The rise of urgent care facilities: risks and rewards

The rise of urgent care facilities: risks and rewards

Driven largely by same-day access for low-acuity conditions, urgent care centers have experienced significant growth as a patient-popular “bridge” between primary care physicians and hospital emergency rooms.

Data from the latest annual benchmarking report from the Urgent Care Association (UCA) shows that the number of urgent care centers in the U.S. reached 8,774 in 2018 – an increase of 30 percent from the 6,100 counted in 2013. Moreover, center revenue is predicted to achieve a steady annual growth rate of more than 3 percent overall through 2023, according to a 2019 study by Kalorama Information.

Risk managers are caught in the middle in fulfilling the missions of their organizations, protecting balance sheets, and protecting patients and employees.

For healthcare networks investing in the future of urgent care facilities, risk managers often face multiple priorities, says Jeff Duncan, chief underwriting officer of Liberty Mutual Insurance’s Healthcare Practice. “Risk managers are caught in the middle in fulfilling the missions of their organizations,” he notes, “protecting balance sheets and protecting patients and employees.” As more hospital systems and physician investors explore the urgent care model, successfully balancing the benefits and risks of the opportunities they provide is a top goal.

Recognizing the benefits 

Thanks to increased use of urgent care, patients with non-emergency health needs can be seen faster than an emergency department, usually at a reasonable cost. Not only may these services help ease overcrowded emergency departments, but they can also improve community health and build care referrals. Key benefits include:

  • Convenience. More than 70 percent of patients wait less than 20 minutes to see a provider at an urgent care center, with 94 percent being seen in less than 30 minutes, according to the UCA report. Nearly 85 percent of patient visits take no more than 60 minutes in total. Median amount of time spent in emergency rooms, meanwhile, ranges from two to four hours, according to CDC data.
  • Appropriate level of care. The robust capabilities of urgent care centers mean that most patients don’t need to be referred elsewhere. The UCA report findings show just 2 percent of patients had to be diverted to emergency departments for higher acuity care or diagnostics.
  • Affordability. Urgent care centers charge $168 per visit on average, while hospital-based emergency department visits, on average, cost more than $2,250 per visit.
  • Connection to primary care. More than a third of patients (35 percent) seeking care at urgent care centers are unaffiliated with a primary care provider. For these patients, urgent care serves as a valued “front door,” often connecting them with a medical home or affiliated specialists.

While the niche has already experienced robust growth and investment, health system researchers say they’re still bullish on prospects. After all, a typical urgent care center sees 294 patients each week, according to Kalorama report on urgent care, and per-site revenue is expected to reach $1.7 million by 2021.

“Urgent care is meeting the needs of people who may not have an emergency, but who also cannot wait weeks for an appointment with their family doctor,” says Duncan. “And it’s also creating an alternative revenue stream for the healthcare systems that invest in it.”

Evaluating the risks

According to the UCA, 39 percent of urgent care centers are owned by corporate entities,16 percent are established in a joint venture with a hospital, and 15 percent are hospital-owned. The rest are either physician-owned or investor-owned.

Along with service expansions and business partnerships come several liability exposures that healthcare risk managers must work to identify and mitigate.

But along with service expansions and business partnerships come the potential for several liability exposures that risk managers must work to identify and mitigate. Some important risks include:

  • Scope of practice liability. Every health professional has a specific scope of practice. Because urgent care centers frequently employ a full spectrum of staff – such as physician assistants, nurse practitioners, medical assistants, and other non-physician experts – it’s critical to ensure that they limit their practice to only what they are licensed to do.
  • Medical malpractice. There are a few clinical issues to be aware of in an urgent care center, which may contribute to potential claims:
    • Abnormal vital signs – Abnormal vitals should be re-evaluated and addressed.
    • Failure to diagnose/delay in treatment – Lack of a thorough assessment or lack of re-evaluation could result in a misdiagnosis or a failure to diagnose a life-threatening condition.
    • Failure to transfer – Not transferring a patient who needs a higher level of care could result in a poor patient outcome.
  • Cyber security and privacy. Because urgent care centers handle protected health information (PHI) cyber coverage could mitigate the risk of third-party liability, fines, penalties, and legal defense arising from any breaches of personal information.
  • Directors and officers. Physician executives or medical directors often are among top leadership contracted to serve hospital-affiliated urgent care centers. Directors and officers (D&O) insurance can provide coverage in the event of legal challenges that occur while acting in their official capacity. Not only does D&O cover legal expenses, but it also helps protect personal assets, as well as the financial well-being of the entity itself.

Protecting your priorities

As urgent care facilities continue to be go-to options for certain types of care, clinical risk managers will be on the front lines of ensuring their safety and success. Liberty Mutual offers the specialized coverages you need to help safeguard your healthcare organization and manage a variety of complex risks. Learn more here.

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