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Why Urgent Care is Growing So Fast · CareTalk: Healthcare. Unfiltered.

• 0:00
  David: Urgent care centers are popping up all over the place.
• 0:03
  David: Patient volumes jumped 60% since the start of the pandemic, and investors keep rushing in.
• 0:08
  David: But what is urgent care anyway?
• 0:10
  David: Why should patients go to urgent care instead of a doctor's office, retail clinics, or the emergency room?
• 0:15
  David: And what does this growth mean for overall cost, quality and access to care?
• 0:19
  David: Welcome to Care Talk America's home for Incisive, and yes, sometimes even urgent debate about healthcare, business, and policy.
• 0:27
  David: I'm David Williams, president of Health Business.
• 0:30
  John: And I'm John Driscoll, the president of Walgreens.
• 0:31
  John: Well, David, I thought all care is urgent.
• 0:34
  John: If you're looking for a doctor, what is an urgent care center?
• 0:37
  John: What is this urgent care thing?
• 0:40
  David: Uh, it's interesting, John.
• 0:41
  David: I mean, it, it's urgent is, you know, it's always, it's always urgent if it's something involving me or my health, but it is something that's different from emergency care or primary care.
• 0:49
  David: The way I think about it is urgent care is handling things that are not emergencies.
• 0:54
  David: So things like a common cold, ankle sprain, ear infection or rash.
• 0:58
  David: Now, those could also be done.
• 0:59
  David: That's
• 0:59
  John: an emergency.
• 1:00
  John: If, if, if, if my kid gets really sick, I think that's an emergency.
• 1:05
  John: If I.
• 1:06
  John: Think I broke my ankle.
• 1:07
  John: Why isn't, what's the difference between emergency and urgent?
• 1:10
  David: Well, hold on.
• 1:10
  David: So the, so those things I for, I didn't say broken ankle, I said sprain.
• 1:13
  David: So if you get stuff, something that's pretty minor, you could wait, you could even skip it.
• 1:17
  David: Something you could do in a retail clinic.
• 1:18
  David: But it also, they can handle some more urgent things, some more serious things like a broken bone.
• 1:24
  David: or if you get like a big cut when you're going out and playing flag football or whatever you do, you need stitches.
• 1:30
  David: So that's stuff that could be done in an er, but the things you don't wanna do to take an urgent care is like a heart attack, stroke, cancer, something like that.
• 1:38
  David: So it's an acute thing, came up all at once, moderately serious to minor.
• 1:44
  David: That's urgent care.
• 1:46
  John: and, and David, what's the, uh, what ha what's, what's going on with urgent care?
• 1:51
  John: Is it growing?
• 1:52
  John: Is it, why?
• 1:53
  John: Like why is this an A, why is this an urgent topic for Care
• 1:56
  David: Talk ? Yeah.
• 1:58
  David: Well it's not an urgent topic cuz we could cover it at any time.
• 2:01
  David: And we could, we could.
• 2:01
  David: It's not an emergency topic either, and it's not a primary topic, so.
• 2:05
  David: You know, I, I was asking how is this chronic topic chronic, Johnny, I was saying, you know, I was asking, you know, how many urgent care clinics are there, and the truth is, there's about 11,000 urgent care clinics, and that compares about 4,000 emergency rooms, and they've been growing about 10% a year in terms of the number of clinics.
• 2:22
  David: Now it's a 50 billion industry.
• 2:25
  David: Uh, as of this year, which sounds like a lot, although that is just a drop in the proverbial uh, bucket, uh, within healthcare there were
• 2:31
  John: trillion dollars.
• 2:33
  John: The Dr.
• 2:34
  John: Evil ion and David, how it, it's not that surprising that when your urgent care visit can cost us as little as a 10th of what an emergency room visit would cost if they're growing like crazy.
• 2:47
  John: I mean, if you look at the actual costs here, I think that the typical even insured costs, Like, you know, 80 to$400 depending on kind of the nature of the visit to, you know, 300 to$600 if you were just to go to a pcp.
