Race Is On to Profit From Rise of Urgent Care

A growing category in health care promises an alternative to the hospital emergency room and perhaps the family practitioner, with low fees and extended hours.

Comments: 73

  1. Back in 1983 urgent care was starting to become the norm where I lived, Yorba Linda, CA. My insurance covered most of it ($5 co-pay). It was WONDERFUL! We rarely used the doctor but if we did it was always urgent care. (Bad sore throat, cut hand, high fever with diarrhea, etc.) They were opened 7 days a week and some until 11:00 pm. We always saw a doctor and there was never a wait. In and out! I have never understood why they faded away (some are still there) but I can hardly wait for them to make a comeback. If you needed follow-up you scheduled an appointment with your doctor for the following day. It was a God send. No taking off work or staying up all night sick!

  2. Took family member to urgent care. Received antibiotic. They did not have rapid blood testing capability as does emergency room. Would up in emergency room several days later with serious pneumonia.

  3. We have basic blood and urine testing at our UC as well as X-ray, so we diagnose a lot of pneumonias. We can give IVs. We can sent stat "esoteric" blood tests to the local hospital and get results within the hour. But we are also a family medicine clinic, and the docs practice family medicine as well as UC, not a free standing UC. We have a doc on duty as well as an experienced NP.

    I would be hesitant to go to an UC without a doctor on premises. You really have to pick your UC center wisely. Unfortunately that is not as easy as it sounds.

  4. “While there is a role for these centers, if I were sick I’d rather see my regular doctor, and I hope my patients feel that way.” -- Dr. Robert L. Wergin.

    I'd love to be able to get in to see my regular doctor, too. The last time I became suddenly, urgently sick, the closest appointment I could get with my doctor was two months away! Off to urgent care I went for a strep test....

  5. Seriously. I don't know what kind of a Marcus Welby land these people inhabit.

  6. Exactly.

    I used a retail clinic a few months ago -- from the time i left home to the time i was back on the couch in my nightgown, codeine cough syrup Rx in hand: 45 minutes. Total cost was $90, my co-pay was $15 or $20.

    Sorry but "regular doctors" had better get with the program and start modeling their practices for patients' convenience instead of their own. Mine moved from a handy location blocks away to an exurban medical complex 10 miles away... any wonder i chose the drugstore clinic?

  7. Hear, hear. My PCP went concierge, with (false) promises to continue to give access to existing patients. Finding a new one from the "providers list" of my health plan proved to be a joke: doctors out of business; doctors who did not actually take that insurance; dead people (yes, dead). As others have pointed out, when you're sick, you can't get an appointment for a week or more: who needs a PCP who will only see you when you're well, and book weeks in advance? I pay $16k a year for health insurance (half by employer) and can't find a decent PCP: at this point, I'm my own PCP, which causes referral problems with insurance. Milford, Neb has 2k people in it, and I'm sure Doc Wergin knows most of them, but the rest of us live in places where urgent care is the new norm. My local one is fast, efficient, clean, and fully professional. The days of a PCP who knows your medical profile, has a long file on your medical history, and can make intelligent recommendations about health care seem to be just about over in our large metropolitan areas. The next step is a genuine concierge doctor, whose only job is to go over lab results and provide referrals to specialists. Pretty soon the urgent care places will have one of them, too.

  8. As large hospitals, insurers and private equity investors gobble up this latest health care opportunity expect prices to approach levels seen at the other facilities owned by these vultures. It's just so much easier to make money when you are a monopoly.

  9. I see (and use) urgent care as different from my PCP and the ER. I think it fills a need, not as a substitute. When I have what I think is a small contained problem (eye infection, rash, small injury, cold/flu, etc) I use UC. When I have what seems more complicated and "systemic" or something that is chronic, or something I want to "talk over" I use my PCP. And ER for occasional serious symptoms (chest pain, etc.). I feel I can do a fairly good triage on my own and trust I will be referred if necessary.

