Boom in urgent care centers comes with concerns

By Phil Hall

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Over the last few years, Connecticut has seen a noticeable increase in the number of urgent care medical centers operating here. In some locations, it is not uncommon to see two, three or more of the facilities opened within a short travel distance of each other.

The Urgent Care Association of America estimates there are nearly 7,100 urgent care centers nationwide that provide full-service urgent care medical needs, including X-ray and lab work. The trade group’s estimate is based on its own membership numbers, as there are no state and federal registries for urgent care centers. Rather, licensing is required of the medical practitioners at the centers.

The concept of urgent care centers, with their extended weekday hours and weekend openings, originated in the 1970s. But today’s culture helped cultivate their expansion, according to Thomas Kelly, president and co-owner of New Dimension Health Care Inc. in Simsbury, , which operates the AFC Urgent Care centers in Connecticut.

An AFC Urgent Care office in Fairfield, CT. (Photo by Phil Hall) An AFC Urgent Care office in Fairfield, CT. Photo by Phil Hall

“We are living in an era of time poverty,” Kelly said. “We don’t have the time to do everything that we want. We seek immediate gratification – think of Google or Siri – and we no longer have the mindset of waiting around for services.”

Kelly said that another tradition that often seems to be evaporating – friendly customer service – has been crucial for this sector’s success. “We try to have Disneyland smiles,” he said of the AFC Urgent Center reception staff. “From my experience, having a person in a medical office sitting behind a sliding glass window that ignores you as you try to sign in is not fun. When you walk into an urgent care, you are face to face with a smiling person who makes you feel welcome. We try to make you feel like you are coming into our home.”

Dr. Frank Scifo, medical director of the multispecialty practice group at St. Vincent’s Medical Center in Bridgeport, said much of the popularity of urgent care centers can be traced to a generational shift away from a tradition of reliance on a family physician. “The young millennials and Generation X are not necessarily looking for a relationship with physicians,” he said. “This type of health care works well with them.”

And the real estate agent’s mantra of “location, location, location” also applies to the urgent care industry’s booming growth.

“They are visible in locations where you go about your daily activities in the community, so you know where to find us if you’re injured or have an illness,” said Dr. Jeannie Kenkare, co-founder and chief medical officer of Brookfield-based PhysicianOne Urgent Care, which operates 12 centers in Connecticut. She credited their success to their ease of access.

Indeed, urgent care centers have opened in popular retail locations. “We just turned an old Taco Bell into an urgent care in New Britain,” said Kelly. “It used to be that you could get a slice of pizza at any corner but health care was inaccessible.”

Urgent care’s critics
But the growth in the urgent-care sector has not come without problems.

Matthew Katz, CEO and executive vice president of the Connecticut State Medical Society, said the rising number of urgent care centers is mirrored by a diminishing health care environment within the state.

“Look at our infrastructure,” he said of Connecticut. “Some communities lost physicians’ offices and hospitals. Are these centers popping up to replace or supplement health care services?”

And while urgent care centers can offer a mix of physicians, physician assistants and advanced practice registered nurses, there is no guarantee that they can treat all problems that come before them, Katz noted. Adding to the confusion is the simultaneous proliferation of walk-in clinics that are not designed to treat urgent medical conditions but are perceived as being under the urgent care umbrella, he said.

“If you are a patient going into an urgent care center, I would assume someone is there to treat your urgent needs,” said Katz. “There should be a clear definition of what is meant by ‘urgent care’ and what is meant by ‘walk-in.’ They (offices) can be both, yes, as long as it is clear to the patient walking in. If I walk into an urgent care, I’d want to know who the clinician is and whether they have a background in treating the condition I have.”

“Not all urgent care centers are created the same,” said Kenkare at PhysicanOne Urgent Care. “There could be a down side if the patient expects a certain service at every urgent care center because they hear the words ‘urgent care.’”

Unlike many primary care physicians that may choose not to accept new patients, especially those on Medicare and Medicaid, urgent care centers do not have a reputation for shunning anyone seeking treatment.

“The majority of centers accept all patients, from those using private insurance to those leveraging Medicare and Medicaid,” said Shaun Ginter, CEO of CareWell Urgent Care in Quincy, Massachusetts, and a director of the Urgent Care Association of America. “In fact, many insurance options feature lower patient co-pays for urgent care service than treatment in an emergency room. The average cost of an urgent care visit is 6 percent less than the average primary care visit and nearly one-tenth the average cost of a typical emergency room visit.”

Ginter claimed that the medical profession recognized and appreciated the value of urgent care centers. “Hospitals and medical centers understand the importance of urgent care centers in the community,” he said. “Urgent care centers are essential to keep up with the daily health care needs of patients, serving as a vital link between the emergency room and the primary care physician in the continuum of care.”

Katz disagreed with Ginter’s claim for urgent care centers. “We don’t see them as bad or good,” he said. “They are another point of access.”

Those points of access will continue to increase in the state. “We plan to have another six to 10 coming next year,” said Kelly, whose AFC Urgent Care will soon open its third Danbury location.

A new player in Connecticut’s urgent care market is Florida-based CliniSanitas, which runs more than 400 medical centers in South America. The company opened facilities in Bridgeport and Newington on Nov. 28 and plans to open a third center in Orange early next year. CliniSanitas is partnering with ConnectiCare on its new operations, which will feature bilingual staff.

“Connecticut has a very large Hispanic market and that market has historically had very low access to health care,” said Dr. Juan Estrada, medical director at CliniSanitas in Miami. “Our organization has a long history in South America and we thought it would be a great opportunity to expand into the Connecticut market in partnership with ConnectiCare to serve this population.”

Along with urgent care service, CliniSanitas also offers primary care treatment at their centers. Estrada said that will give patients an opportunity to deal with medical professionals familiar with their needs.

“Regular urgent care adds to the fragmentation of health care, where the provider evaluates a patient without knowing anything about the patient and not doing a proper follow-up,” Estrada said.

 

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