I have posted a number of notes about walk-in health clinics which are usually located in chain drug stores and staffed by nurse practitioners (NPs). The business model for them is to treat routine minor problems. A recent article discussed the rapid growth of urgent care clinics, many of which are attracting venture capital funding (see: Race Is On to Profit From Rise of Urgent Care). These latter facilities, in comparison to walk-in clinics, are staffed by physicians and offer a wider range of services. A recent article raised the issue of how to understand the mission and scope of services of urgent care facilities. Below is an excerpt from it:
Urgent care is a low-margin, high-volume proposition....The national average charge runs about $155 per patient visit.....Urgent care clinics also have a crucial business advantage over traditional hospital emergency rooms in that they can cherry-pick patients. Most of these centers do not accept Medicaid and turn away the uninsured unless they pay upfront. Hospital E.R.s, by contrast, are legally obligated to treat everyone. But as urgent care centers expand their reach, regulators in some states are scrutinizing their activities. While some states require the clinics to be licensed, most do not. It is unclear whether such urgent care centers offer better or worse care than other providers.....The average charge to treat acute bronchitis at an urgent care center in 2012 was $122, compared with $814 at an emergency room, according to data on the website of CareFirst Blue Cross Blue Shield....The price of treating a middle-ear infection was $100 versus nearly $500 in an E.R. Such cost differences matter not only to commercial insurers, but also to consumers with high-deductible health plans. Still, just how quickly urgent care is proliferating is difficult to measure. The Urgent Care Association of America, which represents more than 2,600 clinics, estimates there are more than 9,000 clinics in the United States....But a bigger issue, he said, is that the industry lacks clear criteria about what exactly urgent care means.“Just because a physician’s office extended its hours doesn’t make it urgent care,” [an expert] said. “To me, urgent care means you can do X-rays, that you can do sutures, maybe you’re open one weekend day, plus one or two evenings.” Regulators in some states are struggling with that question and others as well. In Illinois, for instance, the authorities restrict the use of the word urgent, so clinics there are called “immediate care” facilities. Other states have weighed proposals on whether urgent care facilities should be required to accept Medicaid or uninsured patients. Despite concerns of possible increased regulations, companies are lining up to buy urgent care groups.
I would like to comment on the question of whether a state could or should compel urgent care clinics to accept Medicaid or uninsured patients. Public hospitals can be forced to accept some uninsured and Medicaid patients on the basis of their non-profit status which is granted as compensation for their "charitable" activities. I have commented on the fact that this has become a charade for many health systems (see: Non-Profit Hospitals Drift from Their Mission Despite Subsidies; Cities Begin to Question Non-Profit Status, Tax Breaks of Their Hospitals). I'm not a lawyer but it seems to me that a state legislature can't force a for-profit, urgent care clinic to accept a class of patients who are unable to pay for the services being offered. Why should they be treated differently than any other business offering services for a fee?
This question may begin to sort itself out as a greater number of Medicaid patients are being provided health insurance under ACA (Obamacare). According to the article cited above, urgent care facilities are providing services for a significant lower price than hospital emergency rooms. Because of this, health insurance companies are encouraging their policy holders to use these facilities over hospital ERs. Hospitals may begin to feel the competition as the number of urgent care clinics increases.
Most importantly is that we need to develop a good definition for urgent care facilities, establish a means to assess the quality of care that is provided by them, and educate healthcare consumers about when to seek care for relatively simple problems in urgent care clinics as opposed to ERs. The health insurance companies can provide a great service by addressing these issues.