  10. Another reason for the growth of these urgent care centers is probably due to the inconvenience of showing up at your doctor's office for a scheduled appointment and having to cool your heels because the doctor doesn't build in any time cushion between their appointments, rather the doctor finds it more convenient to have you hang around their sitting room . . . . it's called lack of service. If a restaurant or my hair salon didn't honor my reservation / appointment, I would no longer be a patron / client either.

  11. I recently lost my dentist because I walked out after being told twice they had fallen behind and it would be another 20 minutes. I told them their time was no less valuable than mine and I resented this. Oh well, I have an appointment with a new dentist next week. I spoke to the office indicating I prefer offices that respect my time and stay on schedule.

  12. Interesting article about an interesting trend in health care. But why the constant New York Times bias against innovation prompted by market forces? The title chosen was "Race is On to Profit from Rise of Urgent Care," which insinuates some form of exploitation or unseemliness, rather than a more balanced title like "Race is On to Develop Better Delivery of Urgent Care." Similarly, the third paragraph ascribes the growth of urgent care to "investors [who] try to profit," as if there is something wrong with that, rather than writing that investors are trying to provide consumers with a better, more convenient, and more cost-efficient way of receiving what they want, which is actually the only way that entrepreneurs and businesses legally make money.

    I want the old, neutral paper of record back - I don't need a New York Times that is constantly slanting coverage to suit the prejudices of progressives, rather than simply presenting me with the most interesting and accurate information and analysis.

  13. It is not easy to see what the money market moguls bring to the urgent care business, other than another layer of profit takers. The businesses seem to be delivering an essential service successfully without the intervention of private equity firms.
    The recent mortgage mess in the US ought, at least, to have irevealed that investment companies are not interested in others' well-being.

  14. The constant bias is there because history does repeat itself. If you believe that the equity folks and big health chains are buying everything up so they can provide better health care at a better price I'm wondering what alternative reality you're visiting from. What happens next is as predictable as it is terrible. Employees will be worked harder, services will become thinner and the management will talk about being more productive while providing better return on investment. Competition will pretty much cease to exist and one more viable alternative to the American health care morass will be absorbed into the collective.

  15. There have been urgent care facilities in my area for very many years. And I have used them several times. They fill the gap between what can be done in a doctor's office and emergency rooms. Doctor's offices are closed week-ends, and office hours usually end at 5 p.m. I once got a severe cut on my finger while fixing dinner. The doctor's office was closed and I didn't want to go to the emergency room, so Urgent Care put in a few stitches, stopped the bleeding and sent me on my way. I was a happy customer.

  16. It'd be great to see more urgent-care clinics come online. Too often, we are forced to go to emergency rooms at night or on the weekend for non-emergency medical issues. A few years ago, I spent $900 and five hours in the Howard University emergency room on a Saturday morning just to see a resident for three minutes and get a prescription for some antibiotic eye drops to treat conjunctivitis ("pink eye"). (Of course, it would be better yet if this medication were available over the counter.)

  17. Most conjunctivitis is viral. Antibiotics are usually not necessary and can even be harmful.

    You could have bought a bottle of Visine and saved your time and that $900 and probably had the same result.

    The real problem is people's unreasonable expectation that every minor problem requires a prescription for an instant fix.

  18. Wrong! I have Sjogren's syndrome which affects the eyes. The resulting dry eye causes conjunctivitis. I always go to Mass Eye and Ear E.R. if my opthamologist is unavailable. It's impossible to tell initially. Viral conjunctivitis may be treated with steroid drops. Never use Visine; use preservative free saline drops that come in small individual packets.

    I agree nine hundred dollars is outrageous.

  19. So, the poor are still marginalized to the overcrowded and dwindling number of establishments, right? How many people do not have access to these fast food-like establishments because of that?

  20. Thanks to the ACA, they'll now have insurance and they can go where ever they like. Previously they only had the ER as their healthcare provider.

  21. As soon as they pay their $2-4k deductible!

  22. I have had asthma my whole life and know what's needed when it flares -- 7-day prednisone taper and an antibiotic just in case. If I go see my PCP, I have to go downtown. Parking is $25.00. I am told when I'll be seen (hahahaha!) and I sit in a squalid tiny little exam room with no magazines and wait and wait and wait. It's a half-day enterprise. I have discovered the urgent care center that is a five-minute drive away! I choose when to go. I see an experienced ER doc. The place is so clean! They have bottled water! There's CNN in the exam room (which I can turn off if I want). And I'm in and out in 30 minutes. Sure, I'll see my PCP for long-term health management, and I do love her, but for the quick and easy stuff, nothing beats the local urgent care center.

