Urgent care center

**Urgent care** is a category of walk-in clinic focused on the delivery of ambulatory care in a dedicated medical facility outside of a traditional emergency department (emergency room). Urgent care centers primarily treat injuries or illnesses requiring immediate care but not serious enough to require an emergency department (ED) visit. Urgent care centers are distinguished from similar ambulatory healthcare centers such as emergency departments and convenient care clinics by their scope of conditions treated and available facilities on-site.

The United States is seeing a rapid increase in the number of urgent care centers. In Europe and the United Kingdom, similar services are called walk-in centres. While urgent care centers are usually not open 24 hours a day, 70% of centers in the United States open by 8:00 a.m. or earlier and 95% close after 7:00 p.m.

## Urgent care in the United States

The initial urgent care centers opened in the United States during the 1970s. Since then, this healthcare sector has rapidly expanded to approximately 10,000 centers across the United States. Many centers were started by emergency medicine physicians, responding to a public need for convenient access to unscheduled medical care. A significant factor for the increase of these centers is significant monetary savings when compared to EDs. Many managed care organizations (MCOs) now encourage or even require customers to utilize urgent care options. As of 2014, the urgent care industry is worth an estimated $14.5 billion.

## Demographic features of urgent care patients and providers

In 2014, US communities with non-hospital-based urgent care centers (UCCs) were mainly urban, located in areas with higher income levels and higher levels of private insurance.
Kaissi et al. considered local multi-hospital systems in Florida, Maryland, Nevada, Texas, Virginia and Washington. In 2012 50% of 117 hospital-based "clusters" included either UCCs, retail clinics, or both. 57% of systems in Washington operated an UCC, compared to 36% of systems in Washington, while systems in Florida had the largest share of UCCs (17.6%). Authors noted unexplained state-by-state variation in hospital system partnership with UCC and retail clinic models.
Corwin et al. considered Medicare beneficiaries presenting to an UCC (n=1,426,354) emergency department (ED) (n=334,841) or physicians office (n=8,359,498) with upper respiratory or urinary tract infections, bronchitis, sprains or contusions, and back or arthritic pain, in 2012. Patients who presented to an ED were more likely to be female (67% of ED presentations) compared to those who presented to a UCC or physicians office (65% and 64% respectively). Patients who presented to an UCC were significantly more likely to be aged over 85 (27%, compared to 15% of physicians office presentations, and 13% of ED presentations) or Black (11%, compared to 6% of physicians office presentations, and 4% of ED presentations).
In 2014, 3.1% of Family Physicians in the United States worked primarily in UCCs, with a male:female ratio of workforce is 6:7, and an urban:rural ratio of 2:1. This compares to 3.6% of Family Physicians working primarily in Emergency Care, with a male:female ratio of 5:3 and urban:rural ratio approaching 1:2.

## Criteria for urgent care centers

Both the Urgent Care Association of America (UCAOA) and the American Academy of Urgent Care Medicine (AAUCM) have established criteria for urgent care centers and the physicians that operate them. Each share similar qualifying criteria including:

* Must accept walk-in patients during business hours
* Treat a broad spectrum of illnesses and injuries, as well as perform minor medical procedures
* Have a licensed physician operating as the medical director
* Be open 7 days a week
* Have on-site diagnostic equipment, including phlebotomy and x-ray
* Contain multiple exam rooms
* Various ethical and business standards
* Contain a procedure room where stitches could be placed, a cast be put on a leg, or even a minor surgical procedure if it is not too risky and can be done under a local anesthetic (numbs a small portion of the body; however, will not put patient into a medically induced coma).
* Contain communication lines with local hospitals so that patients who need transfer to an emergency room have easy access.

The UCAOA program is called Urgent Care Certification and the AAUCM is called Urgent Care Center Accreditation.

