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 department. Often urgent care centers are not open on a continuous basis, unlike a hospital emergency department which would be open at all times.
The initial urgent care centers opened in the 1970s. Since then, this sector of the healthcare industry has rapidly expanded to an approximately 10,000 centers. Many of these centers have been started by emergency medicine 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.
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. A qualifying facility must accept walk-in patients of all ages during all hours of operation. It should treat a "broad-spectrum" of illnesses and injuries, and have the ability to perform minor procedures. An urgent care center must also have on-site diagnostic services, including Phlebotomy and x-ray.[1].
Urgent care centers are distinguished from other similar types of ambulatory healthcare centers, such as emergency departments, and walk-in primary care centers by the scope of illness treated and facilities available on-site. 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. 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.
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. JUCM, The Journal of Urgent Care Medicine is the Official Publication of the Urgent Care Association of America (UCAOA). Each issue contains a mix of useful, peer-reviewed clinical and practice management articles which address the distinct clinical and practice needs of today’s busy urgent care medicine clinician.
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.
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 October 2011, New Zealands Accident and Medical Practitioners Association (AMPA) chaired by Dr David Gollogly, changed its name to the College of Urgent Care. 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 and given the tagline, "When it's less urgent than 999." In England, the number to dial for true emergencies remains 999. [2].
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.
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.
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.
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.