State regulators want more oversight of urgent care facilities
PHOTO | Courtesy of Google Maps
Heywood Urgent Care in Gardner
In the past decade, and especially in the years since the pandemic hit, urgent care centers have become an integral part of health care system. But the rapidly expanding centers lack standardized oversight from the state, officials said Wednesday, and the top public health official in Massachusetts feels it may be time for that to change.
More and more patients have turned to walk-in appointments at these clinics for issues such as colds or sprains, where they may have previously either gone to the emergency department or made an appointment with their doctor.
"Over the past five years, and certainly during the COVID-19 pandemic, we saw a lot of changes in how health care is accessed, and therefore how it has impacted our health system capacity. Namely, we've seen more urgent care centers opening and more people seeking their health care, both routine and urgent, through emergent care through our urgent care centers and through our emergency departments," said Katherine Fillo, deputy bureau director for clinical and health care systems quality at the DPH, during a Public Health Council meeting on Wednesday.
At the same time, hospital stays have gotten longer, as workforce shortages have limited the number of patients nurses and doctors can care for at a time. Limited staffing in rehab facilities has also contributed to the backlog in hospitals, as patients stay longer in inpatient settings waiting for a spot to open up.
Those without a life threatening illness or injury may turn to urgent care to avoid long waits or high costs. Even prior to the COVID-19 pandemic, Bay Staters were turning away from emergency department care, driven in part by the emergence of alternatives like these facilities.
Before COVID, 2019 marked the fourth straight year of decline for the state's emergency department use rate, which stood at 367 visits per 1,000 residents in 2016, 358 in 2017, and 357 in 2018.
Meanwhile, DPH reports that the number of urgent care centers rose from 18 in 2010 to 173 across Massachusetts by the end of 2021.
The most common reasons for care at urgent care settings are respiratory infection, urinary tract infections, pain, rash, bites and stings, according to the department.
Despite the increasing reliance on these centers as an important part of the state's health care system, the patchwork of regulatory oversight has led to limited data about the centers.
"We do think that there's a role for the department to play in regulating what is happening, particularly because it would give us access to data, which is really important for us to understand what's happening across the state," said DPH Commissioner Robbie Goldstein.
In 2018, only 16 urgent care facilities -- about 10 percent of all the centers in the state at the time -- reported data to the U.S. Center of Disease Control, which the DPH accesses. That number has grown to 44 reporting facilities by the end of 2023, an estimated 25 percent, according to the department.
While there is no standard for oversight of these centers, urgent cares must be licensed through the state as a clinic or hospital satellite before they start providing services, though there's a limited definition of what exactly an urgent care is.
In a presentation to the Public Health Council on Wednesday, Fillo recommended the DPH create a standard licensure to "apply care standards and improve quality of care," as well as to ensure the state has uniform quality-of-care data coming out of these centers.
"There is a critical role for the department to play in urgent care to make sure we have high quality services at the right cost, available to all residents in the commonwealth," Goldstein said.
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National Urgent Care Center Accreditation (NUCCA) read with interest the recent article regarding the Massachusetts Department of Health’s desire to create a system of regulatory oversight for Urgent Care Centers in the state. What needs to be done is to look at the broken health care system that is currently in place:
For many years, descriptions of the healthcare system in the United States have included phrases such as “serious emergency room overcrowding,” “unraveling safety net,” and “emergency medicine in crisis.” The steadily increasing need for immediate care in this country has resulted in overcrowded Emergency Rooms in nearly every community. Many people chose Emergency Rooms to receive prompt care for medical needs which arise suddenly. With so many people seeking care, the crisis mounts.
Decreased access to timely appointment with their primary care providers is also a contributing factor in patients seeking care in the Emergency Room and the Urgent Care Center. Did you know that during the height of the COVID crisis, oftentimes family practices were refusing to see patients that may have had signs or symptoms of COVID, instead telling patients that they needed to go to an Urgent Care Center first to be tested?! Did you know that patients who have differential diagnoses that are potentially serious are first identified by the Urgent Care Center and then sent to the Emergency Room? If not, those patients would have waited for an average appointment with their primary care provide for a month or more?
Urgent Care Centers have become part of the medical safety net upon which people are increasingly relying. Luckily, the Urgent Care Center has the ability to meet the increased demand. The walk-in basis and extended hours of Urgent Care Centers is convenient for patients. The waiting times and overall treatment times are, on average, significantly less than that for similar evaluation and treatment in the Emergency Room. Also, the price of an Urgent Care visit is significantly less than that of an Emergency Room visit. The public is learning that Urgent Care is the better choice for their immediate healthcare needs.
Regulation of the standards for Urgent Care Centers is important, however any additional regulations, aside from what is already required to operate any medical facility, would be overly burdensome. Singling out and targeting Urgent Care Centers by placing additional regulatory obligations on them would only diminish growth and innovation.
In 2004, the American Academy of Urgent Care Medicine developed the Urgent Care Center Accreditation (UCCA) program. The UCCA program accomplishes the accreditation of centers by setting standards, measuring performance, and providing consultation and education where needed. The accreditation program is now a separate entity, National Urgent Care Center Accreditation (NUCCA), providing accreditation to properly qualified Urgent Care Centers throughout the United States.
Accreditation is meant to be a learning process for those who undertake it. The process prompts the operators of an Urgent Care Center to closely examine their facility and the way in which they care for patients. Knowledge of, and close adherence to, the standards provide assurances to patients and payers that the care provided at a center is exemplary and that a center’s policies and practices provide for ample safety and privacy. Accreditation demonstrates the highest level of commitment to providing the highest quality medical care and symbolizes medical practice that is consistent with the highest ideals of the specialty of Urgent Care Medicine. The assurance that healthcare providers and facilities maintain adequate levels of quality is of vital importance to patients and those who pay for their care.
Because of the accreditation standards and the thoroughness of its survey procedures, many third-party payers, commercial insurance carriers, local and state agencies recognize accreditation as a value and often a requirement. In addition, professional liability carriers acknowledge that accreditation is a valuable indication of quality and frequently consider it in evaluating an organization applying for coverage.
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