  23. Fast, Quick and In a Hurry cash and carry Medicine. In the wild west the same kind of 'investors' did it out the back of their wagon rolling from town to town. As long as all you need is snake oil, and you got the cash, we'll have you on your way in no time, and . . . . with a lighter wallet.

  24. How do we find out about licensing and certification of these walk-in centers in NYC. I am concerned not only staff but what about equipment? Is there a JCAHO or NYS agency that sets standards? Just what are the standards? How do we know that the diagnoses and exams performed are standard practice? How often are radiology and lab equipment tested for accuracy? Is there a rating system for these agencies? How do we find out such info to make informed choices?

  25. Urgent care clinics can be good. When we were stationed in the middle of nowhere, Texas, the two clinics in town offered better care than the AF base clinic or the boutique hospital. In fact, the AF directed service members and family to use clinics for any non-emergency care whenever the base clinic was short staffed (deployments cut already slim manning by 1/3 to 1/2) The big county hospital was good, but often jammed and the VA facility was tiny and overwhelmed.

  26. I actually have some very recent experience with urgent care vs the ER. Recently, I cut my leg very badly. I went to an urgent care unit, which was clean, modern and pleasant. I was greeted immediately by a representative and taken to a treatment room where I was seen within 10 minutes. The doctor injected anesthetic and irrigated the wound, but concluded that it was too irregular, deep and dirty to be treated there and sent me to the ER.

    At the ER, I submitted my request to be seen on a paper shoved through a slot, waited for an hour with many people who were coughing, sneezing and otherwise appeared to have infectious conditions. I was eventually taken to a treatment area. Over the next several hours, I was taken to the X-ray room (waiting for an hour while the anesthetic from the urgent care wore off) and finally to the head PA on call, who (skillfully) sewed up my wound and made sure I got a tetanus shot. At some point the doctor on call poked his head in, asked how I was, and walked off. The next week I got my bill - 2K AFTER insurance.

    So to conclude - I ultimately received good care at the ER, but it was time-consuming, extremely expensive and could have been an even more miserable experience. I would absolutely go to urgent care again as my first resort, and was perhaps unlucky that they could not resolve my situation at what would have been undoubtedly a much lower price, and in a much shorter time.

  27. We have had urgent care attached to our regular clinic (Park-Nicollet Clinic) for many for a few decades. There is a lab including x-ray are also attached to the clinic which is open. They also have access to all my medical history. When I call they will tell me estimated wait time! I had used this many times when my regular physician or any other physician in the regular clinic is not available or for cuts and bruises. Glad it is catching up in other parts of the country. Glad to see rest of the country is catching up.

  28. This is a fantastic example of the kind of new business model that employs specialization to improve quality and cut costs. Combined with the high deductibles of ACA (one of its few good points) it demonstrates that "skin in the game" strategies really can change patient behavior.

    Allowing hospitals to also specialize in what they do well (trauma, ICU, advanced diagnostics, etc.) will lower their overall costs as well, because they no longer have to be all things to all patients. This is a true win-win.

  29. agreed. I don't feel the need to have a personal relationship with my doctor. But I'd probably feel differently if I had one or more chronic conditions that needed managing and coordinating.

  30. Wall Street priced us out of Hospitals and Health Insurance and now they look to profit from our misery one more time. When is enough, enough?

  31. Expect wait times to increase as these centers become more widely known and used. But the reason for their popularity is not so much convenience, but the difficulty in getting in to see one's PCP in any sort of a timely way. The last time I called my clinic to make an appointment to see my PCP for a non-urgent but very troublesome problem, the soonest available appointment was five weeks away. I asked to be on a waiting list for cancellations, but there never were any open slots in that time period. I eventually went to the Urgent Care Center when the difficulty became nearly intolerable.

