Emergency and Urgent Care Services Adapt to Greater Presence in the Healthcare Continuum

April 1, 2021
April 1, 2021

Consumers’ demand for convenience has reshaped the restaurant and retail landscapes, as apps for online ordering, curbside pickup and home delivery for meals, groceries, and more continue to proliferate. And while healthcare isn’t quite at the “care at your door” stage, providers have seen the trend and are working to meet consumers where they are.

Nowhere is that more evident than in the growth of emergency and urgent-care services. Freestanding emergency departments (EDs) and care clinics have popped up in communities of every size. Major healthcare players have begun building out networks of their own, and in some cases, purchasing existing brands, giving this type of care a more solid footing and deeper pockets when it comes to expansion.

As these facilities rush to fill in the gap between physician office/clinic and tertiary hospital, they are facing unique challenges that come with the growth. They include:

  • Capacity

    Freestanding EDs and urgent-care clinics are shoehorned into neighborhood retail spaces, more often than not. A limited footprint is part of their appeal on the development side, but that means small staff, limited exam space, and a finite amount of equipment and services.

  • Reimbursements

    Insurance providers and agencies such as CMS are still getting used to EDs and urgent care centers. Proper coding and checking coverage quickly upon the patient’s arrival are necessary in order to ensure prompt payment and no penalties.

  • Staffing

    Many smaller sites such as these make do with a mix of physicians, physician assistants, nurse practitioners, and other staff who can handle routine medical issues such as cuts and scrapes, colds, and even broken bones. Attention must be paid, however, to making sure that the mix of qualified staff is able to cover as wide a spectrum of care as possible, so that patients can be treated onsite vs. referred elsewhere.

  • Consumer education essential for success
    Communities have embraced the freestanding ED/urgent-care clinic model with gusto, and healthcare providers have responded. In Texas alone, growth has been tenfold over the past few years. There and in other large-population states, it’s not uncommon to see competitors within blocks of each other. From 2008 to 2015, there was a 76 percent increase in hospital-operated freestanding EDs, largely in Texas, Colorado, and Arizona, which don’t require a license-seeking ED to meet determination of need regulations. Now there are hundreds of them, and some are being built ahead of an affiliated hospital, rather than vice-versa, in order to give a major healthcare provider a toehold in a desirable market.

With popularity comes challenge. Because the size of freestanding EDs and urgent care clinics is unlikely to change, they and their partner facilities must continue to educate consumers about which healthcare option they need to exercise when a need arises.

For one, they must be clear and transparent about what they do, and don’t offer:

Freestanding ED: Offers 24/7 access to a qualified emergency room doctor and nurse, as well as lab and radiology technicians, some blood testing and imaging that usually includes X-ray, ultrasound, and tomography. These facilities can treat life-threatening conditions such as heart attack and stroke, as well as minor trauma. The vast majority of their patients are walk-ins, vs. being delivered by ambulance, and few require forwarding to a hospital for admission.

Urgent Care Clinic: Staffing expertise level and number (nurse practitioners and physician assistants vs. doctors and nurses), testing, and therapeutic options vary greatly across these sites, depending on municipal and state regulations. They are rarely open 24/7, but do fill a need for patients who need to arrest or slow down a situation, such as the onset of strep throat, but cannot see their physician because it’s after hours or the weekend, and who are not in severe enough distress to warrant a visit to a freestanding or hospital-attached ED.

Hospitals and hospital systems looking to deepen their community engagement are finding freestanding EDs to be a cost-effective and viable way to do so. Similarly, they also are engaging in urgent clinics that are standalone models or attached to major grocery and drugstore chains. Whatever the case, it’s certain that consumer demand for convenience will continue the push for localized and on-demand healthcare, so providers must be certain they are providing what their communities want, as well as where and when they are doing so.