The growth of urgent care facilities in Austin seemed to appear overnight to Dr. Casey Cochran, director of occupational medicine for the three Pro Med Medical Care Centers in Austin.
Urgent care providers in Northwest Austin have cited a number of reasons for the sudden growth, such as a lack of options for urgent care providers, an anticipated swell in the number of insured residents needing health care, convenience and area population growth. Many say the growth of urgent care is attributed to more than one cause.
"Part of it is the way people's lifestyles are now; they've been more mobile. They move around more, so they don't have a long, established history with a physician. That's part of it," Cochran said.
Dr. Bernard Swift Jr., who owns San Antonio–based Texas MedClinic, said he decided to open two facilities in Austin, including one at MoPac and Parmer Lane, because he thinks the city does not have a dominant urgent care player in the market. He attributes urgent care growth to convenience.
"[People] don't want to have to make an appointment with their family doctor and then wait," he said.
Types of care
Urgent care facilities are able to handle minor emergencies such as minor fractures, cuts and infections. Most are staffed with physicians and are open seven days a week with extended hours. They can handle more injuries and illnesses than retail walk-in facilities, which are located inside existing retail businesses, such as Walgreens, CVS/pharmacy or Walmart. Retail clinics are most often staffed with nurse practitioners or physicians assistants and are able to handle minor illnesses such as flu symptoms, fevers, rashes and vaccinations.
MedSpring Urgent Care opened its first facility in August 2011 at RM 620 and Anderson Mill Road. Since then, five more have opened in Austin, five opened in Houston and two are planned for Chicago.
"We know we have an increasingly mobile society where people are moving from city to city," MedSpring President and CEO Heath Schiesser said. "One of the times when people are most in need of a walk-in physician is when they are traveling or have moved to a new city."
Another alternative to visiting a traditional emergency room attached to a hospital are freestanding ERs. These facilities describe themselves as emergency rooms with the ability to handle life-threatening situations such as chest pain and broken bones. Two are slated to open in the Northwest Austin area in early 2013. First Choice ER, which already has a Pflugerville location, is remodeling the former Blockbuster location at 10407 Jollyville Road.
Austin Emergency Center is planning to open its first location on Far West Boulevard by the end of January, and a second one is planned for South Lamar Boulevard. Managing partner Dr. Tom Vo said the facility will operate just like standard ERs attached to hospitals but offer the benefit of little to no wait time and better accessibility with parking.
"There is a need in Austin, particularly because in Austin, you really don't have a choice," he said of freestanding ERs.
Michelle Robertson, president and CEO of Seton North Group, which includes Seton Northwest Hospital, said the health care community is concerned that patients are visiting urgent care centers continually instead of seeing their family doctor.
"We need to make sure we're promoting a continuum of care," she said. "With episodic care, there is a chance you will miss something. [Urgent care] should not replace a person's medical home."
Since summer 2011, Seton has offered patients the option to make an appointment in the hospital's ER through www.setoner.com for situations that are not life-threatening for better convenience.
History of urgent care
Laurel Stoimenoff from the Urgent Care Association of America said the concept of urgent care began in the late 1970s and gained respect as a viable option when a person could not see his or her physician.
Cochran said Pro Med started in Wichita, Kan., in the 1970s and, as far as he knows, it was the first urgent care facility to open in Austin and in Texas. Back then, he said Pro Med was called a minor emergency center because the city had few ERs and hospitals.
"As you had more hospitals develop emergency rooms with trained emergency staff, board-certified emergency room doctors, the standard of care for that level of service kind of outgrew these freestanding facilities," he said.
Stoimenoff said the UCAOA defines the scope of urgent care as facilities with a lab and X-ray machine on-site and the ability to administer medications and IVs.
"Urgent care centers are all focused on the same thing: providing a broad scope of high-quality, non-emergency care on a no-appointment basis," she said. "The cost of care in the urgent care setting is significantly less than when a patient is seen in the ER."
Driving the growth
People who have health insurance generally will pay a $25–$50 copay to visit an urgent care facility, while ER copays are typically $100–$200, Schiesser said. Even for patients without health insurance who pay out of pocket, the cost is far less at urgent care facilities than ERs, he said. Swift said this reduced cost for health care is another reason for growth of urgent care facilities.
"Historically, people without access to care generally go to the emergency room for non-emergency situations, which is inappropriate because of the high cost and inconvenience," he said.
Vo said that with the new health care initiatives, Texas will not have enough facilities to handle the influx of people needing health care. Freestanding ERs will be able to alleviate overloaded standard ERs, he said.
"More people will be insured, and ERs are going to be saturated because people don't have primary care physicians," Vo said.
But Cochran said he has doubts about those theories. He said what is more likely to happen is that urgent care facilities initially will see growth while patients still have private health coverage but that the trend will die down.
"We've been here for 30 years," he said. "As a business model, I think we've weathered the storms. We've seen clinics like this come and go in town."
Schiesser said for illnesses or incidents that are not life-threatening, urgent care is a more affordable option than ERs. He said that as deductibles and copays increase, more people might choose urgent care for minor emergencies. In the 2012 Employer Health Benefits annual survey from the Henry J. Kaiser Family Foundation, 34 percent of people with insurance have a deductible greater than $1,000 a year for single coverage and 14 percent have a deductible greater than $2,000 in the Southern U.S. region. The foundation is a nonprofit that focuses on major U.S. health care issues.
"That trend towards increased deductibles is only going to continue, even with reform," Schiesser said. "I think you'll see more and more people who are aware of what things cost and [are] thoughtful about what's the right place to go. That's one of the reasons we're bullish on urgent care."