A guide to urgent care in New York

CityMD is one of the fastest growing urgent care chains in New York City with nine locations in the five boroughs, including Astoria, Queens.
CityMD is one of the fastest growing urgent care chains in New York City with nine locations in the five boroughs, including Astoria, Queens.

— When Samantha Patterson injured her arm moving furniture in her Harlem apartment one February night, the 25-year-old wasn’t sure whom to call. She thought about going to the emergency room. But she spoke to her mother in Florida first, who had another suggestion: go to an urgent care center.

Patterson arrived at the clinic on 23rd Street in Manhattan at 8 p.m. that night and was out the door in 40 minutes, with instructions to ice her arm and see an orthopedic specialist in the morning.

“I realized it wasn’t as urgent as I thought,” said Patterson. “But I still didn’t know if it was fractured, sprained, broken.”

Still, Patterson was thankful to have saved herself a trip to the emergency room. The orthopedic later told her she had a hairline fracture that would heal without a cast.

More and more patients like Patterson are turning to urgent care centers. Nationwide, there are 9,000 urgent care centers as of 2012, up from 8,300 in 2008, according to the Urgent Care Association of America. Growth has been slower in New York than in other states because of higher operating costs. Even so, the growth of urgent care facilities in New York City is starting to keep pace with the rest of the country as more patients seek convenient and cost-effective medical care. One urgent care chain, CityMD, has nine centers in the five boroughs and 14 more coming soon, according to their website.

High patient volume and overcrowding in hospitals make urgent care facilities appealing. They are also expanding because the Affordable Care Act has created a larger volume of patients.

Urgent care centers are becoming more popular, in part, to meet the demands of our society, what Dr. Franz Ritucci of the American Academy of Urgent Care Medicine, calls the “McDonald’s society.” “You want something, you want it now, and you don’t want to wait,” he says.

Many patients, however, still don’t know where to find them or understand quite how they operate.

So how do urgent care centers work? Is the medical care sufficient? Here’s what you need to know about the services, quality, physicians and costs at New York’s urgent care centers.

One-Stop Shopping

Urgent care centers are typically open seven days per week on a walk-in basis. They are set up to diagnose and treat a vast range of medical conditions, including infections, viruses and major injuries. Many also offer a variety of specialties from pediatrics to psychiatry to geriatrics, and are staffed with emergency-trained physicians.

Urgent care is different than retail clinics at pharmacies like Duane Reade and Walgreens. Retail clinics are typically staffed by nurse practitioners or physician assistants, who can perform physicals, give vaccines, and treat ailments like ear infections and asthma around the clock, even on evenings and weekends. But they’re not equipped to take x-rays, treat major injuries or cover the same range of medical specialties as urgent care centers. Also many retail clinics will not treat patients younger than 18 months.

They’re cost-effective for patients in need of basic medical care, though. A physical may cost $70 at your local Walgreens Healthcare Clinic as opposed to $125 at CityMD, an urgent care chain, or $200 or more at an emergency room. Retail clinics also accept most insurances, as well as cash and credit cards.

Urgent care centers offer more services than retail clinics, but not quite as many as emergency rooms.  They are not designed, for example, to treat severe traumas and life-threatening conditions the way emergency departments do. In those instances, urgent care physicians refer patients to an emergency room, where they can get the care they need.

“Our job is not to be heroes,” said Dr. Marc Salzberg of StatHealth. “ We don’t take chances with people’s lives.”

Emergency Room v.s. Urgent Care Center

Do you know where to go for fast, comprehensive and cost-effective medical care in the event of an emergency? Click the icons below to learn whether you should visit an emergency room or urgent care center.

Credits: Icons made by Freepik from www.flaticon.com, Danilo Demarco, and Yannick Lung, 2013.

Quality of Care

Like other medical centers, urgent cares have licensed doctors and clean facilities. Patients can expect the same quality of service they would get at a family practice or emergency department. The quality of a center is only as good as the physicians or hospitals that run them.

“There is no reason to believe that urgent care quality of care is an issue any more than any physician practice in New York State,” said the Urgent Care Organization of America.

However, patients should research urgent care clinics before making a visit, the same way they would any other health care provider. There are different levels of urgent care centers – some staffed with emergency trained physicians and others with physician assistants or nurse practitioners. If you need to be treated for a broken arm, you’ll want to make sure your center is equipped for casting. Parents should also check whether a facility offers pediatric services before bringing their child in for a check up. Patients can get this information by calling the center or checking its website.

“Become more informed,” Dr. Marc Salzberg of StatHealth tells consumers. “You live somewhere, you work somewhere, there’s going to be an urgent care within five miles. You really need to go and find out about it, before you need it.”

Some urgent care centers, like Medhattan in Tribeca, provide information on their doctors and offer patient reviews on its websites.

“Everything about us is transparent,” said Dr. Leslie Miller of Medhattan Immediate Care. “We consider ourselves a neighborhood place. Quality is what matters.”

Currently, New York State does not regulate urgent care centers, because they are relatively new to the region. However, on January 7th, 2014 the New York Public Health and Health Planning Council put forth a set of recommendations on accreditation, how these centers should be defined, and the services they could offer. These recommendations are still a long way from becoming law, but they indicate that the urgent care industry is evolving and that the health department would like stronger oversight.

All of the urgent care centers in New York are owned by hospitals or privately by physicians because of the state’s corporate practice of medicine law, which prevents corporations from owning medical practices.

Doctor-Patient Relationship

Urgent care centers don’t offer long-term care the way family doctors do. Although they can diagnose diseases, urgent cares don’t monitor them. Often times, doctors will stabilize patients and then refer them to specialists who provide additional care. Patients with diabetes, for example, can visit an urgent care center if they have low blood sugar, but should see specialists for ongoing treatment.

The doctor-patient relationship at an urgent care center is episodic, but that’s starting to change, according to Dr. Ritucci of the American Academy of Urgent Care Medicine. “For a lot of patients, they are becoming their primary care physicians because of convenience,” he said.

Some centers, run by primary care physicians, are able to treat urgent care patients on a regular basis the same way a family doctor would. Others, mostly staffed by emergency doctors, will refer patients to family practices who are equipped to offer long-term care.

Many urgent care centers also have a strong network of specialists that they can refer their patients to, such as psychiatrists, neurologists and orthopedics.

“We like linking people,” said Dr. Leslie Miller of Medhattan. “We talk to the patients. We talk to the doctors. It’s an important piece of what we do.”

Insurance & Rates

The cost of health care at an urgent care center is typically cheaper than an emergency department, which charges a facility fee on top of the physician’s fee. At an urgent care facility, patients will usually only pay for the visit and additional services like vaccines, lab work or x-rays. On average, a visit to an urgent care center will run patients $150, while a trip to the emergency room can cost $800 without additional services, according to the Urgent Care Association of America.

But, beware; hospital-owned urgent cares may charge facility fees as well.

Urgent care centers also refer patients to emergency rooms if they do not have emergency-trained staffed, or if the patient has a life-threatening condition. Then patients may end up  with two bills – one from urgent care and another, more expensive bill from an emergency room.

Most major insurances are accepted at urgent care centers, but some don’t yet take the new insurances created as a result of the Affordable Care Act. It’s still unclear how this will play out, but out-of-pocket costs are relatively manageable at an urgent care. They accept cash, credit cards, and occasionally checks. Some clinics even offer a range of discounted services to patients who are paying for their treatments upfront.

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