• 3:05
  John: And it can be as much as 10 times to go to an emergency room.
• 3:08
  John: So, doesn't it make sense that these urgent centers are growing as, as, as points as access points for care?
• 3:14
  David: John, I haven't heard that.
• 3:15
  David: You know, that, that cheaper things are growing fast in healthcare, especially when people are insured.
• 3:20
  David: You know, there is, it is an open quote
• 3:22
  John: that that may be the urgent topic we should, we
• 3:24
  David: should address.
• 3:25
  David: Okay, John.
• 3:25
  David: So, I mean, here's how I'd frame it.
• 3:27
  David: I'd say, you know, is urgent care expensive?
• 3:29
  David: And how much does urgent care cost?
• 3:30
  David: Well, you, you gave one answer that it's up to a 10 times less expensive than the emergency room.
• 3:36
  David: However, your research shows that it's nuts could be not such a good bargain for one thing.
• 3:42
  David: Uh, you tend to have over-prescribing.
• 3:44
  David: There was a pew, uh, a study by a Pew Charitable Trust in 2018 that showed that.
• 3:49
  David: There's much more over-prescribing of antibiotics for things like colds, flu, bronchitis, bacterial infections, uh, that, that, uh, or viral infections that actually don't need an antibiotic.
• 4:00
  David: So there's over-prescribing.
• 4:01
  David: So that's a problem because it's ineffective care and you can lose their effectiveness of, of antibiotics.
• 4:06
  David: It may encor encourage more use of care overall.
• 4:09
  David: So the Industry Association talks about how 80% of, uh, 80% of the population lives within 10 minute drive.
• 4:17
  David: Of, of an urban, of an urgent care clinic.
• 4:19
  David: Now, I guess it depends how fast you're driving.
• 4:21
  David: If you're driving like an ambulance at a hundred miles an hour.
• 4:23
  David: Nonetheless, the fact that it's so convenient, uh, means it might be used more.
• 4:27
  David: The same reason there's like a lot of Dunking Donuts around here, so they get used to a lot.
• 4:31
  David: John, that's one of the reasons.
• 4:32
  David: But
• 4:32
  John: you're, you're, you're blaming the fact that there are convenient access points to care where you can, you know, generally be.
• 4:41
  John: within an hour of the time you actually show up for your appointment.
• 4:45
  John: Compare that to the ridiculous challenges of even getting an appointment.
• 4:50
  John: With a doc or a hospital typically for what can be customary.
• 4:54
  John: But you know, sore throat is, I think the most, it's like 20% of or upper sore throat and upper respiratory is 20% of all of the urgent care visits.
• 5:03
  John: But I think that's because people, pe I think the healthcare system doesn't actually respect how in or understand how inconvenient healthcare really is to access.
• 5:14
  John: And so how I, I don't, yeah, I mean, maybe.
• 5:17
  John: There's a little bit more antibiotic use and maybe that should be controlled, but I, I think that the, the fact that they're lower cost and much more convenient is a good thing.
• 5:27
  John: Are you,
• 5:28
  David: yeah.
• 5:28
  David: I mean, are you, I was
• 5:29
  John: just as, as the proverbial conservative crank here.
• 5:33
  John: Are you just sort of just against it because it's, it's growing.
• 5:37
  David: But John, I'm a conservative crank when it comes to cost, but I think you, you put your finger on in an important, uh, piece regarding convenience.
• 5:44
  David: And I think if you ask the question about, you know, why are there so many urgent care clinics and why is the industry growing?
• 5:49
  David: Convenience is the number one reason.
• 5:51
  David: You've got the right locations.
• 5:53
  David: They're open on the weekends, they're open in the evenings.
• 5:55
  David: It's actually a nice environment.
• 5:57
  David: I saw an article that I talked about, a lot of rounded and soft surfaces in there, and it can be seen pretty quickly.
