Urgent Care Information
Urgent care is the delivery of ambulatory care in a facility dedicated to the delivery of medical care outside of a hospital emergency department, usually on an unscheduled, walk-in basis. Urgent care centers are primarily used to treat patients who have an injury or illness that requires immediate care but is not serious enough to warrant a visit to an emergency room. Often urgent care centers are not open on a continuous basis, unlike a hospital emergency room which would be open at all times.
The initial urgent care centers opened in the 1970s. Since then this sector of the health care industry has rapidly expanded to an approximately 10,000 centers. Many of these centers have been started by emergency room physicians who have responded to the public need for convenient access to unscheduled medical care. Much of the growth of these centers has been fueled by the significant savings that urgent care centers provide over the care in a hospital emergency department. Many managed care organizations (MCOs) now encourage their customers to utilize the urgent care option.
Other ambulatory healthcare facilities
Urgent care centers are distinguished from other similar types of ambulatory healthcare centers.
Emergency departments
Emergency departments are located within hospitals and are prepared to care for patients suffering true emergencies, such as myocardial infarctions ("heart attacks"), serious motor vehicle accidents, suicide attempts, and other such life-threatening conditions. Being located within a hospital, these centers are positioned to provide ready access to major surgeries and critical care units. Emergency departments are usually staffed by physicians with specialized training or board certification in emergency medicine. Most states in the USA require all hospitals to house an emergency department within the hospital building. A few states in the USA allow freestanding emergency departments to be built outside of a hospital building. Many authorities would consider most free-standing emergency centers to be better classified as high-acuity urgent care centers, rather than true emergency departments.
Primary care offices with extended hours
Many primary care offices are open for some hours in the evenings and weekends. However, unless these centers are open for walk-in patients at all times when open for patients, offer on-site x-ray facilities, and care for most simple fractures and lacerations—these primary care physician offices are not considered to be true urgent care centers.
Walk-in primary care offices
Allowing walk-in patients is not a sufficient criterion to define a physician office as an urgent care. If the office does not offer the expanded services and significant after-hours care, then the physician office would not fit the definition of an urgent care center.
Mid-level provider offices in retail stores
In 2000, medical treatment centers opened in retail stores with an on-site pharmacy. These centers are generally staffed with nurse practitioners or physician assistants. Prices are generally posted in public view and patients can shop while waiting. These retail clinics are not true urgent care centers because of the limited level of care that can be provided without a physician or proper equipment on site. Concerns about conflict of interest and incentives to over-prescribe medications in a facility rented from a pharmacy have yet to be fully addressed by organized medicine or governmental agencies, but the American Academy of Family Practice has issued Desired Attributes for Retail Clinics [1].
Criteria for Urgent Care Centers
The Urgent Care Association of America established criteria for urgent care centers in April 2009 - The Certified Urgent Care Center designation. These criteria define scope of service, hours of operation, and staffing requirements. Information and Certification criteria are available to the public on the UCAOA website.[2].
Organized medicine and urgent care
The Urgent Care Association of America (UCAOA) holds an annual spring convention and, also, offers an annual fall conference. Many leaders in organized urgent care medicine anticipate the full establishment of urgent care as a fully-recognized specialty.
Codes for urgent care
In recent years the American Medical Association approved the code UCM (Urgent Care Medicine). This code allows physicians to self-designate themselves as specializing in urgent care medicine. Services rendered in an urgent care center may be designated, using the place of service code -20 (POS -20) on the CMS-1500 form, as submitted to third-party payors. The Centers for Medicare & Medicaid Services (CMS) have designated two specific codes to apply to urgent care centers: S9083 (global fee for urgent care centers) and S9088 (services rendered in an urgent care center). Because of the complex nature of coding for urgent care centers, the Urgent Care Association of America (UCAOA) offers a specialized two-day coding workshop for providers and coders as part of its annual fall conference. The workshop is offered two tracks: basic and advanced urgent care coding.
Postgraduate fellowship training
In 2006, the Urgent Care Association of America sponsored the first fellowship training program in urgent care medicine. This fellowship resulted from collaboration between the Department of Family Medicine University Hospitals of Cleveland / Case School of Medicine, the Urgent Care Association of America (UCAOA), and University Primary and Specialty Care Practices, Inc. in Cleveland, Ohio. The program is partially funded by an unrestricted grant from the Urgent Care Association of America to support the fellowship program. Physicians in the urgent care fellowship program receive training in the many disciplines that an urgent care physician needs to master. These disciplines include adult emergencies, pediatric emergencies, wound and injury evaluation and treatment, occupational medicine, urgent care procedures, and business aspects of the urgent care center. In 2007, the Urgent Care Association of America (UCAOA) sponsored a second fellowship opportunity through the University of Illinois. The one-year fellowships are open to graduates of accredited Family Medicine and Med/Peds residencies.
Urgent Care Outside of the USA
Although the urgent care movement began in the USA, urgent care centers have become an important component of healthcare delivery in several other countries, including Canada, England, Ireland, Australia, New Zealand and Israel. In March, 2008 the Accident and Medical Practitioners Association and the Australasian Society for Emergency Medicine hosted the first international urgent care conference in Auckland, New Zealand. New Zealand is the first country to recognize urgent care as a distinct medical specialty. In 2010, the National Health Service of England instituted a national phone hotline (NHS 111) for the public to use to access care for medical problems that are urgent but not true emergencies. The number to dial for this service was designated as 111, while the number for true emergencies remained 999.
Specialized services
One sign that the urgent care industry is truly emerging as an important sector of the healthcare industry has been the development of supporting industries with products and services directed at supporting patient care and business practices of urgent care centers.
Point-of-care medication dispensing
Point-of-Care dispensing enables healthcare practitioners in the urgent care setting to ensure that their patients receive their prescription prior to leaving the clinic. To offer this service to patients, urgent care centers generally contract with a point-of-care dispensing corporation. Point of Care dispensing enables physicians (and in some states, other licensed healthcare practitioners) to dispense at urgent care facilities. Unlike a pharmacy, practitioners may only dispense to their own patients. Regulations regarding state pharmacy law vary from state to state. Dispensing by a healthcare practitioner is not legal or quite limited in certain states, such as Texas and New York.
Practice management software
Electronic medical records (EMR) and practice management software solutions have been specifically developed for use in urgent care.
Group purchasing organization
Group purchasing organizations, focusing on the urgent care industry, have been formed. The concept of these GPOs is that they join hundreds of urgent care centers together to allow the type of price bargaining that previously was only available to hospitals.
Medical malpractice insurance
Malpractice insurance offerings unique to the urgent care industry have begun to be widely discussed in light of the fact that many insurers do not recognize the reduced malpractice risk of urgent care centers. Insurers that recognize this reduced risk do not group urgent care centers with hospital emergency physicians and other high-risk specialties. Features of this type of insurance may include no charge for tail coverage when providers leave ("tail coverage" is coverage for malpractice claims which may arise after termination of a policy), 3-5 day approval of new providers, no additional premium when providers are added to the policy, per visit FTE rating, and lower premiums.
References
- ^ http://www.aafp.org/online/en/home/policy/policies/r/retailhealthclinics.html
- ^ http://www.ucaoa.org/recognition_certification.php
External links
- Homepage of the Urgent Care Association of America
- Homepage of the American Academy of Urgent Care Medicine
- Homepage of the Journal of Urgent Care Medicine (JUCM)
Categories: Hospital departments | Emergency medicine | General practice | Types of healthcare facilities
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