When his 2 1/2-year-old daughter tripped at day care and cut her chin recently, Lance Moore didn’t take her to the emergency room at the nearest hospital. Instead he rushed her to an urgent-care center.
“I wanted her to get immediate attention,” said Moore, who’d been to the St. Charles center before and knew the doctor who gave his daughter five stitches. “He offered to call a plastic surgeon, although he said he didn’t think that was necessary,” said Moore, who lives in Carol Stream. “He did a real nice job.”
Urgent-care centers have been gaining ground in Illinois and across the country recently as an attractive medical option for time-pressed families trying to avoid spending hours in a hospital ER or days waiting for a doctor’s appointment.
Sometimes known as “docs in a box,” the centers offer walk-in medical services and extended hours to customers with sore throats, ear infections, sprained or fractured limbs, simple wounds and other non-life-threatening medical problems. Doctors provide the care, assisted by nurses, and generally X-ray and laboratory services are available. Most centers are open 365 days a year, and insurance policies cover most services.
This convenience-oriented format, started more than 20 years ago, is getting a boost as hospitals and private firms build new centers, responding in part to new competition from retail clinics in Walgreens, CVS and Wal-Mart stores.
For patients, the centers offer easy access and affordable care, charging a fraction of what services would cost in an emergency room. Many insurers, keen to keep costs down, have begun encouraging people to use urgent care as an alternative to ERs in the evenings or weekends when their doctors’ offices are closed.
That puts the onus on patients to evaluate their symptoms and recognize what level of care they need, said Dr. Sandra Schneider, an emergency-department physician at the University of Rochester Medical Center in New York and a vice president of the American College of Emergency Physicians.
Generally, urgent care is for common medical conditions only. Symptoms that warrant a visit to the ER include difficulty breathing, fainting, sudden dizziness, changes in mental status, severe or persistent vomiting or diarrhea, uncontrolled bleeding, changes in vision, and pain or pressure in the chest or upper abdomen, according to materials on the topic prepared by Edward Hospital in Naperville.
In Illinois and most other states, urgent-care centers are not overseen by the Department of Health or other state agencies. Some centers have sought out accreditation, a mark of professional approval, but many haven’t. Patients would be well advised to check out in advance the scope of a center’s services, the credentials of its staff and the hours of operation, Schneider recommended.
For families with young children, parents should call to find out if a center offers pediatric care and, if so, whether it treats babies and infants, said Lou Ellen Horwitz, executive director of the Urgent Care Association of America, a trade organization with offices in Warrenville. The association is drafting a list of criteria that will let consumers know what to expect from an urgent-care center and taking steps to improve professional training for staff.
In a comprehensive 2008 survey, it counted 8,000 urgent-care centers across the country. The vast majority are owned by physicians; about 15 percent are associated with hospitals. Although 1 in 4 centers serves an urban population, the majority — 55 percent — are in the suburbs, where affluent and privately insured patients often are reluctant to spend hours waiting to be seen in an ER.
The survey found that about 60 percent of patients at urgent-care centers are seen by a doctor, nurse practitioner or physician’s assistant in 30 minutes or less, another 25 percent are seen in 30 to 45 minutes, and 15 percent spend 45 minutes or longer.
In Illinois, the facilities are usually called immediate- or convenient-care centers because a state law doesn’t allow them to use “urgent” in their names. (That designation belonged more appropriately to hospitals, lawmakers thought.) A check shows relatively few immediate-care centers are in the city of Chicago; most are in the suburbs, and more are on the way.
Hospitals here are building facilities to ease pressure on their emergency rooms and enhance patients’ access to non-emergency care. Several for-profit firms that specialize in this health-care niche also have an increasingly large presence.
At Edward’s three centers, including one that opened last year in Oswego, visits exceed 50,000 a year. “If we had to take care of those patients in our ER, we’d be absolutely overwhelmed,” said Brian Davis, vice president of marketing.
Mike Vivoda, a vice president at Central DuPage Hospital in Winfield, attributes hospitals’ “resurgent interest in urgent care” in part to the growth in retail medical clinics that began a few years ago.
