- 1 Urgent Care in the United States
- 2 History
- 3 Criteria for Urgent Care Centers
- 4 Organized Medicine and Urgent Care
- 5 Postgraduate training
- 6 Staffing and services
- 7 Hours of operation
- 8 Ownership
- 9 Leading companies in the United States
- 10 Urgent care centers by state
- 11 Urgent care outside of the USA
- 12 Urgent care in New Zealand
- 13 Point-of-care medication dispensing
- 14 Group purchasing organization
- 15 Medical malpractice insurance
- 16 Codes for urgent care
- 17 Advantages of urgent care over emergency departments
- 18 References
- 19 External links
Urgent Care in the United States
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 room. Urgent care centers primarily treat injuries or illnesses requiring immediate care, but not serious enough to require an ER 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. While urgent care centers are usually not open 24-hours a day, 70% of centers open by 8:00 am or earlier and 95% close after 7:00 pm.
The initial urgent care centers opened in the 1970s. Since then, this healthcare industry sector rapidly expanded to approximately 10,000 centers. 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 ERs. Many managed care organizations (MCOs) now encourage customers to utilize urgent care options.
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
Organized Medicine and Urgent Care
The Urgent Care Association of America (UCAOA) holds an annual spring convention and an annual fall conference. Many leaders of organized urgent care anticipate the establishment of urgent care as a fully recognized specialty.
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.
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.
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, they urgent care centers are not an emergency room and do not offer surgical services. If you are experiencing severe trauma or have a life-threatening injury or illness, call 9-1-1 or head to your closest emergency room.
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.
Hours of operation
Urgent care centers are usually great options for seeing a physician, particularly after traditional office hours, on weekends or even holidays. In fact, 85% of urgent care centers are open 7 days a week. Common hours of operation are 8:00 am to 8:00 pm daily. In fact, 81.1% of urgent care centers are open by 8:00 am and 90.6% are open until at least 7:00 pm.
These extended hours are particularly helpful if patients are looking to avoid the hassle of hospital emergency rooms for less severe conditions. Over 80% of ER visits occur during the most common hours of urgent care centers.
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
Leading companies in the United States
While most are clinics are independently owned and operated, there are several large regional and national urgent care brands including the following:
- Concentra (330 locations in 40 states) 
- AFC Doctors Express (140 locations in 26 states) 
- MedExpress Urgent Care (114 locations in 9 states) 
- NextCare (90 locations in 8 states) 
- FastMed (72 locations in 2 states) 
- CareSpot (54 locations in 5 states) 
- Doctors Care (49 locations in 1 state) 
- Patient First (46 locations in 4 states) 
- CareNow (23 locations in 1 state) 
Urgent care centers by state
Given the constantly evolving industry and opens and closures of urgent care centers each week – and lack of standardized SIC or NAICS codes – it is impossible to know the exact number in the country, much less by state. However, according to the most accurate, known database of walk-in clinics, the following is a state-by-state breakdown of urgent care centers:[when?]
|State||Urgent Care Centers|
Urgent care outside of the USA
Although the urgent care movement began in the US, urgent care centers are now an important healthcare delivery component in several other countries, including Canada, England, Ireland, Australia, New Zealand and Israel.
Urgent care in New Zealand
In 2000 New Zealand, also the first country to give women the vote, became the first country to recognize Urgent Care as a medical speciality. According to a MCNZ  report, consultations in Urgent Care (formerly known as Accident and medical) clinics accounted for an estimated 9% of consultations in primary care. By 2013, 120 fully qualified Urgent Care Physicians were registered with the Medical Council of New Zealand. In terms of size the College of Urgent Care Physicians ranked at 14 out of the 36 vocational branches recognised by the Council.
In 2007 an  original article in the NZMJ described these clinics as "unique to NZ". Typically limited liability companies with salaried staff, they were characterised by extended hours with a no-appointments schedule, in a central city location. Being distinct from both the deputising services available to General Practitioners in the UK, and the co-operative After Hours centres becoming more common in the rest of the Western world, authors felt the closest comparisons could be made with Canadian Walk-in clinics. Their article summarised findings from a 2001/2  report in which data was collected from 12 randomly selected Accident and Medical Clinics, defined by onsite X-ray facilities, opening hours (seven days a week and until at least 8pm), and being community rather than hospital based.
