BY TONY WEST
A new kind of health-care provider, unknown to our grandparents, has become an important option for Americans seeking treatment for what ails them.
Urgent-care clinics began to form 40 years ago. They spread slowly into the Northeast but have become a basic feature of Philadelphia’s medical landscape in the last 10 years.“They have proven their service to the community,” said Mark Austerberry, executive director of the Philadelphia Medical Society. “It seems like they’re filling a need.”
There are 16 different urgent-care operations scattered around town. They replicate some functions of the old community hospitals, which are now virtually extinct. These are places where you can go to get immediate care, seven days a week, for ills that can’t wait until you can see your primary-care physician.
Today, we spotlight one urgent-care center: AFC Urgent Care South Philly. This clinic, located next to the former Methodist Hospital at Broad & Snyder, is delivering emergency care for one-tenth the cost of a hospital emergency-room visit, its manager, Jim Raporte, asserts.
“A procedure that might cost you $1,000 if you go to an emergency room, we can perform for $100,” he said.
A full-service hospital is equipped to handle extremely complicated and expensive cases. They need costly tools, specialized talent, elaborate bureaucracies. As a result, said Raporte, “Hospitals have a lot of overhead, some of which is applied to the emergency room. They’re not as efficient as an urgent-care facility.”
When you need to see a medical doctor, Raporte suggested you think of your options as a three-legged stool.
The first and best choice is your regular primary-care physician. This person knows you as an individual and is familiar with your medical records. In these times, though, primary-care physicians are tightly scheduled, often months in advance. They cannot help you with problems that pop up overnight or over the course of a week. And they seldom keep nighttime or weekend hours.
Emergency rooms offer just that. They are available around the clock, and a patient can show up unannounced. But in addition to being costly, they are time-consuming. While the procedure you need may be done swiftly, check-in and waiting can drag on for hours, depending on the traffic. An incoming traffic injury can bump your cold symptom to the back of the line.
Urgent care is all about walk-in convenience. “We handle cases of low acuity,” Raporte said. “If your leg hurts badly, we have an x-ray laboratory. But if it turns out your leg is broken, then we will refer you on to an ER.” This frees his clinic to concentrate on medical problems that are not immediately life-threatening but still need to be tended to right away: coughs, flus, sprains, GI disorders, routine physical examinations required for some official purpose.And it can be done fast. AFC expects to get a patient in and out within an hour, on average.
Like other medical practices, many urgent-care clinics employ nurse practitioners and physician’s assistants as well as MDs, although there is always a physician in supervision. AFC uses only physicians. Raporte said his typical doctor has 30 years’ experience.
“The University of Michigan surveyed primary-care doctors and found a high level of frustration among them,” said Raporte – “not with patient contact, but with the high volume of management demands. Our doctors love to work in urgent care because they get to focus on the doctoring.”
AFC is the oldest urgent-care chain. It was started in Alabama in the 1970s by Dr. Bruce Irwin, the son of a small-town cobbler who lost both legs in a train accident. It now has 170 locations nationwide. It opened its South Philadelphia clinic five years ago.
“At first, we were talking about having to educate people about what urgent care is,” he reported. “Today there is such growth. A much-larger swath of people knows what urgent care is.” AFC South Philly now sees three patients an hour, around 40 a day. Its goal is the efficient use of time for quality care. Raporte is proud of his clinic’s online customer rating.
This clinic does not deal with opioids or chronic-pain management, thereby avoiding a quagmire of public risk and responsibility.
As a free-standing chain, AFC is not the only model for urgent care. In Philadelphia, many hospital networks operate their own clinics. Some drugstore chains now provide urgent-care services in house. There are also “solo practitioners” in the field, independent clinics, although these are more often found in rural communities.
As with the rest of the medical industry, consolidation is happening in urgent care. Brands are being bought and sold as shakedowns eliminate less-efficient operations.
In return for convenience, urgent care expects self-payment up front. But most insurance plans will work with established urgent-care clinics.
Raporte says 30-40% of his patients are repeat visitors. But his goal is not to take patients from primary-care physicians: “We don’t say, ‘Use us as your primary.’”
Austerberry stresses this point as well. “You need to have a medical home,” he said. “People need to make sure there is a transition of care.”
AFC has a software system that can transmit reports to a patient’s primary-care physician and urges that they use it. But it cannot legally do so without authorization signed by the patient.