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The Changing Landscape of Convenient Care: How Urgent Care and Retail Clinics are Evolving in the Time of COVID-19

Clinician applies a blood pressure cuff to a patient in an urgent care facility.

Many news stories emerged during the COVID-19 pandemic about rapid changes in healthcare delivery. One key trend: since early 2020, retail clinics and urgent care facilities have been caring for more patients than ever before.

Prior to COVID-19, urgent care and retail health were already experiencing rapid growth — with over 3,500 new urgent care locations opening between 2013 and 2019.1 Recent Delta Variant outbreaks have increased COVID-19 testing needs and led to overcrowded emergency rooms, impacting urgent care facilities and causing average daily visits to surge more than 50% compared to a 3-year baseline.2

Meanwhile, freestanding physician office visits have been declining approximately 3.5% since 2014, but not necessarily because of the increased visits to convenient care locations.3 Physician offices acquired by hospital chains are classified as “Hospital Outpatient Departments,” and in most data sources, visits to these acquired offices are not counted as physician office visits.3 Given the trend towards hospital groups acquiring physician offices, this likely accounts for much of the apparent decline in physician office visits. Despite this trend towards practice reclassifications accounting for an apparent decline in physician office visits, other factors are also contributing to the rise in urgent care and retail clinic activity. Long-term studies will be needed to fully understand the root causes of this shift, but those in the industry can see additional factors at play.

The increase in urgent care and retail clinic activity may be influenced by the type of patient encounters now occurring at those locations, rather than cutting into traditional office appointments. For example, more visits to convenient care sites may come from patients who traditionally went to an emergency room. Roughly 35% of urgent care visitors have no primary care physician and may have historically visited an emergency department when they needed care.4 Among the 65% of urgent care patients who have a primary care physician, it is unknown exactly what percent of their visits to convenient care would have historically A) not happened at all, B) been emergency room visits, or C) been visits to their primary care doctor.An increase in convenient care visits can also include patients that are now seeking care who may never have pursued medical attention in the past.

Public health researchers recently found that emergency room visits dropped significantly in areas where a new urgent care facility opened. In fact, total Emergency Department (ED) visits within the same zip code as a new urgent care facility decreased by 17%.5 Researchers also found that uninsured visits to the ED were reduced by 21% and Medicaid visits by 29%.5 It is important to note that the study did not examine cost reductions or the rate of transfer to the ED from urgent care.

An evolution in the types of conditions and treatments/procedures available in a convenient care setting may also be a driving factor in the shift away from emergency departments. Urgent care and retail clinics have always treated conditions such as respiratory infections, sprains and UTIs, but they are increasingly building on-site capacity for more sophisticated diagnoses.6,7 This includes use of X-rays, ultrasounds, etc. to help diagnose and treat conditions that are not immediately life-threatening, but previously required an emergency room visit.5,8

With 1,200 urgent care facilities slated to open through 2023, and retail clinics like CVS Health and Village MD expanding their footprints across the country, it is clear convenient care plays a key role in the ever-evolving healthcare ecosystem.9 It will take time to clearly understand how the number of physician office visits relates to health system consolidation and the increased availability of same-day care. However the data shakes out, enabling patients to seek care in format that may be more convenient to them can benefit both patients and their communities.

References
  1. UCA Admin (2019) URGENT CARE INDUSTRY WHITE PAPER, 5 https://www.ucaoa.org/LinkClick.aspx?fileticket=Q4TP7cypW94%3D&portalid=80
  2. Experity Staff, Urgent Care Quarterly., Issue 11 Winter 2021, The Effect of COVID-19 on Reimbursement-2020, https://www.experityhealth.com/research/urgent-care-reimbursement-trends/
  3. Saulet, Deirdre, The Advisory Board, 2021 Summit: Site-of-Care Shifts, Advisory Board analysis of Optum’s de-identifed Clinformatics® Data Mart Database 31 https://custom.cvent.com/8F58338F8DD14CC18BB1BE6C222ACEA9/files/event/26ef2c11b3e44274b7a0805ac14159c2/c7b08cf0236942cbb3503c2f9688abe0.pdf
  4. UCA Admin (2019) URGENT CARE INDUSTRY WHITE PAPER The Essential Role of the Urgent Care Center in Population Health, 18 https://www.ucaoa.org/LinkClick.aspx?fileticket=Q4TP7cypW94%3D&portalid=80
  5. Allen, L., Cummings, J. R., & Hockenberry, J. M. (2021). The impact of urgent care centers on nonemergent emergency department visits. Health services research, 56(4), 721–730. https://doi.org/10.1111/1475-6773.13631
  6. Hicks, James, Journal of Urgent Care Medicine, Web Exclusive, Point of Care Ultrasound (POCUS) in Urgent Care, https://www.jucm.com/point-of-care-ultrasound-pocus-in-urgent-care/
  7. Skoufalos, Matt, (May 2020) ICE Magazine, Matters of Urgency: Imaging, Urgent Care Centers and the Growth of Choice, https://theicecommunity.com/matters-of-urgency-imaging-urgent-care-centers-and-the-growth-of-choice/
  8. Also, this article heavily implies this as well: Poon SJ, Schuur JD, Mehrotra A. Trends in Visits to Acute Care Venues for Treatment of Low-Acuity Conditions in the United States From 2008 to 2015. JAMA Intern Med. 2018;178(10):1342–1349. doi:10.1001/jamainternmed.2018.3205
  9. Kennedy, K (2021, April) Urgent Care Centers: OD5458, IBISWorld. Retrieved June 08 2021, from https://my-ibisworld-com.proxy.library.vcu.edu/us/en/industry-specialized/od5458