Insurance Mandate Could Spur Walk-In Clinic Boom
RediClinic, a walk-in medical center inside a New York City drugstore - Walk-in medical centers like this RediClinic inside a New York City drugstore are increasingly treating people who either don't have a regular doctor or can't get in to see one when they need to. (Spencer Platt / Getty Images)
As it gets more difficult to make an appointment with a primary care doctor, one business model is picking up the slack: walk-in medical centers.
Walk-in clinics — like drugstore chains that offer limited services from a nurse or stand-alone clinics operated by emergency room doctors — are increasingly treating people who either don't have a regular doctor or can't get in to see one when they need to. And if Congress succeeds in passing a nationwide health insurance mandate, the urgent care industry expects even more growth.
Recently, Denise Gagnier found herself in the Family Medical Care Center, a stand-alone urgent care clinic in Springfield, Mass. Gagnier had first gone to her primary care doctor to get checked out, but the office didn't have any appointments open.
"And they sent me here," Gagnier says.
It's Gagnier's first visit to the clinic, which is set up for minor but urgent problems like sprained ankles and strep throat — problems that people want treated quickly and that don't require a hospital setting.
'An Escape Valve'
There are about 8,300 urgent care centers nationwide, offering services that straddle emergency medicine and primary care.
Dr. Ira Helfand, who works at the Springfield, Mass., clinic, says most of his walk-in patients either don't have a primary care doctor or can't get in to see their doctor because of the overwhelming demand on general practices. In Massachusetts, doctors say that pressure has intensified since 2006, when the state required nearly all residents to have health insurance.
"We have a number of primary care physicians in the community who regularly use us as an escape valve for their practice," Helfand says. "They get a call from a patient who has a problem. They clearly need to be seen, but they don't have time to see them that day, so they refer them here."
The Massachusetts Medical Society recently found that 40 percent of primary care practices are closed to new patients. Meanwhile, hospital emergency rooms are seeing more patients for routine, non-emergency problems.
Urgent care entrepreneurs are expecting this scenario to play out nationally if Congress succeeds in getting insurance coverage to most Americans.
Prepared For High Volume
Lou Ellen Horwitz, executive director of the Urgent Care Association of America, says roughly 100 new walk-in clinics open a year, and she thinks the pace will quicken if millions of previously uninsured people suddenly get insurance cards.
"If there aren't enough physicians to see those folks, they're going to have to go somewhere else," Horwitz says.
And unlike primary care offices, she says urgent care clinics — which tend to refer out the most complicated cases — are ready for an onslaught.
"We're set up to take walk-ins. It's not as if our panel of patients would become full, and we can't take any more patients anymore. Urgent care doesn't work that way," Horwitz says.
In fact, as a business model, urgent care clinics rely on high volume. They are paid per patient at a rate much lower than emergency rooms, which is why Horwitz thinks urgent care centers offer one solution to rising health care costs.
"The difference between the cost of coming to us and the ER is tremendous. You multiply that over the number of visits we see per year [that] possibly would be seen in [the] ER, and you're in multiple billions of dollars pretty quickly," Horwitz says.
Of course, many doctors would rather see incentives put in place to retain and attract more people to primary care. Helfand of the Springfield clinic agrees that urgent care shouldn't replace regular checkups with a doctor who knows you — but at the moment, he says there are enough patients in line for care to fill all the waiting rooms to capacity.
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As the number of primary care providers shrinks, one business model is picking up the slack: urgent care. Business is brisk at walk-in medical centers, from drug store chains staffed by nurses to stand alone clinics operated by emergency room doctors. And if Congress succeeds in passing a health care bill that requires people to have insurance, the urgent care industry is expecting even more growth.
From member station WFCR in Massachusetts, Karen Brown reports.
KAREN BROWN: Denise Gagnier has felt miserable for days. She can't keep food down. She has a fever. So, this morning she decided that it was time to get checked out by her regular doctor.
Ms. DENISE GAGNIER: My primary care doctor didn't have any urgent care appointments open and they sent me here.
BROWN: Here, being the family care medical center, a stand-alone urgent care clinic in Springfield, Massachusetts, where Dr. Ira Helfand is catching up on Gagnier's recent medical history.
Dr. IRA HELFAND (Medical Clinic, Springfield, Massachusetts): So, you got sick, when?
Ms. GAGNIER: On Monday.
Dr. HELFAND: Are you feeling nauseated still today?
Ms. GAGNIER: I'm still nauseated.
BROWN: It's her first visit to the clinic, which was set up for minor but urgent problems - acute illnesses or infections, sprained ankles, strep throat, problems that people want treated quickly and which don't need a hospital setting.
Dr. HELFAND: If I press on your stomach, does this feel sore?
Ms. GAGNIER: Yeah.
Dr. HELFAND: How about over here?
Ms. GAGNIER: Mm-hmm, tender.
BROWN: This is the kind of care that straddles emergency medicine and primary care at about 8,300 urgent care centers nationwide. Dr. Helfand says most of his walk-in patients either don't have a primary care doctor or can't get in to see their doctor because of the overwhelming demand on general practices. In Massachusetts, doctors say that pressure has intensified since 2006, when the state required nearly all residents to have health insurance.
Dr. HELFAND: We have a number of the primary care physicians in the community -regularly used us as an escape valve for their practice. They get a phone call from a patient who has got some illness. They clearly need to be seen. They don't have the ability to see them that day. And so they refer the patient here.
BROWN: The Massachusetts Medical Society recently found that 40 percent of primary care practices are closed to new patients. Meanwhile, hospital ERs are seeing more patients for routine non-emergency problems. Urgent care entrepreneurs are expecting this scenario to play out nationally if Congress succeeds in getting insurance coverage to most Americans.
Lou Ellen Horwitz, executive director of the Urgent Care Association of America, says roughly 100 new walk-in clinics open a year. And she thinks the pace will quicken if millions of previously uninsured people suddenly get insurance cards.
Ms. LOU ELLEN HORWITZ (Executive Director, Urgent Care Association, America): If there aren't enough physicians to see those folks, they're going to have to go somewhere else.
BROWN: And unlike primary care offices, she says urgent care clinics which tend to refer out the most complicated cases are ready for an onslaught.
Ms. HORWITZ: We're set up to take walk-ins. It's not as if our panel of patients would become full, and we couldn't take any new patients anymore. Urgent care doesn't work that way.
BROWN: In fact, as a business model, they rely on high volume. They are paid per patient at a rate much lower than emergency rooms, which is why Horwitz thinks urgent care centers offer one solution to rising health care costs.
Ms. HORWITZ: The difference between the cost of coming to us and the cost of going to the emergency room is tremendous. You multiply that over the number of visits we see per year that possibly would have gone to an emergency room, and you're in multiple billions of dollars pretty quickly.
BROWN: Of course, many doctors would rather see incentives put in place to retain and attract more people to primary care. Dr. Ira Helfand agrees that urgent care shouldn't replace regular checkups with a doctor who knows you. But at the moment, he says there are enough patients in line for care to fill all the waiting rooms to capacity.
For NPR News, I'm Karen Brown in Springfield, Massachusetts. Transcript provided by NPR, Copyright National Public Radio.
