News & Press: Urgent Care News

Rise in Number of Urgent Care and Retail Clinics Has Lead to More Coverage Options for Patients

Monday, May 15, 2017   (0 Comments)
Posted by: Omaha World-Herald
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Shawna Fisher knew the ear pain she woke up with earlier this week likely meant an ear infection.

So she called her doctor’s office at Nebraska Medicine-Midtown to see about an appointment. She learned the clinic recently had begun offering urgent care hours — evenings, weekends and holidays. So she stopped in after work, got diagnosed with an outer ear infection and left with a prescription for drops, all in under an hour.

“It’s going to be really nice,” Fisher said. “I’m really glad they have this now.”

Nebraska Medicine began offering urgent care, which the health system calls immediate care, at some of its existing clinics about two years ago. In doing so, it joined in the continuing growth of urgent cares and retail clinics in Nebraska and nationwide.

The list locally includes a variety of options, including retail clinics in grocery and drug stores; full-time, free-standing urgent care clinics; and the urgent cares that the area’s large health systems now offer inside at least some of their primary care clinics. Telemedicine services and virtual care, a CHI Health service that connects people with minor ailments to a health care provider 24/7 via phone or video chat for $10, also are on the menu.

Demand for care outside of regular business hours is the main driver behind the growth.

“It primarily is (patients saying), ‘I need to be seen when I need to be seen,’ ” said Matt Hazen, division director for service excellence, corporate and retail services for CHI Health. The health system operates urgent care centers in six clinic locations and has 10 Quick Care clinics inside area Hy-Vee stores, with a couple more to come.

The growth comes amid a push nationwide to reduce health care costs and expand access to primary care. More people have gained insurance under the Affordable Care Act. Primary care increasingly is seen as the best — and most cost-effective — way to help patients manage their health, particularly when it comes to chronic conditions.

The clinics provide an alternative to emergency rooms. While emergency rooms are the place to go for serious illnesses or injuries, they can cost patients twice as much or more and come with significantly longer wait times. Surveys by the Urgent Care Association of America indicated that 90 percent of urgent care visits take 60 minutes or fewer. The average wait for an emergency room visit, according to the group, is four hours.

Jamie Rudd, Nebraska Medicine’s immediate care clinic manager, said the health system began offering urgent care hours as part of an initiative to expand access for its primary care patients who couldn’t get into clinics during regular hours, such as those who come home after work to a sick child or sprain an ankle on the weekend.

The organization also sought to pull some patients who could be treated in clinics from its emergency rooms. The system now has immediate care at three clinics. The Midtown urgent care recently relocated from the Clarkson Family Medicine clinic at 42nd and Dodge Streets to the Midtown location at 139 S. 40th St. Nebraska Medicine also will offer urgent care at its new Chalco clinic at 168th Street and Giles Road when it opens this fall.

Children’s Hospital & Medical Center recently opened a third urgent care at the Children’s Physicians Dundee office at 48th and Dodge Streets for similar reasons.

“The availability of some of the retail clinics has made the consumer aware that health care should be available when they need it,” said Megan Connelly, vice president of operations for Children’s Urgent Care.

Indeed, patients appear to be putting the clinics to use.

A recent report from the Blue Cross Blue Shield Association found that visits to urgent cares and retail clinics nearly doubled over the past five years among commercially insured Blue Cross members. In Nebraska, use of such clinics by Blue Cross members has increased steadily since 2013. Visits jumped 74 percent from 2014 to 2015.

Still, the Blue Cross report indicated that nearly 30 percent of emergency room visits potentially could be handled by urgent cares or retail clinics. A 2010 study published in the journal Health Affairs similarly found that between 13 percent and 27 percent of emergency room visits could be seen at urgent cares or retail clinics, which could save $4.4 billion in health care spending annually.

Dr. Debra Esser, Blue Cross and Blue Shield of Nebraska’s chief medical officer, said the insurance company would like to see less use of emergency rooms for illnesses and injuries that fall short of emergencies.

“What we’d really like to offer our patients is, ‘Go first to your primary care office, but if they are for some reason unable to see you, the retail clinics are a good alternative,’ ” she said.