• 6:02
  David: So that's what people.
• 6:03
  David: It's like your David, I, John.
• 6:05
  David: It's just like my wife puts me in the, in the room.
• 6:07
  David: It's all soft and padded.
• 6:08
  David: I'm never exactly sure why that is, but, uh, she takes my belt and shoelaces away too.
• 6:13
  David: But John, in addition to convenience, it's also the case that primary care is not doing that great in this country.
• 6:19
  David: You know, it is not convenient to get an appointment if you can get one, if you can even get a doctor at all.
• 6:24
  David: Coupled with the fact that, you know, one reason the, these urgent care clinics have grown, they've, they've largely parallel.
• 6:30
  David: Uh, the growth of coverage.
• 6:32
  David: So with the Affordable Care Act, uh, in place, more people have access.
• 6:35
  David: You're
• 6:36
  John: blaming the Affordable Care Act for creating more access for to sick patients to get the care they need.
• 6:42
  John: I mean, like, again, I'm just trying to understand where are we going here?
• 6:45
  John: I think this, this, the lower cost access to convenient care.
• 6:48
  John: How can that be
• 6:49
  David: a negative?
• 6:51
  David: Well, John, it depends who it's access for.
• 6:53
  David: Okay.
• 6:53
  David: So it's access to people who've got commercial insurance.
• 6:56
  David: Uh, you know what?
• 6:57
  David: An emergency room or emergency room, they, they have to take everybody who comes in.
• 7:01
  David: You know, they might wanna try to squeeze you after the fact and, and get money out of you, but you can go there if you're insured, uninsured, if you have Medicaid.
• 7:10
  David: If you're, uh, undocumented immigrant, you try doing that at an urgent care clinic, uh, you're not gonna get very far past the door, so, well, it's
• 7:18
  John: not designed for that data.
• 7:19
  John: I mean, the emergency room was genuinely designed as the entrance point for our hospital, and it was historically, and it still is.
• 7:27
  John: The last line.
• 7:28
  John: Uh, but the challenge is that when you, when you get your pr that use that access point for primary care, it's just Titan inexpensive cuz they have to run all of the costs of running the hospital through that emergency room and as well as probably the cost of a lot of the uncompensated care.
• 7:45
  John: But I, I think that we are at a point now where we should acknowledge that the reason why they're growing is because urgent, urgent care centers get what the healthcare system doesn't, which is that people really value their.
• 7:55
  John: and uh, and I think this, this, this PCP thing is a little bit of a canard, but I, I think the, the broader move towards.
• 8:04
  John: , you know, fast serve, uh, smart, casual like food.
• 8:07
  John: Um, people are looking for convenience in every part of their life.
• 8:12
  John: The, the, of the utilization of, you know, digital access.
• 8:15
  John: Like Amazon people are used to shopping and getting what they want relatively quickly.
• 8:20
  John: And I think that the healthcare system just is not dialed into that perspective.
• 8:26
  John: Um, which was probably different a generation ago.
• 8:29
  John: more, more of the, there were more single, single earners in households and, and you know, even though the women are still making the vast majority of healthcare decisions for the family, those women are working.
• 8:42
  John: And I, I think that, you know, the, the lesson for urgent care growth and profitability mean private, you know, this is, this is a sector where hospitals used to own all the urgent care centers and then doctors got in the game, and now a lot of it's private equity.
• 8:58
  John: Invest around.
• 8:59
  John: And it, and, you know, it's a, it's a profitable part of the healthcare system that's growing at over 10% a year.
• 9:04
  John: I think it's 10.99% over the last few years.
• 9:07
  John: Uh, so it's healthy growth and it exploded during c O D.
• 9:12
  John: . Um, yeah.
• 9:12
  John: Why did, why did Urgent Care explode under Covid, David?