    With the business model that has driven PCPs to book and double- or triple-book patients, it's impossible anymore to have a relationship with a PCP or get treatment in a reasonable time. The Urgent Care Centers are filling a very important gap in health care.

  32. I will argue " Doc in the Boxes" are driving up cost and contrary to goal of Obamacare. A physician unfamiliar with your condition is far more likely to order a test and practice defensive medicine than a GP familiar with your personal history. In our " I want it now" society, no one wants to wait to see the GP and is far more likely to go the ER for very minor problems that can wait. Many centers advertize wait times as an inducement and administrators recognizing a cash cow, encourage as many test as possible and the patient still requires follow up with a primary care MD. Also, most are staffed by non ER trained doctors.

  33. There's a difference between urgent care and stand alone ER's, which I think do warrant your complaints. First I would say, its not a want it now situation with urgent cares or ER's-- its a need it now! If you've sprained your ankle on a Sunday afternoon, you're not waiting til Monday morning to call your family doctor only to be told they dont have any appointments, go to the ER! And in America these days, a large percentage of people do not even have a GP. Where do you go when you need a flu test, or you have a UTI or ingrown toenail, if you are generally healthy and don't have a regular doctor? Urgent Cares have much much lower billable rates and copays. Stand alone ER's, on the other hand, are often not staffed with ER doctors, are often not affiliated with a hospital, and if you have a true life threatening emergency and need to be admitted to the hospital, they will just call 911 and have you transferred by ambulance. Plus they charge ER rates and copays for small illnesses and injuries that can be treated at an urgent care for a fraction of the cost. For example, if you're uninsured a sprained ankle at the ER is going to cost you at least $2000, possibly so much more! Go to an urgent care and pay $200-250 max. Know the difference!

  34. ha...if there are wait times, they'll start springing up like Starbucks, every other corner. Build it and they will come, especially if there's insurance.

  35. The good news for the clinics that they don't have to take those who can't or won't pay. Everyone that works there speaks English.
    Unlike our emergency rooms when after 9PM the only sound you will here is Spanish

  36. What are you insinuating?

  37. I am thrilled to be in an area with excellent urgent care facilities. I have used them twice. In and out. No appointment. Sinus infection, get examined, get a prescription, get out. In my opinion, it takes the burden off the emergency rooms. Of course, there is no way I'd go to an emergency room for a sinus infection but there is no way I'd get an immediate appointment from any practicing doc. I'm relatively new here and there is no option for calling up your doc and having them call in a script for that once a year event.

    Brilliant! and absolutely necessary.

  38. My husband has had a host of maladies that afflict him regularly, from headaches to GI pains, to being bitten by a stray dog. Each time we were stuck at the University of Arizona Medical Center ER for at least eight hours, on a work night mind you. I have only positive things to say about their professional staff, but I cannot afford such a long wait after my ten hour, six day a week job.

    He recently enrolled on my medical plan and his recent bout of GI pain brought us to an urgent care facility down the street from us. He was seen in less than twenty mins, his doctor ordered X-rays and was able to write a prescription to make him feel better. Best part of all, on a Sunday afternoon we were the only ones waiting to be seen as they finished up with a patient there before us. Urgent care staff were very professional and we will be returning to them, should any future ailments come our way. Its nice to know we now have options aside from the long waits at the ER for simple afflictions, instead of taking time from those who have life threatening emergencies at UAMC.

  39. Notice that they don't take Medicaid. In WA, it's called Apple Health and it is a part of the Affordable Care Act. I wonder how they know it's Medicaid as some of its insurance companies are the same as the non-Medicaid companies.

    Also if I am on a PPO and the urgent care clinic is not in-network (but the ER is), it may cost a heck of a lot more to be seen at the clinic.

  40. Urgent Care of Connecticut does take Medicaid.

  41. Even if it's the same insurance company it's never *the same.*

  42. I have been a family doc for 25 years, 14 in mainly fam med, where I am now, and 11 in mostly UC.

    In our clinic we have both fam med and urgent care and it works well. We have a nurse practitioner assigned to UC, but there is also always a doctor over there who also is seeing pts and who can provide immediate help to the NP those infrequent times when it is needed. Pts who need longer-term followup care, for example if hypertension is found at the UC visit, get sent to the regular clinic side for followup.