NZ health and disability services are funded mainly by taxation. The government agency ACC, which takes premiums directly from wages and provides insurance covering any injury (including treatment injury/medical malpractice), is also a significant source of funding.http://www.health.govt.nz/new-zealand-health-system/funding . Like NZ General Practitioners, but unlike hospital Emergency Departments which are free at the point of service, Accident and Medical clinics bill patients with a part-charge. The report noted that a third of consultations were subsidised by ACC, for which funding depends on treatment required. Non-ACC consultations may be eligible for GMS, the subsidy available to General Practitioners.
The report noted that injury/poisoning, respiratory and non-specific symptoms were common presentations. Consultations took, on average, just over 15 minutes with most relating to new or short term problems. Depending on the time of day, X-rays were ordered on between one fifth and one sixth of visits. Overall, about half of visits resulted in a prescription, commonly for antibiotics or analgesics. About a quarter of visits during normal hours resulted in no treatment. During normal hours, 4.2% of patients were referred to a hospital emergency department, compared to 2.1% of patients seen after hours.
In March 2008 the Accident and Medical Practitioner's Association and the Australasian Society for Emergency Medicine hosted the first international urgent care conference in Auckland, New Zealand. In October 2011, New Zealands Accident and Medical Practitioners Association (AMPA) chaired by Dr David Gollogly, changed its name to the College of Urgent Care Physicians (CUCP). CUCP runs a four year Fellowship programme in Urgent Care.
Point-of-care medication dispensing
Point-of-care dispensing enables healthcare practitioners in the urgent care setting to ensure that their patients receive their prescription prior to leaving the clinic. To offer this service to patients, urgent care centers generally contract with a point-of-care dispensing corporation. Point of Care dispensing enables physicians (and in some states, other licensed healthcare practitioners) to dispense at urgent care facilities. Unlike a pharmacy, practitioners may only dispense to their own patients. Regulations regarding state pharmacy law vary from state to state. Dispensing by a healthcare practitioner is not legal or quite limited in certain states, such as Texas and New York.
Group purchasing organization
Group purchasing organizations, focusing on the urgent care industry, have been formed. The concept of these GPOs is that they join hundreds of urgent care centers together to allow the type of price bargaining that previously was only available to hospitals.
Medical malpractice insurance
Malpractice insurance offerings unique to the urgent care industry have begun to be widely discussed in light of the fact that many insurers do not recognize the reduced malpractice risk of urgent care centers. Insurers that recognize this reduced risk do not group urgent care centers with hospital emergency physicians and other high-risk specialties. Features of this type of insurance may include no charge for tail coverage when providers leave ("tail coverage" is coverage for malpractice claims which may arise after termination of a policy), 3-5 day approval of new providers, no additional premium when providers are added to the policy, per visit FTE rating, and lower premiums.
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).
Advantages of urgent care over emergency departments
For injuries and illnesses that are urgent but not life threatening, it is more efficient to use urgent care than an emergency department in terms of both money and time. The typical wait time to be seen at an urgent care center is less than 30 minutes, compared with hours at an emergency department.
As of 2009, urgent care centers cost less than emergency departments and have the potential to provide much more efficient care for nonurgent cases. Reimbursement by insurance companies for urgent care centers is comparable to general/family practice reimbursement ($101–$103), which is well below the average contribution for emergency department visits ($560).
- Urgent Care Association of America. "2012 Urgent Care Benchmarking Survey Results." Urgent Care Industry Information Kit. 2013. Available online at http://www.ucaoa.org/docs/UrgentCareMediaKit_2013.pdf
- Weinick, R. M., Burns., R. M., and Mehrotra, A. "Many Emergency Department Visits Could Be Managed At Urgent Care Centers and Retail Clinics." Health Affairs. September 2010. Available online at http://content.healthaffairs.org/content/29/9/1630.abstract
- Urgent Care Association of America. "2010 Urgent Care Benchmarking Survey Results." Journal of Urgent Care Medicine. July/August 2011. Available online at http://jucm.com/magazine/issues/2011/0811/files/42.html
- Urgent Care Association of America
- American Academy of Urgent Care Medicine
- Journal of Urgent Care Medicine (JUCM)