• 9:15
  John: Well, John,
• 9:16
  David: I guess the thing is, you know, you're, you're, you know, I was getting this sort of, uh, you know, fast casual diet, so this is like the Paneras and Chipotle's of the healthcare system.
• 9:23
  David: That's what urgent care is.
• 9:24
  David: You know, I, I started to use Sweet Green
• 9:27
  John: David, come on, we, you got me playing forward.
• 9:29
  David: Given the diets, that's very healthy, John.
• 9:33
  David: , I started to use urgent care centers and a lot of people that I know did during the pandemic.
• 9:37
  David: And the reason is that first of all, doctor's offices never mind being able to get an appointment.
• 9:41
  David: They were just shut and the emergency room, you know, think about going there.
• 9:46
  David: They didn't want anyone to come there unless you're, you were, you know, dying or, or close to it.
• 9:50
  David: So CLO Covid sort of closed off other options and, uh, the urgent care centers generally stayed open.
• 9:56
  David: You could actually go there and it was one of the few places, at least in, in my neighborhood in Boston, where you could.
• 10:01
  David: uh, you could get a PCR test done, uh, pretty quickly.
• 10:05
  David: So that was a, that was a big reason for it.
• 10:07
  David: And once people got habituated to using urgent care, they might use it again.
• 10:10
  David: So I used it again when I had, uh, an accident, uh, and I went in and, and, um, you know, got examined that way where I wouldn't have done that in the past.
• 10:18
  David: So I, I think it's pretty straightforward.
• 10:19
  David: John, I don't even know if that was a serious question, cuz I, I think it's blindingly.
• 10:24
  John: Well, David, David, if that's so blindingly obvious, who owns these urgent systems and, uh, and Uhhuh and what's going on there?
• 10:32
  John: There's a lot of, there's a lot of drama around private equity and investor owned healthcare assets, and that appears to be growing really fast.
• 10:40
  John: Here
• 10:41
  David: it is, John.
• 10:41
  David: So these.
• 10:43
  David: These clinics have been around for a long time, as you said originally hospitals and actually insurers, uh, opened them, uh, as sort of a more convenient alternative and less expensive to the emergency department.
• 10:54
  David: And then a lot of these changes started growing.
• 10:56
  David: So you have private equity that owned ones like Concentra and CareNow and MedExpress.
• 10:59
  David: Well now, um, and then.
• 11:02
  David: Uh, those are now, some of them being bought up and some of the retail revolution, um, in healthcare as well because it, it is an important part of the continuum that fits between sort of doctor's offices, retail clinics, and the emergency department and, and the hospital.
• 11:14
  David: And as you say, the private equity firms have come into it.
• 11:16
  David: Now, why do they wanna do it?
• 11:17
  David: Of course it's not, cuz it's lower cost, but because there is good profit potential, because they see the, the possibility of having, uh, convenience and having good reinforc.
• 11:27
  David: , frankly, one of the issues though is that it, it does not cover everything in terms of equity and access.
• 11:33
  David: And this is one of the reasons you're seeing pushback on some of the private investments, uh, in, in healthcare, is that it may be stripping out some of the profitable parts of hospitals and leaving the hospitals to battle it out on tough turf.
• 11:46
  David: But
• 11:46
  John: let's, let's be honest, the, the, the, the urgent centers used to be owned by hospitals.
• 11:50
  John: Um, if they'd done a, if they, if they wanna do a, a, they want to keep these.
• 11:55
  John: Um, members and patients, they would be opening more of them.
• 11:58
  John: Um, the, they're, they're really meeting a big consumer demand.
• 12:01
  John: David, you've got, you know, the silver tsunami of, of, uh, 10,000 people turning Medicare eligible, um, every day.
• 12:09
  John: Uh, and you do not, we are not minting doctors as fast as we are growing patients.
• 12:15
  John: And so I've gotta think that the, that increasing access points for non-urgent.
• 12:20
  John: Uh, or, uh, for, for, um, and I don't really buy the distinction you make between emergency and urgent.
