchmarking survey asked a variety of questions to have better data on the extent of this in the industry.

Staffing Models

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 sometimes 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.

Average Cost of Operating/Annual Revenue/Etc.

This number is impossible to provide.  We have tried, and the “washing out” of different variables renders a meaningless number.  This depends on your location, staffing model, services offered, contracts, rent/buy choices, and on and on.  Each owner will need to do the due diligence to determine this for their own center.

Rules/Criteria for Opening
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. 

Certification Standards vs. Rules/Criteria for Opening

UCAOA provides a Certified Urgent Care designation program to help centers differentiate themselves and to help the industry overall establish a baseline definition for urgent care centers. Currently, Certification is not a requirement for opening in any state. However, some payers are beginning to require it or to accept it in lieu of their own credentialing process.

Can a Non-Physician Own?

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) clinics 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 clinics in those states should work with an attorney to examine this issue. 

How to "Add" Urgent Care to Primary Care

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.

How Much Does It Cost to Start an Urgent Care?

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.

Does UCAOA Do Consulting/Recommend Consultants?

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.

Does UCAOA Recommend/Endorse/Prefer Vendors?

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.

Does UCAOA Help Sell or Fill Real Estate Space?

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. 

Relationship with ACEP/Emergency Departments

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."

Relationship with American Academy of Family Physicians and Primary Care Physicians

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. 

Do you provide a sample business plan?

We do not.  We do provide for members only 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. 

Do You Have Board Certification for Urgent Care?

We do not. 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)

How to Bill?

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.

New vs. Established

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.

Basically, if all of the providers in your center are the same specialty, and you’ve treated the patient in the last 3 years, that patient is an established patient for you.

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