## Organized medicine and urgent care

The Urgent Care Association of America (UCAOA) holds an annual spring convention and an annual fall conference. Founded in 2004, the UCAOA does not own any urgent care centers itself, but rather provides resources, training, and leadership to the industry. Many leaders of organized urgent care anticipate the establishment of urgent care as a fully recognized specialty. This organization launched an accreditation program in 2014, and has since partnered with an insurer called Urgent Care Assurance Company.

Urgent Care Management Monthly hosts a bi-annual conference, teaching doctors, investors, and owners about the business side of an urgent care center.
Urgent Care Management Monthly (UCMM) is the official publication for urgent care management, with discussions on topics such as billing, staffing, marketing, accounting, and logistics.

JUCM, The Journal of Urgent Care Medicine is the Official Publication of the Urgent Care Association of America (UCAOA). Each issue contains peer-reviewed clinical and practice management articles.

Board of Certification in Urgent Care Medicine (BCUCM) provides board certification for physicians with requisite training and experience. The Urgent Care College of Physicians (UCCOP) offers educational programs for physicians in the urgent care field, and advocates for the field's overall status as a unique specialty.

Another entity, the American Board of Urgent Care Medicine (ABUCM), was founded in 1997. This organization provides certification to urgent care programs.

## Postgraduate training

In 2006, the Urgent Care Association of America sponsored the first fellowship training program in urgent care medicine. A collaboration between the Department of Family Medicine University Hospitals of Cleveland / Case School of Medicine, the Urgent Care Association of America (UCAOA), and University Primary and Specialty Care Practices, Inc. in Cleveland, Ohio made this fellowship possible. The program was partially funded by an unrestricted grant from the Urgent Care Association of America. Fellowship physicians receive training in many disciplines, including: adult emergencies, pediatric emergencies, wound & injury evaluation and treatment, occupational medicine, urgent care procedures, and care center business aspects. In 2007, the Urgent Care Association of America (UCAOA) sponsored a second fellowship opportunity through the University of Illinois. The one-year fellowships are open to graduates of accredited Family Medicine and Med/Peds residencies.

## Staffing and services

Unlike other walk-in clinics such as retail clinics, urgent care centers are generally staffed by a physician and supported by nurses, physician assistants and medical assistants. Sixty-five percent of urgent care centers have at least one physician on-site at all times.

Of the physicians that staff urgent care centers, 47.8% are family medicine, 30.1% are emergency medicine and 7.6% are internal medicine.

With these licensed physician on-site, urgent care centers are able to offer a wide range of services including broken bones, moderate cuts and lacerations requiring stitches, and most common injuries and illnesses. These services, of course, are made possible with the diagnostic equipment and x-ray machines typically found at an urgent care.

Of course, the urgent care centers are not an emergency department. They do not offer surgical services, as a rule- particularly invasive surgical procedures (more than cutaneous or subcutaneous procedures- those involving body organs and organ parts, and/or deep penetration of deep fascia, tendons, ligaments, bursae, joints, muscles, or bones), any procedures requiring the use of regional or general anesthesia (more than topical local anesthesia), those procedures requiring a full operating room or suite, having lengthy recovery times, or requiring more than the level of imaging or specialists available at the center.

That said, an estimated 13.7 to 27.1 percent of all emergency department visits could take place at an urgent care center or a retail clinic, generating a potential cost savings of approximately $4.4 billion annually, according to a 2010 study in *Health Affairs*.

## Ownership

The majority of urgent care centers are owned by physicians or physician groups, however, more corporations and investment banks are acquiring urgent care centers and creating regional and national brands in the industry. The following is a breakdown of urgent care ownership following a 2012 study by the UCAOA:

* 35.4 percent of centers owned by physicians or physician groups, down from 50 percent in 2010
* 30.5 percent owned by a corporation, up from 13.5 percent in 2010
* 25.2 percent owned by a hospital
* 4.4 percent owned by a non-physician individual
* 2.2 percent owned by a franchise

## Codes for urgent care

In recent years the American Medical Association approved the code UCM (Urgent Care Medicine). This code allows physicians to self-designate as specializing in urgent care medicine. 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 payers. The Centers for Medicare & 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).