• 12:26
  John: I think, you know, my,
• 12:27
  David: John, I'll take you.
• 12:28
  David: Listen, when
• 12:29
  John: you, my emergency is, is, is is your urgent and it shouldn't be surprising that it's not a perfect sector cause it's grow, it's just exploding right now and it probably needs more clinical direction.
• 12:39
  John: But I think whether it's retailers getting into different aspects of the health, Like, like my own employer, Walgreens or Walmart or cvs.
• 12:48
  John: Um, uh, getting more involved in, in, in, in, in basically lowering the burden on docs and hospitals to care for people and give them the answers and the care they need.
• 12:59
  John: I don't see how that can be a positive.
• 13:01
  John: I, most of the urgent centers are staffed by, um, some are staffed by doctors, but a lot of them are largely staffed by, uh, nurse practitioners.
• 13:09
  John: Um, and so you could see a world where there.
• 13:13
  John: Multiple access points in multiple layers.
• 13:16
  John: Um, are you worried, really worried about urgent care centers, undermining the doctor, the, the, the sainted doctor-patient relationship?
• 13:25
  John: David: Well, John, there is this, problem with urgent care centers is that they do detract from the doctor-patient relationship.
• 13:32
  John: Having said that, you know, my primary care, uh, doctor one retired, another one became concierge, doesn't want a relationship with you.
• 13:38
  John: One became a concierge, you know, uh, physician.
• 13:42
  John: And so there's different types of relationships.
• 13:43
  John: John from the, uh, from the one night stands to, uh, you know, the long standing ones.
• 13:47
  John: So I don't, I think that the, the doctor patient relationship isn't in great shape.
• 13:51
  John: I told you I use them cuz they're convenient, I think.
• 13:54
  John: You can get around the issue of, uh, lack of continuity of care, um, with things like interoperability.
• 14:00
  John: So you can actually see the medical record from one place, um, to the other.
• 14:03
  John: And look, they're, they're good for, I like to use them, but they're, I don't know if they're, if they're good for the system.
• 14:07
  John: How about you, John?
• 14:08
  John: You ever make use of urgent care center or is it a big executive?
• 14:11
  John: You probably have like a mobile one.
• 14:12
  John: That you have a mobile one that travels around following you, like the guy who had the second jet follow.
• 14:16
  John: Yeah, but that's Urgent, urgent Center.
• 14:18
  John: No.
• 14:19
  John: That we, we don't have anything like that, but no Urgent Care Center.
• 14:21
  John: My experience with urgent Care Centers has been great and I, I, I, I'm a, I'm a strong believer in expanding the base and lowering the, lowering the cost and ac in improving access points.
• 14:32
  John: You know, one of the fastest growing risks in, in, in American healthcare is a visitor to the hospital.
• 14:36
  John: You know, the, during covid, it really scared a lot of people like.
• 14:40
  John: 89 year old mother that, uh, a vista the hospital could, could, could make her, you know, put, put her at significant at mortal risk.
• 14:48
  John: And so I actually think these acc access, we, what we need to do is come up with more creative, and to your point, more responsible.
• 14:55
  John: Management of these, uh, new access points to healthcare, new access points, to care and leverage the heck out of all of it, because we are not gonna have enough.
• 15:04
  John: Uh, hospitals are too expensive and doctors are too, too, too, too hard to reach and people are busy.
• 15:11
  John: So I, I think this is, uh, the, the, the right.
• 15:13
  John: So it's the right solution for a lot of props.
• 15:15
  John: It just needs to be tuned.
• 15:17
  David: Great.
• 15:17
  David: Well, that's it for yet another episode of Care Talk an an important conversation, if not an urgent one.
• 15:25
  David: I'm David Williams, president of Health Business Group,
• 15:28
  John: and I'm John Driscoll, the president of Walgreens Health.
• 15:30
  John: If you like who you heard or you didn't, please subscribe to your favorite service.