For-profic Urgent Care clinics

[mcnacht]

There is a recent increase in the number of free-standing Urgent Care clinics in my area. I think in some parts of the country they've been around for a longer time. I've actually been working at one of them for almost a year as an NP, and I'm having a few qualms about it. My background was as an ER nurse in a public hospital, so we saw a wide range of income levels and treated everyone regardless of ability to pay. At the UC clinic, they have to either pay cash ($99 where I work), or provide proof of insurance before being seen.

In some ways I like this model, that if you're paying out of pocket, all costs are disclosed before you agree to the service. So if I order an x-ray or a lab test, or put on a splint, the patient is made aware of how much they will be charged before we do the service. On the other hand, I wonder if they get overly focused on the pricetag, and decline service based on cost. For example, I once had a patient in whom I suspected PID. She needed GC/CT testing, and an injection of Rocephin. Each of those costs over $100, and she said she could only afford one, and opted for the treatment rather than the testing.

Does anyone else have moral or professional qualms about this model of care?

[Altra, BSN, RN]

Without getting into ethics ... this is not unique to urgent care facilities. The entire US healthcare system is fee-for-service. "Insurance" payors including the government (CMS) complicate the model a bit ... but other than isolated charity care programs, all care is fee for service.

Once upon a time PCPs could and often did leave adequate room in daily appointment schedules to see sick/injured patients with little to no notice. Over time, an increasing reliance on highly technological diagnostic tools AND decreasing reimbursements from all payors for office visits have created a primary care model that pretty much demands that PCPs book their days solid in order to survive financially.

What the urgent care chains have done recently is to attempt to serve a market niche providing walk-in care to those who have the financial ability (either self pay or through insurance coverage) to pay for it. They have proven pretty effective at doing exactly what they set out to do -- to make the healthcare consumer very aware of and fully responsible for the cost of care.