So far, Blue Cross members in Nebraska continue to be seen more often in their doctor’s offices than in urgent cares or retail clinics, despite their growing availability.

A total of 84 clinics — retail and urgent care combined — now operate in Nebraska, according to the latest count by the University of Nebraska Medical Center College of Public Health’s Health Professions Tracking Service. That’s up from 55 in 2013.

Nationally, the Urgent Care Association of America reported 7,357 urgent care centers alone in 2016, up 10 percent from 2015.

Family physicians generally have held that such urgent cares and retail clinics offer a good alternative as long as they stick with the appropriate scope of care — minor acute illnesses or injuries that don’t require complex diagnoses or involve ongoing care for chronic conditions such as diabetes.

“It is always the better answer to reach out to your primary care physician first,” said Dr. Matthew Burke, a member of the American Academy of Family Physicians’ board who practices at an urgent care in Virginia. Those doctors know patients best and understand their medical history, he said. Many hold appointment slots open for patients who need to get in quickly.

One concern has been that urgent cares can split up care and fragment patient records. Both the American Academy of Pediatrics and the family physicians group stress the need for patients to have a “medical home” where care is coordinated.

However, many clinics have systems in place to help make sure care is coordinated. Health systems’ urgent care records are shared in their electronic medical record systems. During Fisher’s visit, the nurse practitioner seeing her pulled up her chart in Nebraska Medicine’s system and noted her history of allergies. Nebraska Medicine and a number of other systems also have care coordinators who follow up with patients seen at urgent cares, making sure they got their prescriptions and are getting better.

Many urgent cares also check whether patients have primary care doctors and send records from the visit, even if they’re not in the same system.

“When my patients are seen in an urgent care or ER, I like that information so if there’s a question, we can follow up,” said Dr. Jason Bruce, a pediatrician and medical director for Boys Town Pediatrics’ Same Day Pediatrics. Patients can call the clinics, including one added about a year ago at 180th and Harrison Streets, to get an appointment that day. The three also offer evening hours by appointment Monday through Thursday. The clinic adjacent to Boys Town Hospital near 139th and Pacific Streets has weekend hours.

A number also refer patients who don’t have a regular doctor to a primary care physician. The urgent care association reported that 85 percent of surveyed members indicated they had mechanisms in place to help such patients find a doctor.

Mick Krupski, marketing manager for the locally owned Urgent Care Network of Omaha, said the clinics have always sent records to primary care doctors at a patient’s request. They also maintain lists of local doctors who are accepting new patients and refer patients to them.

The network, which has locations in Bellevue, Rockbrook and a new one on 72nd Street east of Crossroads Mall, tries to cooperate with primary care doctors.

“We’re an addition to, not a replacement for, primary care,” Krupski said.

And sometimes the primary doctor is the urgent care doctor. Dr. Ryan Isherwood, urgent care medical director for Methodist Physicians Clinic’s Gretna location, said he sees a lot of his regular patients when he works urgent care hours a couple times a month.

“They know I work every other Wednesday, so if they see me, they’ll come in,” he said.

Methodist has added urgent care operations at two clinics in the past two years, including the Gretna office, bringing the total to five.

While price comparisons are difficult, Burke, the family physician association board member, said primary care generally is the least expensive, followed by urgent care, with emergency room visits costing the most. The urgent care association’s surveys put the average cost of an urgent care visit at $168 vs. $2,259 for an emergency room visit. Co-pays for one local insurance plan list at $30 for an office visit, $50 for an urgent care stop and $175 for an emergency room trip. CHI’s Hazen said that Quick Cares have a menu of services and prices. The website for CVS MinuteClinics includes a long list of services and prices.

However, most of the officials interviewed said their urgent care clinics bill at a primary care rate, which varies by insurance.

Urgent Care of Omaha, which has locations at 88th and Maple Streets and at 168th Street and West Maple Road, is working to expand its HealthGap membership program. Individual members pay $50 a month and $10 a visit, which includes potential add-ons such as X-rays or vaccinations. The doctor-owned group also operates a clinic in Norfolk and is considering a third location in Omaha.

Julie Price, clinic manager, said the program can mean significant savings for patients who don’t have insurance or have high-deductible plans.

“Once people understand it, it makes quite a bit of sense,” she said.

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