    We all rotate through urgent care. It's good to see some acute care as a break from all the chronic care.

    This works well for us and pts love it. Plus they don't have to pay 500 bucks for an ear infection, which is beyond absurd.

  43. Of course you should go to urgent care instead of ER for many of these things. Even IF your own doctor says, come in, I'll see you today, how long a wait will you have, being fitted in around his regular appointments?

    This is great, if you live in the 'burbs. But I live in a high-poverty neighborhood, so there's no urgent care within 5-10 miles of where I live.

  44. This won't end well.
    Where are the 'B' corporations and non-profits who want to get into this? Urgent care is a great idea; no kids ever get sick or injured during bankers' hours.

    But private equity has no stake in the community or the health of individuals. They've seen the spreadsheet and this was a better idea than franchise nail and tanning salons.
    Right now, the facilities are all new, as is the equipment, and it isn't too crowded.
    Ten years from now, when profits stop spiking b/c of replacement costs for outdated equipment & carpet? It's going to get substandard fast, if substandard will bring a good ROI with minimal lawsuits.
    It is an excellent idea that will probably get warped by profiteering. It's the American Way.

  45. It's called a market. If it's substandard, people won't go. Health care is not a public good. For the most part, it's rivalrous and excludable. Not taking Medicaid, for example, is evidence that it's rivalrous, and obviously a huge marketing advantage. Yes, there are many market failures. Information market failures. Monopoly issues. Once you are in a hospital, for example, you don't have a lot of choice. But this is clearly an example of a market based solution addressing a demand side problem. It's also the market trying to correct for all the cultural changes that are occurring in the country, as we become less prosperous. The ambiguity you sense here is that Times journalists and readers obviously like Urgent Care centers. But it goes against their professed ideologies. So they are verklemmt. Surprise, surprise.

  46. Wrong. Health care is a public good, which is why it is better and less expensive in all developed countries but the US. They all understand this truth and do not let the "market" control health care.

  47. I use them exclusively for all my ailments except for physicals. From broken bones to colds. The service is same day and far faster than my GP and far far cheaper than any hospital

  48. I've been to urgent care facilities (CityMD) a couple of times in the past few years. They were quite helpful for the pressing but far from life-threatening (shingles outbreak, sinus infection) conditions I had. The weeknight/weekend availability is crucial; I love my gp but seeing him requires taking half a day off of work. If primary physicians are concerned about the competition they should change their office hours to allow for the fact that many people have jobs to go to during the day.

  49. Ana, your physician also has a job that s/he works during the day, and s/he likely spends a good chunk of evening hours doing notes, paperwork, forms, etc. It's no wonder primary care physicians burn out so much...

  50. I was recently on a paid research market panel by one of these groups. They were asking the panel about their thoughts on the drug store clinics and the urgent care centers. I think they did not like some of the answers.

    No one like the clinics in the drug stores at all. We all felt that now that pharmacists could give flu and a couple of other shots that was fine. But the use of the Nurse practioners in the Drug Store chains was too limiting. Everyone still wanted a doctor on site.

    Then the urgent care, people did want them to have xray and be able to cast and suture. They wanted them closer to home. Everyone in the Atlanta area gave high marks only for Humana's Concerta's chain ($30 if you have Humana; $50 co pay with most BC/BS & United Healthcare policies.) and the Children's Healthcare pediatric Clinics. No one like or wanted to consider any other chain.

    People saw them as secondary to their Primary doctor. They were trying to see if people would use them as replacement of Primary and everyone who had a Primary all but 1/16 said no). I pointed out that a friend from college told me he got burnt out from med school and only did a 1 yr residency and works at one of these places. Another guy, said I was correct his sister who had a problem passing her boards, only has a 1 year residency and works at one of these too. People were surprised that the doctors are not specialty board certified. Proctor did not like that info getting out.

  51. My experience with the UC Davis Medical Center Family Practice Unit in Sacramento has been uniformly excellent. On the occasions that I had to see a physician, I got same-day appointments, and with no hassle.

