Urgent care

Overview
Urgent care is the delivery of ambulatory care in a facility dedicated to the delivery of unscheduled, walk-in care outside of a hospital emergency department. Urgent care centers are primarily used to treat patients who have an injury or illness that requires immediate care but is not serious enough to warrant a visit to an emergency room. Often urgent care centers are not open on a continuous basis, unlike a hospital emergency room that would be open at all times.

The initial urgent care centers opened in the 1970s. Since then this sector of the healthcare industry has rapidly expanded to an approximately 17,000 centers. Many of these centers have been started by entrepreneurial physicians who have responded to the public need for convenient access to unscheduled medical care. Other centers have been opened by hospital systems, seeking to attract patients. Much of the growth of these centers has been fueled by the significant savings that urgent care centers provide over the care in a hospital emergency department. Many managed care organizations (MCOs) now encourage their customers to utilize the urgent care option.

Other ambulatory healthcare facilities
Urgent care centers are distinguished from other similar types of ambulatory healthcare centers.

Emergency departments
Emergency departments are located within hospitals and are prepared to care for patients suffering true emergencies, such as myocardial infarctions ("heart attacks"), serious motor vehicle accidents, suicide attempts, and other such life-threatening conditions. Being located within a hospital, these centers are positioned to provide ready access to major surgeries and critical care units. Emergency departments are usually staffed by physicians with specialized training or board certification in emergency medicine. Most states in the USA require all hospitals to house an emergency department within the hospital building. A few states in the USA allow freestanding emergency departments to be built outside of a hospital building. Many authorities would consider this type of facility to be a high-acuity urgent care center, rather than a true emergency department.

Primary care offices with extended hours
Many primary care offices are open for some hours in the evenings and weekends. However, unless these centers are open for walk-in patients at all times when open for patients, offer on-site x-ray facilities, and care for most simple fractures and lacerations--these primary care physician offices are not considered to be true urgent care centers.

Walk-in primary care offices
Allowing walk-in patients is not a sufficient criterion to define a physician office as an urgent care. If the office does not offer the expanded services and significant after-hours care, then the physician office would not fit the definition of an urgent care center.

Mid-level provider offices in retail stores
In 2004, medical treatment began to be offered at small offices in retail stores with onsite pharmacies. These centers are generally staffed with nurse practitioners or physician assistants. Prices are generally posted in public view and patients can do shopping while waiting. Some experts consider these medical treatment sites to be the wave of the future in light of consumer driven health plans such as Health Savings Accounts. These retail clinics are not true urgent care centers, because of the limited level of care that can be provided without a physician nor x-ray facilities on site. Concerns about conflict of interest and incentives to over-prescribe medications in a facility rented from a pharmacy have yet to be fully addressed by organized medicine or governmental agencies.

Organized medicine and urgent care
The Urgent Care Association of America (UCAOA) holds an annual spring convention and, also, offers an annual fall conference. The American Academy of Urgent Care Medicine (AAUCM) and the National Association for Ambulatory Urgent Care (NAFAC) hold a joint annual convention. Many leaders in the urgent care industry now eagerly anticipate the full establishment of urgent care as a fully-recognized specialty with fellowships and/or residencies that allow for proper training in the unique patient mix and patient presentations that are seen in urgent care centers.

Codes for urgent care
In recent years the American Medical Association approved the code UCM (Urgent Care Medicine) for physicians to self-designate themselves as specializing in urgent care medicine, this code was developed with the assistance of the American Academy of 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 payors. 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). Because of the complex nature of coding for urgent care centers, the Urgent Care Association of America (UCAOA) offers a specialized day-and-a-half advanced coding workshop for providers and coders as part of its annual fall conference.

Postgraduate fellowship training
In 2006, the Urgent Care Association of America sponsored the first fellowship training program in urgent care medicine. This fellowship resulted from 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. The program is partially funded by an unrestricted grant of $30,000 from the Urgent Care Association of America to support the fellowship program. Physicians in the urgent care fellowship program receive training in the many disciplines that an urgent care physician needs to master. These disciplines include adult emergencies, pediatric emergencies, wound and injury evaluation and treatment, occupational medicine, urgent care procedures, and business aspects of the urgent care center. 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.

Urgent care journals
The official publication of the Urgent Care Association of America (UCAOA) is the Journal of Urgent Care Medicine (JUCM). It is a monthly publication published specifically for professionals in the urgent care industry. A free subscription to JUCM is available to licensed physicians, who sign up at www.jucm.com. The American Academy of Urgent Care Medicine publishes the journal Urgent Care. The official publication of the American Academy of Urgent Care Medicine is the Urgent Care. It is a monthly publication published specifically for physicans, physician assistants and nurse practitioners in the urgent care industry. A free subscription to Urgent Care is available to licensed physicians, who sign up at [urgentcarejournal.com].

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 need to partner with a point-of-care dispensing corporation.

Specialized services
One sign that the urgent care industry is truly emerging as an important sector of the healthcare industry has been the development of supporting industries with specialized urgent care products.

Practice management software
Software developed just for urgent care has been developed.

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.