Urgent care center success is often dependent on a quality reputation, visible signage, locations adjacent to high vehicular traffic volume, and aggressive marketing (1). With increases in competition and healthcare reform, urgent care center owners need to consider additional pathways to success, including direct marketing to hospitals, healthcare systems, and specialists. These relationships become mutually beneficial with referral of urgent care center patients to the hospital or specialist and reciprocal directing of lower acuity patients to the urgent care center. Expansion of clinical services, including complex wound care, occupational medicine, wellness programs, and post-discharge care further increase marketability for the clinic. Clinical integration with health systems provides several benefits, including access to advanced technology, marketing, capital, and electronic medical records. Integration occurs via affiliation, joint venture, or employment.
Urgent care vs. emergency department care
Urgent care facilities provide unscheduled evaluation and treatment for minor illness or injury. Urgent care centers often expand services to include immunizations, occupational medicine, health promotion, sports and executive physical examinations, physical therapy, and wellness (such as smoking cessation and weight loss) (1,2). Minor illness and injury care is often provided at a lower cost compared to emergency departments, with urgent care centers delivering similar quality, greater convenience, and higher patient satisfaction (3, 4).
Emergency departments have been the safety net in health services for those patients that are uninsured or underinsured. Patients with similar complaints cared for in emergency departments compared to urgent care clinics are charged substantially more (5). Emergency department charges are skewed by hospital cost shifting and unreimbursed care. In addition, these charges often exceed actual collections by over 70 percent due to contractual write-offs, Medicaid, Medicare, and bad debt from self-pay patients. Urgent care centers, on the other hand, have much lower overhead and provider costs, resulting in an overall lower cost structure along with lower Medicaid and self-pay populations. Use of emergency departments versus urgent care centers varies by geographic location, social class, and payer status. Comparing the cost of care (without any testing) for a patient with a simple sore throat, the following are average costs to the patient.
1. Cash Clinic $45-55
2. Retail Clinic $65-75
3. Urgent Care $100-120
4. Primary Care $120
5. Emergency Room >$200
The above pricing strategy plays a major role when population healthcare expands and less focus is placed on fee-for-service reimbursement. In addition, patients desire ease of access (location, parking, travel distance), and lower costs with similar quality (1, 3, 5).
Marketing for hospital affiliation
The first step in the marketing process is defining the key contact individuals in the hospital, including the emergency department medical director, hospitalist director, and an administrator (preferably a decision maker at the vice president level or higher). Hospital-based physicians, including emergency department and hospitalists, are solid partners for the urgent care center and may become critical allies for hospital affiliation. These individuals make or break the relationship or affiliation.
The focus for the urgent care center owner as she or he speaks with the emergency department director is salesmanship as a solution rather than competition for minor illness and injury care (5). This solution could include referral of low acuity emergency department overflow and follow-up rechecks for hypertension, cellulitis, packing changes, and suture removals. It is critical that all parties understand the purpose of the urgent care center is not meant as medical home; long-term relationships along with chronic care are not the focus of the site. Fostering the relationship with the emergency department director also helps with quality monitoring. The urgent care center often refers patients to the emergency department for further care, admission, or imaging. Feedback to the urgent care center regarding these patients should include any challenges or problems occurring with the referral, unexpected negative outcomes, or outstanding performance.
Often, patients with higher acuity complaints, including chest pain, abdominal pain, and neurologic symptoms, require referral to the hospital. Many of these could be directly admitted to a hospitalist’s service. If the urgent care center has the ability to contact a hospitalist, the emergency department may be avoided, potentially preventing delays and patient holding (patient boarded in the emergency department). This process often requires greater testing on the part of the urgent care center.
Health system partnership may allow for expansion of a robust imaging center for the urgent care center. The combination of imaging and urgent care provides a dual marketing benefit. Utilization of the imaging center provides marketing for the urgent care and vice versa (1). This concept may be implemented to reduce volume loss from other competitor imaging programs, but it is an expensive alternative and service duplication should be avoided.
When hospital administrators and urgent care center owners consider affiliation, it must be done with care and the relationship developed at “arms-length” to avoid Stark issues. A joint venture or affiliation with a private urgent care center must be of mutual benefit. Hospitals often offer integrated medical records, access to information technology, potential access to capital for expansion, and referral gateways for admission and specialty care. Systems need to understand that urgent care operators provide a “middle option” in the patient care spectrum outside of the emergency department and primary care offices (5).