    That said, it would appear that having a widespread network of community-based, neighborhood urgent care facilities available to handle run-of-the-mill injuries and illnesses that people and their families experience on a daily basis would be an excellent idea, and cost-effective as well.

    In all likelihood, the relevant statistical data will provide strong support for having these programs. These facilities would not be expected to handle trauma cases, but for the vast majority of visits they offer an opportunity to take care of patient needs quickly and cost-effectively, while at the same time providing early evaluation and treatment for patients with serious injuries or acute illnesses.

    It would also appear that staffing levels in these facilities could be tailored to the size of the catchment area that these facilities serve. Some facilities might have one or more physicians on staff, with nurse practitioners focusing on routine patient care. Others might have only a nurse practitioner or two on staff, but with inability to transfer a patient to an acute care facility at a moment's notice if that need be. That would certainly be preferable to having to rely upon paramedic personnel employed by local public safety agencies for emergency medical assistance.

  52. Managing a private family practice I am astounded that so many patients are being seen in "urgent care" facilities and insurers are paying an average of $155 per visit. The name is a misnomer - convenience care is more like it. Most patients are not experiencing true emergencies yet the vulture capitalists have figured out insurers pay 2 to 10 x the amount per visit compared to the patient's PCP. Because the visit is classified as an emergency encounter they can lard on expensive on site testing and procedures under the theory the information/treatment is needed immediately. Is this how we're planning to control costs - treating emergent symptoms that often have a chronic disease origins, as true emergencies because patients find it more convenient?? In the mean time primary care practices, where the underlying chronic aliments are treated, have seen the average reimbursement per visit drop substantially over the last five years. Many are going out of business.

  53. I disagree with Dr. Mehrotra's argument that people visit Urgent Care because they are used to instant gratification. People visit Urgent Care mostly because their own doctors are too busy to see them. It doesn't always make sense to wait several days, or even weeks, for an appointment.

  54. I would love to have an urgent care clinic in my community. I moved to my town a few years ago and have not had much need for medical attention, but if something does come up, the doctors' clinics here are unable to accomodate new patients for months. It's a choice between waiting months for an appointment, or going to the ER which is vastly more expensive. Yes, I have health insurance, but I still have to pay a significant portion a year out of pocket. My pockets just aren't that deep for something simple that could be done in 30 minutes!

  55. I've been to the Urgent Care here several times. I am one of the uninsured in a state that did not expand Medicaid, and it is a lot less expensive to go in with my medical problems than to see an actual doctor. The care has been great and they will call my other doctors with info and follow-up. They even gave me free drugs the last time that would have cost almost $100 with a prescription. I know they were trying to get me to sign up for their pharmacy plan, and I didn't, but it was fast and painless and a lot cheaper than my alternatives. I wonder if that will continue once it is entirely commodified?

  56. I would love to see physicians figure out a way to outsource the jobs of hospital CEO, CFO, COO and their administrative minions to tech savvy, lower cost managers via Skype in India, Phillipines, and South America. As a NYC physician who worked in hospital administration, I am certain the job can be effectively done by young foreigners, perhaps except for the golf fundraisers our ceos attend while doctors are up late caring for patients in understaffed hospitals and clincs.

  57. I wish that the "private equity" people could be kept out of this.

    I have mixed feelings about the docs in the box, but certainly once the greedy fund managers demand high profits and maximizing revenues, those services that were much cheaper at these small offices than at the Emergency Room will cost much more.

  58. I've been using urgent care clinics for years for visits that needed immediate attention but didn't warrant an ER visit. The ones where I go are a part of a larger network and are staffed by doctors from within that network so they're usually at least decent (I was raised by a nurse and have some formal medical training so I tend to be a bit picky) and they have access to our medical record with our regular doctors. In the clinics we've had a variety of things treated, from strep/bronchitis/flu to treatments for lacerations that sometimes needed stitches, to a rash breakout as a result of an unknown antibiotic allergy.

