Is the integration of urgent, emergent, inpatient and
care of patients with
acute medical conditions.
By Gail Silver, MD
We are beginning to see changes in healthcare delivery in the United States as the Healthcare Reform Bill is implemented. As anticipated, there is tremendous interest nationally in understanding and strategizing how to provide access to care for all Americans, and to deliver that care in an efficient and cost effective manner. While one of the stated goals of the Healthcare Reform Bill is that every patient should have a ‘Medical Home’, the projected shortage of primary care physicians will make the attainment of that goal a distant hope, rather than an imminent reality. Urgent Care Centers (UCCs) are starting to proliferate as health care delivery systems begin to respond to that need.
UCCs can help fill the access gap for patients whose conditions do not require the level of care provided by Emergency Departments. UCCs provide expanded hours, walk-in care that often includes many primary care services in addition to treatment for minor emergencies and acute illnesses. Many UCCs have on-site x-ray capability and point-of-care lab testing. Many also offer immunizations, sports physicals, pre-employment physicals, immigration physicals, as well as care for injured workers.
UCCs can serve as a resource to ensure that patients who have been hospitalized or discharged from the ED can get necessary follow-up and further outpatient evaluation in a timely manner. This role as the outpatient interface with the ED and the hospital is a critical piece of the Acute Care Continuum. Having a place that can provide guaranteed follow-up whenever it is needed can reduce hospitalizations for ED patients, length of stay for hospitalized patients and decrease the costs of care while maintaining patient safety and satisfaction.
The cost of care per patient for acute, but non-emergency conditions is lower in the UCC setting than it is in the ED, since the UCC does not need the diverse array of resources that are necessary in the hospital environment. This makes UCCs attractive to payers, patients and organizations responsible for managing patient care, such as ACOs.
As the US population increases, primary care shortages worsen and the nation’s emergency departments become increasingly crowded, alternative options for patients requiring acute care and follow up care are imperative. Urgent Care centers are one such alternative. They help close the loop from the outpatient setting to the ED or the inpatient setting and back to the post-hospital environment.
Dr. Silver is CEP America's Regional Director for Ambulatory Care with CEP America. She earned her Bachelors Degree in Animal Sciences at the University of California in Davis California She then went on to earn her Masters Degree in Animal Behavior and her Medical Degree at the Chicago Medical School in North Chicago, Illinois. Dr. Silver completed her Residency in Family Practice at Long Beach Memorial Medical Center in Southern California. She is a Diplomate of the American Board of Family Practice. Currently she practices at both Saddleback Urgent Care Centers - Mission Viejo and Lake Forest.
Trackback from Perspectives on the Acute Care ContinuumHere are recent news items that address trends within the Acute Care Continuum in a colorful and striking manner. One makes the claim that, aside from the patient, the entity most in need of emergency care is the ED itself and calls attention to four... ...
The title of your article says it all, and it has been long overdue that healthcare providers and hospitals embrace this concept. The proposed CMS rule to increase reimbursement for primary care physicians will help drive more demand for urgent care centers in the future. The physicians who work in these facilities (who are mostly primary care providers already) can serve and important role in the reduction of inappropriate admissions on the front end, and readmissions on the back end of the acute care continuum. We are beginning to define this segment of the health care continuum to create a focus on one segment of health care costs (inpatient services) which is being targeted for reduction by CMS. We hope others will join us in promoting a definition of this health care segment which echos the CMS statement of 3 days before and 30 days after a hospital admission, where Medicare will determine spending per beneficiary for diagnostic related groups. But so long as we have fee for service payments from commercial payors the potential for urgent care centers will not be realized, but that seems to be coming too as managed care companies follow the government's lead in their future reimbursement strategies. Perhaps recognizing this future, our hospital clients have shown a renewed interest in establishing hospital owned urgent care centers as well as federally qualified health care clinics. These alternative options for healthcare access are available and reliable places to send patients to determine if an intervention by a primary care urgent care center based provider can avoid an admission or readmission. This becomes an important option when a patient's regular primary care physician is not available, as well as for those who do not have a physician. I expect urgent care centers will rapidly increase in number and will be important partners working with emergency medicine and inpatient physicians across the acute care continuum in the future.
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