Streams

What Exactly Is an Urgent Care Center?

Thursday, April 15, 2010

(Photo by Spencer Platt/Getty Images)

(Photo by Spencer Platt/Getty Images)

'An urgent care center is not what this community needs. They’re trying to throw us a bone!'

That’s a doctor earlier this week protesting the closure of St. Vincent’s Medical Center –- and criticizing the state’s proposal to replace it with an “urgent care center.” What’s that, you ask? It can be a lot of different things, but is generally a medical center that’s a lot closer to a neighborhood clinic than to a full-service hospital with an emergency room. WNYC’s Fred Mogul has been looking at what these relatively new hybrids can and can’t do. He answers some key questions:

So, Fred, WNYC is a dozen blocks from the soon-to-be-closed St. Vincent’s. If I have a heart attack or get in a serious car accident, would they be able to take me to this “urgent care center”?
Typically not. A trauma center is a trauma center because it can admit you into surgery, if necessary, and from there keep you an inpatient for a while or admit you to Intensive Care.
An “urgent care center” can treat serious but not life-threatening conditions -– a bad kitchen cut or burn, broken bones.

That doesn’t sound too assuring to people who live near St. Vincent's and are worried about what might happen in the event of an emergency.
I couldn’t get the state official I spoke with to say how severely ill patients he pictures being treated in one of these centers –- beyond it being more than a sprained ankle and less than a gunshot wound.

But this official and various advocates and elected officials definitely want something more robust than the average “urgent care center.”

There is a model in some rural areas for facilities that do provide some “critical care” and can even hold patients on a limited basis before transferring them to full-service trauma centers.
But the state says it will be up to health care providers who bid on this urgent care center to make a strong proposal of what services they’ll offer.

How much of what goes on in an Emergency Room is ‘severe trauma,’ anyway? For years we’ve been hearing how a lot of people, especially the uninsured, use ER’s for basic medical care.
One NYU professor named John Billings has studied this, and according to his figures, only about 15 percent to 20 percent of people in emergency rooms really need to be there.
That obviously suggests the vast majority don’t need to be there, but the catch is it’s easier to say whether someone should’ve gone to the ER or not after the fact, rather than before.

So is the main idea of the urgent care center, really, just to get all those people who need primary care to go someplace other than ER’s?
Exactly. Here’s what the state’s chief health systems planner, Richard Cook, says:

'If you have a comprehensive ambulatory, primary care/urgent care center that has extended hours, many of those emergency room patients are going to be able to be dealt with through that kind of system.'

So, St. Vincent’s last year had 60,000 people in its ER, and the hope is that an urgent care center would take a good many of those, and prevent them from swamping the closest trauma centers -- Bellevue Hospital, Beth Israel, St. Luke’s-Roosevelt.

The deadline for the state’s “Request for Proposals” to replace St. Vincent's is tomorrow. It sounds like they don’t yet know who’s going to apply. But what would be in it for a hospital system, like a Mt. Sinai or a New York-Presbyterian, to open an urgent care center?
Hospitals typically lose money on emergency rooms, but they have them because that’s a necessary role they need to play in a community and, more importantly, economically, because ER’s feed them patients who use other, more profitable services, like cardiac surgery.

That only works from a business perspective if your patients are insured, which is why private hospitals are only too happy to let city hospitals take over the treatment for the uninsured.

So, the state would have to make sure anyone bidding on this wasn’t just cherry-picking the most financially healthy patients…
Right, and the state might well have to sweeten the deal for someone opening an urgent care center –- giving them tax breaks and maybe paying them a higher Medicaid rate than usual for a basic urgent care center.

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