The Changing Health Care Landscape
How might urgent care centers fare in the future? The Patient Protection and Affordable Care Act is expected to be fully implemented by 2014. “It’s going to be interesting,” said Dr. Das. “The big change of the Affordable Care Act is the development of a value-based purchasing of care. In that system, it is theoretically possible that care is more efficiently allocated utilizing urgent care centers. However, I’m concerned that urgent care centers might be used as a gateway to deny access to specialists.”
Explore This IssueJanuary 2013
Dr. Das cited the early days of health maintenance organizations, when it was harder for patients to access care to specialist physicians without prior approval by a primary care physician. “If there are huge cost controls for urgent care, it might be that urgent care and primary care physicians receive a financial incentive not to refer to specialists,” he said, which could delay needed care. “The financial penalties of referring patients to specialists might cloud the judgment of primary care physicians, nurse practitioners and physician assistants. It’s tough to see if it will be a good thing or a bad thing.”
However, something needs to be done about spiraling medical bills, added Dr. Das. “We desperately need to reduce health care costs. We need efficient ways of delivering health care. If urgent care can do that, then it will be beneficial. If they act as a way to ration health care, there will be a bigger problem.”
Urgent care facilities will likely see an influx of cases once the Affordable Care Act is enacted. “Fewer patients will have care with a primary care physician and, with the influx of Medicaid patients into the health care environment, there will be an inadequate number of primary care physicians,” said Dr. Lambert.
Such clinics can help relieve the burden of noncritical patients flocking to hospital emergency departments, too. Dr. Doxey has already seen this happen. He is the founder and a board member of The Doctor’s Volunteer Clinic of St. George, Utah, a clinic for uninsured patients that is funded entirely by grants and donations and staffed almost entirely by up to 40 volunteer health care professionals. Founded in 1999, the clinic provides dental, mental health and general medical care, similar to many urgent care clinics, and had 12,000 patient visits in 2011.
“When we opened our doors, the numbers of visits to the emergency room went down, particularly [from] those who shouldn’t have been there in the first place,” said Dr. Doxey, who said the facility doubled in size a year ago, and patients continue to seek care, filling the space. Like Dr. Lambert, he thinks his and similar urgent care centers will be busy after the Affordable Care Act kicks in. “Personally, I think Obamacare will not cover every person, and there’s always someone who will fall through the cracks,” he said. “But who knows exactly how Obamacare will play out? We just don’t know.”