About seven years ago, the California Healthcare Roundtable and HealthAffairs sat down to prepare a white paper on the emerging “phenomenon” of urgent care centers, and what it might mean for primary care. At the time the group couldn’t agree that urgent care was a “disruptive” innovation, but it seemed clear to all participants that it represented a threat to primary care: The rise of UC, the group noted, would lead to 1) less preventive care and 2) concentrate acuity in primary care clinics. They wrote: “ means fewer patients per day, a higher intensity environment for providers, and potentially lower reimbursement.”
In particular, the group couldn’t understand if patients were choosing to leave primary care because they didn't value having a PCP, or if they were settling for the inherent limitations of UC because cost and convenience outweighed its disadvantages.
Since the roundtable in 2007, there has been a flood of urgent care centers with ongoing rapid growth. The American Academy of Urgent Care estimates that there are around 9300 UCs nationally. Across the country,
, but often by hospitals and health systems who are
in repurposed strip malls,
The reasons for growth, according to the American Academy of Urgent Care? Primarily extended hours (as compared to primary care) and better wait times and lower prices than the ED.
As the private-equity fueled urgent care bubble expands,
For all of UC's utility, it's also possible that urgent care may just get out- maneuvered by the next generation of primary care. First,
. They’re an incremental improvement in care delivery that arose in response to two separate areas of consumer dissatisfaction in medicine: 1)
who've been unable to batch patients by acuity leading to long process and wait times; and 2)
with no incentive to be consumer oriented.
As a primary care alternative (and, I don’t want to address the UC value proposition for emergency department patients here-- though it’s quite high and a different story) UC offers many consumers a Fuastian bargain: In exchange for transparent and affordable costs, extended hours with reasonable cycle times-- plus ready access to assurance (what the California whitepaper calls “emotional care”)-- consumers give up integration, coordination of care, preventive medicine and a loss of relationships with providers who know them.
Extended hours, transparent pricing and process flow analysis are business 101, and particularly as ambulatory practices consolidate and large physician groups grow, they basics will be easy to implement in primary care. What we’ll see (if my thinking is right) is primary care 2.0: consumer-focused, well managed and with a move toward higher acuity in-clinic diagnostics and treatment. Delivered by people you know, in a system you know…
, but they didn’t, and can’t replace them.
We’re seeing examples of this consumer focus on the extremes of the primary care organizational spectrum—small subscription groups (such as Atlas MD in Kansas) who refuse to take insurance but offer care on demand, and at large physician groups who have the resources to add extended hours and in-house diagnostic services. Walmart, which promises to be among the largest providers of primary care in the next few years is also liable to step into the fold. Interesting times ahead.
Comments