Since 1973, the National Association for Ambulatory Care is an organization committed to helping its members open new facilities, become nationally certified and thrive in the changing world of ambulatory healthcare.
Members are predominantly physicians and clinic operators from a range of healthcare provider organizations.
The association publishes the well-known “Bill’s Book: Developing Urgent Care Centers,” and is offers national certification in Urgent and Convenience care.
NAFAC’s President, is William H. Wenmark, a former Navy corpsman in Vietnam, who started NOW Care Medical in Minneapolis. NOW Care, started in 1982, is one of the most popular walk-in clinics in the Twin Cities of Minneapolis and St. Paul, MN. “Bill’s Book” was developed by Bill Wenmark and his staff, based on their ongoing learning and improvement of the NOW Care model and newly developed NOW Express clinic specializing in the new Convenience Care delivery. The NOW Care Network was recently sold toa major health system in Minnesota.
Urgent Care Medicine Defined
The United States health care system is the best in the world. It has become common to refer to our system as "health care". The fact is we do not have a Health Care system, but a Disease, Illness, Injury system. There are a few "health" exceptions, such as pap smears, blood pressure checks, weight, blood sugar test, and lipid profiles. Yet the system has been designed and built around the events of a disease, illness, and injury. In fact, financial aspects of our industry are driven by CPT, ICD 9 codes, and fee structures, which are triggered by these events. The "state" of health has little to do with our system except the need to have "healthy people" financing the system of care for the disease, illness, and injury population.
The system of hospitals, and clinics has been built under the same circumstances. Clinics have been operated on the basis of appointments, long-term medical record, and a Monday through Friday, 8 am - 5 PM delivery system. Because of consumer demands some clinics have chosen to extend these hours into the evening and weekend. The hospital emergency room has served as an after hours delivery system, but is recognized as the wrong site for routine medical problems due to the cost structure and inconvenience.
It has become evident that 85% of the public is otherwise healthy with only an episodic need to access our disease, illness, and injury system. * The consumer demands on our delivery system have forced the market and providers to reconfigure the distribution of our services. This consumer group is well informed and has demanded these episodic services be delivered similar to other services they consume in a competitive marketplace. We have seen these demands on medicine; un-bundle the hospitals based focus of many services and distribute these into a community based ambulatory care facilities. The free standing surgical center is one of many examples. In addition, primary care and family practice have seen this demand grow well beyond their traditional practice patterns. The consumer and employer demand for service has created new sector of care.
The largest growing sector for this care is Urgent Care. UCC practitioners specialize in treating a disease, illness, or injury when presented on an episodic basis. The disease, illness or injury which is treated in a AUC setting is usually acute, and with treatment, is fully corrected in seven to fourteen days. The services are provided seven days each week, on average 13 hours each day, and an appointment is not required. Physician and medical staffs are full time providers in the UCC clinic. Because of the focus on only episodic problems, the UCC practitioners do not provide obstetric services, in-hospital admission, long term management of chronic diseases such as cancer, diabetes, heart disease, hypertension, or other condition requiring long term medical management and continuity of care using the medical record history.
UCC practitioners provide an affordable and convenient gateway to the traditional medical practice community. In fact, when the UCC medical encounter and examination indicates the need for a more extensive evaluation and possible long term management plan, the patient is referred to the appropriate specialist or primary care physician. The plan of care is then supervised in the traditional multi-speciality community where appointments can be made and a continuity of care and medical record can be maintained.
Urgent Care medicine is one of the largest growing practices in the United States. In fact, there are more UCC practices opening than Managed Care Plans. The demand is driven by the eighty five percent of the population who are healthy. They are medical consumers who want treatment quickly, want it convenient and affordable.
Many physicians are moving into the UCC practice. Physicians from traditional family practice, with all the demands to be on call, travel between an office, hospital, and nursing home, and are looking for a change from this demanding schedule. Emergency room physicians, as well, who sometimes experience "burn out" between the ages of 42-47 and are looking for a way to use their triage skills and reduce some of their stress. These physicians, both independent, and in concert with hospitals are opening new centers everyday. Let’s examine the growth of this industry.
We will outline the following areas of Urgent Care Medicine.
- Definition of Urgent Care (UCC)
- Common scope of services in an UCC
- Facility design for UCC
- Definition of Extended Office Hours
1. Definition of Urgent Care Medicine (UCC)
All Urgent Care Medicine is provided in an office based practice.
