In Missouri, the average patient will spend 30 minutes in the emergency room before being seen by a doctor, according to ProPublica. After that, they will wait an additional three hours and 13 minutes before being admitted to the hospital.
Robert Veno, a student at the University of Missouri in Columbia, has experienced long waits and other difficulties in accessing medical care. It has driven him to seek other options.
“It’s been harder and harder for me to see my doctor,” Veno said. “Urgent care is a lot easier for me to visit, and I can get more immediate help.”
At Family Medical Walk-in Clinics, a chain of urgent care facilities in southwest Missouri, patients spend an average of about one hour being treated, according to Brian Casey, Family Medical’s practice manager. Casey said urgent care facilities can provide an alternative for patients hoping to avoid a trip to a hospital emergency room, delivering more practical care for issues that are not life-threatening.
Factors including wait times and cost are contributing to the rise of urgent care clinics across Missouri and the rest of country. The clinics cater to patients whose ailments are not life-threatening but require attention more immediate than a scheduled appointment can offer. They aim to differentiate themselves from other health care options with their operating hours, lack of appointments and focus on delivering care quickly, according to the Urgent Care Association of America (UCAOA), an industry group.
The first urgent care facilities emerged in the 1970s. Currently, there are about 7,400 of the clinics in the U.S. Historical data on the growth of the industry is spotty, according to the UCAOA, but “there is no indication that (recent growth) will slow down any time in the near future.”
Physicians shortages, long waits
Hospital overcrowding and long wait times have many causes, with one being a shortage of medical personnel. A 2016 report from the Association of American Medical Colleges projects that by 2025 there will be a nationwide shortage of between 15,000 and 35,000 primary care physicians. The numbers are similar for specialists, with a projected shortage ranging from 37,000 to 60,000 physicians.
“Under every combination of scenarios modeled, an overall physician shortage is projected,” the report says.
Dave Dillon, vice president of public and media relations at the Missouri Health Association, sees Missouri mirroring the national trend.
“We did research a couple of years ago that focused on primary care in rural parts of the state,” Dillon said. “Not only do we have a primary care physician shortage, but every indication was that that was likely to get worse over time.”
In Greene County, where Springfield is located, the ratio of primary care physicians to citizens was 960 to 1, according to County Health Rankings from 2013. But those numbers pale in comparison to other counties. In neighboring Hickory County, that ratio spikes to 9,310 to 1. The ratios vary widely from county to county, but the shortage is felt most heavily in rural areas.
“It’s harder to draw … medical providers into the rural areas just because maybe they haven’t lived there or (they want) those conveniences of a larger city,” Casey said.
Out of the 19 counties in Missouri with more than 5,000 citizens to every primary care physician, 14 had a population of less than 20,000, according to 2013 estimates.
Dillon also said Missouri has trouble retaining primary care physicians, noting that many doctors who are trained in the state end up relocating.
Doctor shortages at rural hospitals can represent an opportunity for urgent care facilities, and some providers are looking to capitalize.
“I definitely don’t believe it’s saturated,” Casey said of the urgent care market. “There’s a lot of rural areas in southwest Missouri, between here and Arkansas and here and Kansas … so we may get people from up to 60 miles away in some cases.”
Contrasts in costs
Operators of urgent care clinics tout another advantage over hospital emergency rooms: cost.
In general, urgent care facilities take payment through either insurance or self-payments, just like emergency rooms. However, the two types of facilities differ in their ability to turn away patients. Under the Emergency Medical Treatment and Active Labor Act (EMTALA), Medicare-participating hospitals with dedicated emergency departments cannot deny emergency care due to a patient’s inability to pay. This means that the costs of unpaid care are spread amongst other patients.
Many urgent care facilities usually do not meet the EMTALA guidelines for being considered an “dedicated emergency department” and can therefore deny care, driving down costs.
Emergency departments tend to offer the most intensive levels of care, which often require specialized equipment, lab technicians and specialized physicians. Those costs add up quickly.
“(The emergency department) runs 24 hours a day, which requires also that other parts of the organization run 24 hours a day,” Dillon said.
According to a 2013 study analyzing the 10 most common reasons for emergency room visits, the median cost of those visits was $1,233. The costs varied widely. The bill for an upper respiratory infection ranged from $19 to $17,421, with the median being $740.
At Family Medical, Casey said, patients tend to see lower and more standardized costs. If uninsured, patients pay a $169 flat fee to be seen. In addition to taking insurance payments, the clinics also offer a membership system, through which patients pay a $55 monthly fee and $35 per visit.
“We offer to patients that don’t have insurance or may have a high-deductible plan,” Casey said, “and therefore they don’t have a copay when they see the doctor.”
Even so, health insurers can also benefit from the rise of urgent care clinics. The less insurers spend on patient care, the higher their profit margins are.
“By stair-stepping those costs, that helps insurance companies help their enrollees make good decisions about what venue of care to go to,” Dillon said.
Some Missouri providers, such as Blue Cross Blue Shield and Cigna, provide guides to help people decide which type of care is appropriate. Many insurance companies encourage the use of urgent care through cheaper copays while charging higher copays for emergency room visits.
“They definitely benefit the patients,” Casey said of urgent care clinics. “That’s the whole purpose of why an urgent care facility would exist and thrive and succeed.”