Report Offers Policy Options to Balance Consumer Demand and Consumer Protection
The United Hospital Fund today published a report on urgent care centers and retail clinics—collectively known as “convenient care”—in New York State. A major market-driven development in the delivery of ambulatory care, convenient care presents both potential benefits and risks for the health care system, as well as for special populations like the medically underserved and children. Costs per episode of care may prove to be lower through convenient care than through other care options, and these providers offer expanded access to care for some patients. But because convenient care services and staffing vary so widely, consumers may lack information to select the most appropriate site of care, and the episodic nature of convenient care may put some patients at risk for less continuity of care.
The report, Convenient Care: Retail Clinics and Urgent Care Centers in New York State, found 366 urgent care centers operating statewide, 103 of them in New York City; another 55 are slated to open in the near future. The report also identified 18 retail clinics, including 12 in New York City.
To explore the possibility that convenient care providers have the potential to be a new source of care for the medically underserved, researchers plotted existing convenient care locations over regions of the state designated as having insufficient access to health care resources. Statewide, 33 of the 366 urgent care centers and 6 of the 18 retail clinics are located in an area considered to be medically underserved. In New York City, 18 of 103 urgent care centers and 3 of 12 retail clinics are in a medically underserved area.
The report presents five policy options that the State could consider to establish basic consumer and public health protections:
- Define urgent care centers and retail clinics, and adopt or develop standards for their services.
- Encourage convenient care providers to proactively connect patients who lack primary care providers to a permanent source of care, and support their doing so.
- Promote connection with regional health information exchanges and the SHIN-NY health information system when it is operational.
- Develop consensus on quality and safety measures and their reporting.
- Encourage greater access for underserved areas and populations, without jeopardizing current special designations.
Special attention is also paid to two vulnerable populations—Medicaid beneficiaries and pediatric patients. For the Medicaid population, urgent care centers in particular are to date of only modest value. For pediatric patients, the report raises important questions about the convenient care model, which is designed primarily for relatively healthy adults, and the conditions under which those services should be extended to children and adolescents.
“Developing this picture of convenient care has been a logical extension of our work to document the continuing evolution of primary care in New York,” said Gregory C. Burke, MPA, director of innovation strategies at the United Hospital Fund. “The more analysis we did for this report, the more unanswered questions we discovered. We hope the report helps accelerate the discussion.”
In addition to providing a national picture and a literature review for context, the report takes a closer look at convenient care’s new opportunities, such as redirecting care from emergency departments and supplementing primary care through extended hours, and its significant challenges, including possible disruption of ongoing care relationships, affecting continuity of care.
“This report connects the dots between the rise of convenient care and, more broadly, the restructuring of how care is delivered, paid for, and coordinated,” said Jim Tallon, president of the United Hospital Fund. “While challenges exist, the prospect of shaping these new types of health care providers early on so that they might support better coordinated primary care has enormous appeal. And people like them.”
Convenient Care: Retail Clinics and Urgent Care Centers in New York State was written by Ji Eun Chang, MS, of the Department of Population Health of NYU Langone Medical Center and NYU’s Wagner School of Public Service; Suzanne C. Brundage, SM, and Gregory C. Burke, MPA, of the United Hospital Fund; and Dave A. Chokshi, MD, MSc, of the Department of Population Health of NYU Langone Medical Center and the New York City Health and Hospitals Corporation. Support for this project was provided by the New York State Health Foundation. The report is available at http://www.uhfnyc.org/publications/881033.
About the United Hospital Fund: The United Hospital Fund is a health services research and philanthropic organization whose primary mission is to shape positive change in health care for the people of New York.