    There are some cheaper (and, undeniably less reliable) clinics that are the medical equivalent of a McDonald's knockoff and don't think I could bring myself to visit one for any serious reason. Though I did get a flu shot at one once - it actually wasn't terrible and I would consider it again if we didn't have a different arrangement where I work. I just wouldn't trust the McDoctors there with anything my accident-prone son could throw at them.

  59. When I have an illness, my dr.'s office tells me to go to Urgent Care. I can only get in to see my regular dr if I schedule an appointment a couple of weeks in advance.

    After 2 bad experiences with Urgent care (out of only 2 visits), I avoided it for years. This past year I had to go and it was ok -- luckily this time my problem was more run-of-the-mill. But, unfortunately, there's not much choice in my area due to a shortage of doctors. Your choice is suffer for at least a week with whatever symptoms you've got, or, to avoid the wait, roll the dice with dr you don't know.

  60. Lot's of "Doc in a Box" facilities opening in the Pacific Northwest. They can cherry-pick those who need a quick medical service and who have readily available cash to pay. They can leave the seriously ill and poor people to the ERs or to the traditional medical clinics who pretty much have to accept Medicaid to stay in business.

    In many states only licensed physicians can own a business that provides medical care for a fee. The Wall Street investors are getting pretty creative with their business models to avoid those state laws.

  61. Urgent care centers are usually used when quality doesn't matter. I go to an ER if something needs to be treated immediately and is serious. I go to my regular dr for check ups and if something ongoing and mysterious/serious is happening. I go to urgent care when I know I have strep throat and need a dr to confirm it and write a script for antibiotics.

  62. An interesting twist on an old concept. When I was growing up in the South Bronx in the early 1960s, Bronx-Lebanon had a free or semi-free (I was a child, and can't remember; if there was a charge it was minimal) clinic available to the poor in the area for non-urgent care. The clinic would transfer any cases it couldn't handle -- for example, for someone who might truly need emergency care -- to the hospital's emergency room. In fact, there were a number of small clinics, but just about all of them closed down in the 1970s, what with the economic downturn and the city nearly going bankrupt. Unfortunately, these new types of clinics are focused solely on making a profit rather than providing a service -- they're of no service to the poor, who so desperately need the services.

  63. We regularly are told by our physicians that the wait to be seen is 5+ days. Even a pediatrician told us around 2 months for immunizations for our 2 small children, for a rash one of them developed on his feet the wait was 6 weeks. Along with having everyday unexpected issues, it is not uncommon for us to be forced to use regular or pediatric urgent care. Just as good as what we would get in the office and better than the ER. A long time physician of mine started a boutique practice and offered to continue to care for me - for 7,500 a year. Perhaps it is regional but the nice family doctor that fits you in for urgent matters if and when they occur is going by the wayside.

  64. It would be great to be able to go to urgent care and get care, but both times I've tried in the past 5 years, they were unable to assist and sent me to the ER. A bruised, infected index finger should not have been beyond their capabilities or licensure, but apparently it is. They said they did not have the wherewithal to numb and lance it. Same with the splinter/infection in my foot a couple years earlier. Maybe its just Indiana law or this particular chain? However, because my problems were too much for urgent care, my health plan did not impose the larger non-emergency copay for using the ER.

  65. I occasionally visit a nearby urgent care clinic for situations that can't wait until the next available appointment with my regular doctor, but aren't severe enough to justify an ER visit. This clinic offers both urgent care and primary care, and I've been fairly impressed with the doctors I've seen there. For something like a sprained ankle, going to the ER, waiting many hours and incurring much higher charges isn't worth it when there is a decent quality alternative available.

    Most of the time a visit with my regular doctor requires a wait of a week or more and takes a significant chunk out of a workday. If the situation that required urgent care also requires a follow up, I will do that.

  66. Not sure whether these are considered urgent care centers, but they seem to operate that way. The Dignity Health-affiliated hospital near us has opened several "family care" centers in outlying towns. This puts "prompt care" only 15 minutes away, versus an hour drive to the nearest ER. For routine stuff like blood draws, this can't be beat. The physicians all have admitting privileges to nearby hospitals. For serious stuff, they refer and can transport to the ER or hospital as seems best. The quality of care is excellent. As a Medicare patient with good supplemental insurance, I never see a bill, so I don't know whether it is really cheaper.