Urgent Care Medicine specializes in the treatment of any disease, illness, and injury, which is presented by otherwise healthy consumers.
Urgent Care Medicine provides services to 85% of the population who do not suffer from a long-term chronic disease, or require the services of a hospital.
2. Common scope of services in an UCC
90% or more of all UCC’s are episodic and acute. Minor laceration, fractures, bumps sore throats, ear infection, and other "just don’t feel good" conditions
87% of all UCC’s provide a wide range of Workcomp, Pre-placement services, DOT exams, BAT testing, etc.
68% of all UCC’s provide acute on-site physical therapy. This is a very effective case management tool for WorkComp.
97% of all UCC’s provide pre-packaged prescription services. (I.e.. average of 28 frequently used drugs.) This may vary by State laws.
100% of all UCC’s have X-ray departments for basic radiology covering fracture care chest exams, etc.
State licensing regulate the delivery of this service.
98% of all UCC’s have a CLIA level II laboratory department for routine blood test and other diagnostic procedures. Federal laws regulated the delivery of these services.
100% of all UCC’s have life support capabilities but do not advertise this service to the public. People who present to the ACC with life threatening situations are immediately transferred to the Emergency Departments or referred to the 911 EMS system.
100% of all UCC’s are licensed to practice medicine by the State in which the practice is located. No other certification or accreditation is required.
95% of all UCC’s are open seven days each week, 13 hours on average and require no appointment.
Less than 5% of all UCC’s do traditional primary care. Those centers that do are located in service areas, which have a limited number of providers.
95% of all UCC’s physicians do not have and do not require hospital-admitting privileges. Patients requiring this care are referred to their own PMD or are referred to a local PMD for appropriate follow up and continued care.
95% of all UCC’s will see managed care patients, traditional insurance, and private pay. These centers offer the customer discounts for cash payment when the service is not billed to a third party.
96% of all UCC’s us a fee for service system of payment. This provides for a specific measurement of cost, benefit, and value in purchasing ACC services. Other forms of reimbursement vary by contract and from state to state.
60% of all UCC’s are privately owned by physicians and other owners. Hospitals account for the remaining ownership. Private ownership is increasing while hospital ownership is declining. Variations occur from year to year.
97% of all UCC’s are staffed by full time physicians and medical staff.
70% of all UCC physicians are board certified in Family Practice or Emergency Medicine. A state and federal license to practice medicine is required for practice in an UCC as in all private practices of medicine.
Medical staff is comprised of RN’s, LPN’s, Medical Assistants, Lab Technologists, X-ray Technologists and other medical support personnel. The configuration of the staffing is in accordance with state laws and varies from state to state and within different community’s standards of care.
100% of all UCC’s have the physician available at all times. Some variation of this may be seen in very rural remote areas where Nurse Practitioners and Physician Assistants are present.
4. Facility Design For UCC
50% of all UCC’s are freestanding clinic buildings. 50% are in retail shopping centers. The sites vary by state and group development preference. All are routinely convenient and easy to locate and utilize.
UCC’s differ from traditional Physicians office with procedure rooms for lacerations and fractures, Radiology department for x-ray services, laboratory
for lab services and onsite physical therapy. While some traditional physician practices may have these facilitates, it is more the exception. It is the rule for UCC’s to have these service spaces available.
The average UCC’s is between 3600 square feet and 12,000 square feet. The variation is based on common practice and the extent of services offered.
The names used to advertise these centers vary. MedStop, Urgent Care, ProCare, and others.
5. Definition of Extended Office Hours
With the specialization of Urgent Care Medicine, Extended Office Hours has now been defined as the "fragmented" delivery of services. Extended Office Hours is care provided by a traditional primary care practice that has chosen to be open a few hours in the morning, few hours in the evening and a few hours on Saturday and Sunday? These hours are added to the normal 8-5 appointment based practice as a "convenience" to the patient. These hours are usually covered by a part time staff but may on occasion be covered by the primary care physician.
Extended Office Hours will continue to be a term loosely applied to the industry. As the industry and its providers continue to advance, terminology will have a more consistent meaning.
These results were complied by a random survey of AUC operations throughout the United States. The results in any area of the United States may vary as noted. The standard deviation is +/- 5%.
* Results of the review of utilization of medical insurance by Insurance industry.