By Bill Toland / Pittsburgh Post-Gazette
When insurer Highmark Inc. sunk upward of $50 million into the MedExpress Urgent Care chain a year ago, buying a 10 percent stake in the company, MedExpress was valued at somewhere north of $500 million.
Today the 11-year-old West Virginia company, with about 90 locations in six states, is valued at close to $1 billion, meaning the value of Highmark’s stake has doubled, too — and continues to grow.
That’s but one illustration of the enormous growth within the overlapping “urgent care” and “convenient care” markets.
Here’s another: By 2014, an estimated 3,200 “convenient” care medical clinics will operate in the U.S. That’s up from about 200 in 2006, a 15-fold increase in eight years.
Meanwhile, “urgent” care clinics — larger, stand-alone units with a bigger staff, offering more diagnostic services — number more than 9,000, which is greater than the number of U.S. hospital emergency rooms. Clinics small and large have appeared in suburban strip malls and in urban cores, inside pharmacies and supermarkets, flanking Pizza Huts and sub shops.
UPMC runs its own chain of eight stand-alone urgent care clinics, while Heritage Valley Health System operates smaller clinics inside Wal-Marts. Walgreens has its own brand of clinics (Take Care Clinic), as does CVS (Minute Clinic). Giant Eagle, Kroger and Target are now in the health care game, too.
For those who haven’t been to one, the smaller retail clinics — sometimes called, derisively, “take-out” clinics — provide a variety of services, from treating cuts, coughs and colds to offering physicals, vaccinations, immunizations and screenings.
Urgent care clinics can do more, treating broken bones and allergic reactions, taking blood and X-rays. Many have physicians on staff.
Both usually have longer hours than physicians’ offices, and see patients strictly on a walk-in basis — meaning there’s no need to wait two days for an appointment slot to come open or to get a prescription for that pink eye.
Together, they draw millions of patients a week and have become an increasingly important piece of the American health care system, said Ateev Mehrotra, health policy analyst at the Rand Corp. and assistant professor at the University of Pittsburgh School of Medicine. He’s co-written about a dozen studies on retail medicine in recent years.
If you were sick “20 years ago, you could go to your doctor’s office or go to the emergency department,” Dr. Mehrotra said. Today, he said, the market is seeing “so many different options that are opening up for patients that will help with access.”
That access, though, comes at least partly at the expense of established physicians’ practices, a concern for doctors who say that the patient-physician relationship is being diminished and that continuity of care can suffer.
“Medical care is more than just a sequence of treatments for minor acute illnesses,” said Glen Stream, a California-based physician who is president of the American Academy of Family Physicians.
When care occurs in parallel provider “silos,” he said, those silos often don’t communicate well with each other.
If physicians are wary, patients don’t seem to be.
Retail clinics, in the last decade, have emerged as a genuine fourth entry point to the medical care system, in addition to the primary care practice, the emergency room and the nursing home.
The clinics have relieved some of the pent-up demand in the primary care system, both for people who avoided the doctor because they didn’t want to wait for an appointment, as well as for those who wanted care but lacked insurance.
It’s no surprise that for the uninsured, their usage of express clinics “was more about cost,” Dr. Mehrotra said of the surveys he’s conducted. “They really appreciated that the price was posted, and they knew what they were going to pay.”
The larger urgent care model, meanwhile, can be a boon to insurers in that it keeps people out of the emergency room and it can benefit affiliated hospital systems by driving referrals to specialists.
Yet, despite all that has been learned about how the urgent care clinics are best used, the fact remains that some clinics haven’t figured out how to turn a profit.
“Stand-alone urgent care models struggle because you’ve got high overhead, a building, staff running 12- to 16- hour days,” said Paul Keckley, executive director at the Deloitte Center for Health Solutions.
The retail, 600-square-foot clinics aren’t big revenue generators either, but that’s not their purpose.
“It becomes a traffic-builder,” Mr. Keckley said. “[Stores] count on a set of other purchases to make that work.”
When those purchases don’t happen, the floor space devoted to the clinics isn’t always worth it.
“We were never recession-proof,” said Tine Hansen-Turton of the Convenient Care Association, a trade group for the smaller clinics. “The profit margin in this business is not very big, [and] our members spent a lot of time figuring out [what] else needs to be added to the menu” in 2008 and 2009, when hundreds of clinics were shuttered or decided to open only during flu season.
Despite the growing pains, “Consumers like the model,” she said. “That hasn’t changed from Day 1. They like to walk in without an insurance card” and know they can be seen within half an hour.
The appeal cuts across demographics. Usage has been rising among seniors, Dr. Mehrotra said, even though seniors are the consumer bloc most likely to have a longtime attachment to a primary care doctor.
Young professionals and college grads who don’t have insurance or simply haven’t selected a doctor are frequent visitors.
And parents, too, like that they can bring a sick child in the evenings or on the weekend, and not have to rearrange their work schedule to accommodate a visit to the pediatrician, or even call in advance.
Todd Wolynn, a physician with Kids+ Pediatrics in Squirrel Hill and Pleasant Hills, remembers being mystified as to why some families stayed away from his practice, and then visited retail clinics and urgent care clinics instead — even after his practice had extended its hours into the weekend and the evening.
He said he heard the same story from patient after patient: “I don’t even want to call for the appointment. We just want to walk-in,” they told him.
His practice, as a result, had to adapt, offering daily walk-in hours. Other pediatric clinics have done the same, because of the pressure from — and popularity of — the retail model.
Dr. Wolynn, like other physicians, believes that nurse practitioners and urgent care physicians aren’t as familiar with their patients and have little ability to tap into a patient’s medical history or manage chronic conditions. But he also realizes, as other physicians do, that the express clinic isn’t going away, and that the option is a response to a major gap in the decades-old primary care.
And it’s a gap that simply can’t be filled by physicians.
“There are about 18,000 people who graduate from medical school each year. That’s it,” said Terence Starz, former chair of the Allegheny County Medical Society and a UPMC rheumatology specialist.
Physicians already have a full patient load, he said, and with millions of new patients set to enter the American health care system via President Barack Obama’s Medicaid expansion, there’s a need for capacity.
Which means, in the future, drug store clinics and urgent care centers will be forced to get into chronic illness management and telemedicine, selling suites of services to employers, linking up with hospitals or health plans to share in the savings when a costly emergency room visit is avoided and even plugging into the electronic health information systems so they, too, can view a patient’s medical history.
Whatever evolves, Dr. Mehrotra said, “It will be a very different world.”
First Published September 16, 2012 12:00 am