“Hospitals are looking at the trend and saying, ‘Boy, we need to create a competitively priced option, or [retail clinics] will take our patients away,'” said Vivoda, whose hospital recently added a sixth convenient care center in Glen Ellyn. The St. Charles center that Moore uses is also part of the hospital’s network.
For some consumers, urgent-care centers are usurping primary care physicians — a trend some medical experts view with alarm. Pina Lobraco, a mother of two young girls who lives in Addison, said she finds it easier to pop into a nearby Alexian Brothers Hospital Network immediate-care center than to call her doctor and wait to get an appointment.
On Mother’s Day, Lobraco was at the center with Daniella, 4, who had started crying and holding her ear earlier in the day. “I don’t know why it is, but a lot of times it seems [the girls] get sick in the evening or early in the morning or on the weekends,” she said.
“My regular doctor doesn’t know who I am,” Lobraco said later in an interview. “But these people [at the center] know me — they see me all the time.”
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Experts see room for expansion
An informal survey turned up several new developments in urgent care in Illinois. Among them:
* In the northwest suburbs, Alexian Brothers Hospital Network plans to add 11 centers to the four it already runs. Some of the existing sites are devoted to occupational-health services — job-related tests and treatments for workers — and others focus on primary care. Now, all of the services will be offered at each site, said Tracy Rogers, chief operating officer of the Alexian network.
* Two weeks ago, Central DuPage Hospital added a sixth convenient-care center in Glen Ellyn. All are on the ground floor of medical office buildings; in the future, the hospital plans to include more diagnostic imaging services, including CT and MRI scans, said Mike Vivoda, a hospital vice president.
One goal is to ease pressure on the hospital’s emergency room, which Vivoda said is best used by people with true medical emergencies. Central DuPage’s six convenient-care centers have about 200,000 patient visits a year, compared with 70,000 visits to the hospital’s ER.
* In Illinois, a large for-profit player in this medical niche is Concentra Inc. The company, which specialized in occupational health, decided a year ago to add urgent-care services to all of its locations, including 13 in the Chicago area. Concentra is trying to distinguish itself by posting prices for services at its centers. For instance, at its Addison and Morton Grove centers, a basic visit (with several tests included) is $85, while an intermediate visit (with X-ray and lab work) is $145. An advanced visit (wound repair, IV therapy, a cast or a splint, or a nebulizer treatment) is $179.
* Physicians Immediate Care, owned by three physicians, has 11 centers, including facilities in Elgin, Niles and Bolingbrook, that opened in 2007 and 2008. It plans to expand but has put those plans on hold for six months until the economy improves, said Dr. John Koehler, chief executive officer.
Although Illinois’ 302 urgent care centers rank No.7 among the states by numbers alone, there’s plenty of room for growth, several experts suggest.
“My belief is there’s room for five times as many centers in Illinois as there are now,” Koehler said.
— Judith Graham
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Know your terms
Retail clinics: These facilities, in outlets such as Walgreens, CVS and Wal-Mart stores, treat a limited set of common illnesses: sore throats, ear infections, sinus infections, women’s bladder infections, pinkeye and non-complicated respiratory conditions. They’re staffed by nurse practitioners, nurses with advanced degrees who can write prescriptions. There are about 1,200 retail clinics across the U.S., including 56 in the Chicago area.
Urgent care centers: The scope of services is broader and includes treatment of wounds, injuries, fractures, asthma attacks and mild concussions. Most centers have X-ray and lab facilities; some are adding more advanced diagnostic equipment. Physicians typically provide the bulk of medical services, helped by nurses and physicians’ assistants. There are an estimated 8,000 urgent care centers in the U.S., including 302 in Illinois.
Emergency rooms: Intended to provide care to people with serious medical issues that need expert, immediate evaluation and treatment — conditions such as traumatic injuries, heart attacks and strokes. About 40 percent of patients who visit hospital ERs have conditions that do not require high-level emergency care, studies show. Because of overcrowding, waits in ERs average three to four hours, and in some areas are much longer.
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Turn to Triage
Read Tribune reporter Judith Graham’s health-care blog at chicagotribune.com/triage
jegraham@tribune.com