  67. Just went to CityMD for what turned out to be strep, when the clinic I usually go to couldn't see me till the next day. I was glad to get the strep diagnosed quickly, and be started on a prescription. The service in the facility seemed fine. A follow up call to check on my progress, however, was made by someone who evidently had no medical knowledge. She essentially indicated that it would be ok to stop taking the prescribed antibiotic if I felt better. Bad medical advice like this, offered by a worker without medical training, is where cutting corners and doing things on the cheap shows up.
    I also had a UTI, and they lost or spilled my urine sample, and only acknowledged that when I called back to find out the results. I had to go in again to provide one.

  68. At first the visit may seem reasonable, with what we put on our credit card at the clinic. Later as we get multiple additional bills it starts to seem very unreasonable. There may be a facility fee, the x-ray, and a separate fee for the tech who looked at the xray. The attending PA who is already charging you the visit also bills for glancing in at the x-ray. I am among the working poor who don't qualify for health care subsidies but could never afford insurance premiums, the high deductibles, and the 40% of medical bills the insurance doesn't cover, plus thousands in dental care and other things that aren't covered and don't even count against the deductible. I'll continue to pay for what care I choose to receive and have no intention of getting insurance under this scheme. Yes I would go to urgent care when truly necessary, but find that Good Samaritan is anything but.

  69. There is a definite need for urgent care; in between GP and ER.

    I don't mind paying for urgent care clinics to make a profit because I get something of value from their services. In fact, that's why I resent paying insurance companies; they provide nothing of value, but skim profit out of the system anyway.

  70. The one time I thought I might need urgent care for a possible eye infection/allergic reaction issue the only urgent care I know turned out to have the same days and hours as my PCP! I finally just rode it out because the ER is such a hassle. But if the urgent care had been open I would have gone.

  71. Here we go again, commoditizing and marketing medicine through rebranding. The old primary care docs had always done urgent care - on top of his usual patients with appointments, working 12-15 hour days, nights, weekends. Sometimes he did it for free.

    With respect to services, no, NYT, it's not that urgent care has mushroomed. Services actually had been on the decline since managed care took over 15 years ago. You see the incorporated logo, you see the new facilities with glossy acrylic tiles, but the actual delivery of services as compared to the past has been rationed and the docs nowadays only want 9-5 jobs. After all, if you'll be treated like an employee, 9-5 is fair enough. The less you see the patient, the less the insurance spends on the patient, and the pot is divided up.

    Is it good medicine, or is it business that "profits are in the billions?" The lack of access was intentionally created first as a form of rationing by managed care. That created "need (or demand)." With the ADA, everyone is subsidized one form or another. That resulted in "supply." Now you just have to manipulate the "demand-supply" curve. Nothing to this point has said that we'll guarantee "good medicine."

    95% of urgent care business is really non-urgent, and coming in is really a waste. Save money and establish a relationship with a doctor that you can trust, and you'll get free advice (may be even a house-call). Save your dollars on that 5% when you really need an expert to make a difference.

  72. This article caught my attention because I never thought clinics could take more priority in profiting from urgent care than giving patients the quality time they deserve like in hospitals. The concept of people going to urgent care centers instead of the traditional doctor's office because it's more affordable shocked me. Recently, my mother had to get an immediate liver transplant at our local cafe center. A week before the operation the doctors called saying she couldn't be accepted because of her lack of medical insurance. Thanks to this article, my family has a better understanding of why hospitals are better than urgent care centers.

  73. It is a relief to see that there is still enough freedom within our healthcare system for innovation solutions. One key issue that was not mentioned in the article is why exactly E.R.s are at least five times more expensive than urgent care centers. When you pay your E.R. bill, you are also paying the bill of four other people who did not pay. Since E.R.s are required to treat every patient regardless of if they can pay, the cost is shouldered by those who do pay.

    Even though I lean conservative, I support ObamaCare in no small part because of this issue. Once everyone has insurance, E.R.s won't have to charge so much.