A middle-aged man stood outside the Southern Urgent Care clinic on Whitemarsh Island one morning this week as it opened at 8 a.m.
His wife told the check-in attendant he was suffering from severe shoulder pain and while she filled out a clipboard in the lobby, the man was taken back to a room within 15 minutes of the doors opening, at least three times faster than would be likely at a nearby hospital.
Across the country, a perfect health care storm has created a boon for the urgent care industry, the result of a shortage of primary care physicians, overstretched emergency rooms and an uptick in newly insured patients since the passing of the Affordable Care Act.
One of the fastest-growing segments in health care, urgent care facilities are filling the gap for those who have non-life threatening medical problems and at lower costs than going to the emergency room.
According to the Urgent Care Industry of America’s annual benchmarking study, there were 9,000 of these centers in the U.S. in 2012 with growth estimated at 10 percent per year.
“This is much less expensive for the patients, and it’s much quicker for the patients,” said Dr. Stephen Pohl, a partner and practitioner at Georgia Emergency Associates, which operates the St. Joseph’s/Candler and South Georgia Immediate Care centers.
Not only are they convenient for those who need after-hours care, but they save time as well. The average wait time at the emergency rooms of local hospitals varies from 41 minutes (at Memorial) to an hour and a half (Effingham County Hospital), according to a recent search of the online “ER Wait Watch” tool by investigative nonprofit ProPublica, though it can often be much longer.
Pohl, who spent 21 years as an emergency room doctor, mostly at St. Joseph’s, said these clinics also take some of the burden off hospitals.
“If you interview ER physicians, they’ll tell you 70 percent of their work is not emergent,” he said. “A lot of people that come there, they consider to be not real emergencies.”
In Savannah, urgent care clinics have popped up at strategic points around the area, catering to different communities and clientele.
The major players include Southern Urgent Care with two locations, Urgent Care 24/7 with five outlets and St. Joseph’s/Candler Immediate Care with six sites scattered around the region. Memorial also operates two urgent care clinics, one in Pooler and the other at Savannah Mall.
Most say they are expanding or looking to expand in the coming year or two to meet increased health care demand.
St. Joseph’s officials said they will look at opening a seventh location by 2015.
“We’re doing it cautiously,” said Pohl. “There’s always plenty of people who can’t get in to see their doctor, and for that reason it’s a good business to be in.”
Arvin Ward, a physician assistant, started Southern Urgent Care with two other business partners in 2010 after working in Beaufort County’s emergency room. His wife, Martha Ward, who is regional director of their clinics, said people on the island didn’t want to leave to seek medical care.
“We had lived on the island for a while, and we definitely saw that there was a need here on the island for a clinic,” said Martha Ward. “When people have a sniffle or a cold or a sore throat, people just want to feel better.”
Urgent care is a competitive industry as well, and many clinics are adding to their services to cater to the wider range of patients coming through their doors.
Dr. Jerry Williams of Urgent Care 24/7 says he will be adding a CAT scan, while Ward said he will be advertising an on-call number later this summer for medical emergencies that occur after regular hours, a service he’s already provided to organizations such as SCAD, area hotels and Savannah Maritime Association.
Most office visits to these facilities begin just above $100, less for those with insurance coverage, and those prices have siphoned business from both regular doctors and hospitals.
According to Healthcare Bluebook, a visit to the local emergency room can cost anywhere from $585 for a non-surgical emergency at a Level 1 ER to $2,077 at a Level 3.
“For both insured and self-pay patients, the cost of being seen at an emergency room is typically two to three times more expensive than the cost of being seen at an urgent care office,” said Dr. Amanda Cowan, medical director of urgent care at Memorial.
Most urgent cares operate from 8-9 a.m. to 8-9 p.m., with a shorter window on weekends and holidays. Urgent Care 24/7 keeps its DeRenne Avenue location open 24 hours year-round, though patients must also pay an after-hours fee and should first call ahead.
The Affordable Care Act effect
Something urgent care facilities are not immune to, however, are the changes in health care since the implementation of the Affordable Care Act. As insurers, employers and even lawmakers are pressuring health providers to give less expensive patient care, urgent care providers also feel the squeeze.
“With higher co-pays and deductibles, patients are less likely to visit an urgent care facility and more likely to wait to be seen by their primary care physician,” said Cowan.
She said patients, however, also are less likely to visit emergency rooms, which may help balance the deficit.
“As a result, these patients are being seen in either the urgent care or primary care physician offices,” Cowan said.
Arvin Ward said insurance changes have made it more difficult, in some instances, to get patients the types of treatment they need. In one case, he said, a woman who had one of the new Healthcare.gov plans was having difficulty obtaining a generic prescription he wrote for her at a nearby pharmacy.
“I get a fax from the pharmacy that I need to change the prescription to what’s called a prior authorization, so basically they want me to call the insurance company and explain to them that it’s a medical necessity,” said Ward.
“With the Affordable Care Act, we’ve definitely seen people’s co-pays increase,” said Martha Ward.
Williams runs a cash-only business model, a decision he said he made after years of battling insurance companies.
He said he is seeing more patients who neither can afford the higher co-pays and deductibles of regular insurance nor qualify for the subsidies on the new exchanges.
“Having the government-run health care the way it’s headed, there’s only going to be an increasing need, and it’s why we’re positioning ourselves to meet that need,” said Williams, who is planning to open clinics statewide.
Pohl said he believes the industry will continue to expand, though some consolidation may eventually occur as the market gets crowded.
“I think there’ll be more growth of the urgent care industry,” said Pohl. “You’re going to see the Wal-Marts push more of these than the small Ace Hardware mentality. In other words, the small pop-ups are going to have a harder time competing with the prices of the bigger entities.”
MEMORIAL URGENT CARE
Memorial Urgent Care opened its first outpatient immediate care facility in 2002.
Locations: The Savannah Mall and Godley Station (Pooler)
Payment Accepted: Self-pay, multiple types of insurance and Medicare/Medicaid
Basic office visit*: $158 for new patients; $104 for return patients
SOUTHERN URGENT CARE
Southern Urgent Care started by Arvin Ward and two other partners in 2010.
Locations: Whitemarsh Island, Historic District and Murrells Inlet, S.C.
Expansion plans: Possible
Payment accepted: Self-pay, multiple types of insurance and Medicare/Medicaid
Basic office visit*: $110
ST. JOSEPH’S/CANDLER IMMEDIATE CARE
St. Joseph’s/Candler Immediate Care is operated by Georgia Emergency Associates. Its first location opened in Savannah in 2001.
Locations: Midtown, Hinesville, Garden City, Statesboro, Pooler and Bluffton, S.C.
Expansion plans: Will open a seventh location in 2015.
Payment accepted: Self-pay, multiple types of insurance and Medicare/Medicaid
Basic office visit*: $114
URGENT CARE 24/7
Urgent Care 24/7 started by Dr. Jerry Williams in 2011 on Tybee Island.
Locations: The Historic District, Midtown, Tybee, Sandfly and Pooler
Expansion plans: Williams said they are preparing to open a clinic on Whitemarsh Island will be expanding statewide.
Payment accepted: Self-pay only
Basic office visit*: $125
*Prices may vary depending on services and procedures required at time of visit. Check with location for specific pricing. Many offer discounts of 25-50 percent for tests needed beyond initial check-up.