These programs include affiliation, co-branding, joint venture, or ownership. Affiliation may be a simple agreement between the two parties with rights to advertise the relationship or co-branding where the urgent care center may list the hospital affiliation on signage. The hospital or healthcare system may also provide marketing support, information technology or support, access to capital, integrated electronic medical records, and assistance with referrals to primary care physicians, specialists, and hospital admissions. Joint venture extends the relationship where both parties share in the facility profit and management. The final option is employment, where the hospital purchases the urgent care center site and has full management as an employer
Marketing to specialists
Similar to hospital relationships, urgent care centers often need specialists for follow-up of patients requiring further care. The most common specialties required are orthopedics, ophthalmology, wound care surgeons, and family physicians. Rather than competition, the urgent care center can be seen as a relief valve for family physicians, covering office overflow, after hours care, and wound care. Ensuring that a patient’s return to the family physician’s office for continued care is critical, along with the referral of new patients for chronic medical care. By gaining the trust of the ophthalmologist, the urgent care center can increase its care for eyes, including minor foreign removal and corneal burring with the back-up support of the specialist. Complicated wound care may be referred to the wound care surgeon for final excision, complex debridement, and hyperbaric care. The urgent care center may get referrals from the wound care surgeon, including simple abscess drainage, wound checks, and packing removals. These relationships result in a sustainable business model and combat competition.
Telemedicine is becoming significant competition for minor illness care with a price point of about $49 (6, 7). Injury care is difficult or impossible to manage over the phone, especially with laceration repair, abscess drainage, and orthopedic splinting. This concept is implemented via “proceduralist” nurse practitioner and physician assistant staff. The idea involves providing advanced training for nurse practitioner and physician assistant staff in higher levels of wound repair, including z-plasty, subcuticular suturing, and cosmetic repairs. These skills can then be aggressively marketed to the local public, family physicians, specialists, and emergency departments.
Marketing via population healthcare
Finally, population healthcare focuses on health maintenance and care coordination. Hospitals will seek out urgent care centers developing wellness programs that include diabetes education, weight loss, and smoking cessation. In addition, screening with diabetic foot evaluation and smoking cessation education provide billable interventions. Post-discharge clinics (early evaluation after hospital discharge) provide early evaluation of recently hospitalized, high-risk patients within two to three days of a hospital stay. The evaluations focus on patient education and may reduce hospital readmission (8, 9). Setting up a program at the urgent care center provides an off-site geographic benefit and patient convenience. Hospital readmission of Medicare patients may become unreimbursed events and result from medication noncompliance, lack of patient understanding of the disease process, and failure to obtain timely follow-up appointments (9). These programs may reduce readmissions by ensuring medication compliance, discharge instruction compliance, and establishing definitive primary care physician follow-up appointments.
Urgent care centers market themselves as a solution for minor illness and injury care by touting speed of service, quality of care, lower costs, and higher patient satisfaction. It provides an alternative to the emergency department, an area for post-discharge follow-up, and an expanded footprint for the healthcare system. Urgent care centers benefit from affiliation with orthopedists, ophthalmology, wound care surgeons, and primary care providers. Specialty and primary care physician relationships assist in obtaining reliable follow-up for patients with specific needs, but also may become an income stream for referral from these specialists to the urgent care centers. Significant expansion into wound care, including complicated laceration repairs and abscess drainage, assist in decongestion of the hospital based emergency department, and also maintains services that cannot be accomplished via telemedicine. Mutually beneficial relationships provide revenue to all parties.
1. Boyle, MF. Kirkpatrick, D. 2012. The Healthcare Executives Guide to Urgent Care Centers and Freestanding EDS. Healthleaders media: Danvers, MA.
2. Urgent Care Association of America (UCAOA) 2014 Benchmarking Survey retrieved 11/18/2014 from http://www.UCAOA.org/2014Benchmarking.
3. Gangler, A. (2009) Milk, Bread, Newspaper…and a Flu Shot? Money. 38(1):1-7.
4. Mehrotra, A, Hangsheng L., Adams, JL et al. Comparing Costs and Quality of Care at Retail Clinics with That of Other Medical Settings for 3 Common Illnesses. Annals of Internal Medicine. 9/1/2009, 151 (5), p321-W.109.
5. Bedner, J. 2014. The Era of Urgent Care: This Growing Model Bridges Gap Between Primary, Emergency Care. Business West. 31(5), 46-48.
6. Desjardins, D. (2014). Telemedicine going mainstream. Medicine on the Net (MED NET), 2014. 20 (8): 1-3.
7. Eramo, L (2014). HEALTHCARE on Demand… An Expanding World of Telemedicine Raises New Questions for HIM Professionals. Journal of AHIMA (9): 26-30.
8. Park H. Branch L., Bulat T., Vyas B., Roever C. Influence of a transitional care clinic on subsequent 30-day hospitalizations and emergency department visits in individuals discharged from a skilled nursing facility. Journal of the American Geriatrics Society. 2013. 61 (1): 137-42.
9. Leppin A. Gionfriddo M. Kessler M, et al. Preventing 30-day hospital readmissions: a systematic review and meta-analysis of randomized trials. JAMA Internal Medicine. 2014. 174 (7):1095-107.