Urgent Care Centers a Growing Alternative to the Emergency Room

Oct 9, 2019

When Theresa Barr woke up with a bad cough one morning recently, she and her husband Kenneth went directly to an urgent care — something they couldn’t have done ten years ago, before urgent cares existed on the Cape.

"To be honest, in her case, her primary [doctor], if she had called today with symptoms, they might not see her for two to three days," Kenneth Barr said. 

Sitting in a CareWell, an urgent care center in Dennis, the Barrs said coming to the urgent care was an easy choice.

"We like it because it's efficient, it's easier than getting into the regular doctor's office," Barr said. "The copay is a little more, but it's effective."

Across the state, more people are taking an approach similar to the Barrs when they run into minor health problems. If you cut your finger or come down with the flu, the emergency room isn't your only option anymore. The Barrs prefer CareWell because they like the customer service approach and the short wait times. They don't have to schedule an appointment or risk getting hit with an enormous emergency room bill.

In the last decade, Massachusetts has gone from having 18 urgent care centers, to 145 today. And the Cape has one of the highest number of urgent cares per capita in the state, with six serving 15 towns.

Ateev Mehrotra, a health care policy professor at Harvard University has been studying the rise in urgent care centers across the country. He says their rise is due to several factors, with a big one being convenience.

"You know, in an era where we can do banking, shopping, in many cases 24 hours, 7 days a week, to be told for your healthcare issues you have to call your primary care doctor and wait a few days, it just doesn't fit," Mehrotra said. 

Another factor is the nationwide shortage of primary care doctors, which has gotten worse in the last few years and has put further pressure on that healthcare system. 

"At the same time, we're having an issue that when you do call your primary care physician, people still have to wait a while, and that wait appears to be increasing," he said. 

CareWell was the first urgent care center to open on the Cape, back in 2012. Since then, centers like ConvenientMD and ones run by Cape Cod Healthcare have also opened, in part because of a lack of healthcare options in the region. 

And aside from accessibility, for patients, urgent care centers can mean big savings. A recent state study showed that prices for urgent care treatment were about 15 to 20 percent of the cost of what would be charged in an emergency room. Michael Lauf, CEO of Cape Cod Healthcare explained that emergency rooms are more expensive because they have to be prepared to handle bigger issues.

"In an emergency room, you have to understand, we're there to equip for every unforseen situation, so we have cardiology support, neurosurgery support, we have all the imaging, all the life-saving measures," Lauf said. 

And regardless of if they use them, patients who go to emergency rooms end up being charged for the overhead of these costs.

"We have to be prepared to save your life each and every time, that's why costs are so much different between an urgent care and an emergency center," Lauf said. 

But Mehrotra cautioned that despite the fast growth of urgent cares and lower prices, there’s very little data studying their overall quality of care. For one, he said he’s heard anecdotally that these centers can over-prescribe antibiotics.

"Specifically, you come in and you're worried about sinusitis, and in an effort to please the patient, they may provide more antibiotics than are necessary," Mehrotra said. "If you had gone to that primary care physician, they would have been more prudent in their antibiotic prescribing." 

One more point patients should be cautious of is that an over-reliance on urgent cares can fragment a person’s medical record. Alan Steinbach, an urgent care doctor at ConvenientMD in Falmouth said sometimes patients can mistake a chronic condition for a one-time event.

"If someone came in with a stomach pain one time, it [could be] evaluated and treated with something that decreased their stomach acid. Great idea. Very common. Six weeks later, they come back with the same thing and nobody takes their weight to find out they've lost 10 pounds, which a regular doctor would do in a visit, but which an urgent care, even if they were a good urgent care, might not do — and that person might have stomach cancer," Steinbach explained. "I'm not talking hypothetically."

But for Theresa Barr, whose cold had previously seemed insurmountable, her urgent care visit gave her peace of mind. Plus, it cost just $50, and she said she’s happy with that.

"If my doctor couldn't see me, I'd have to go to the ER and pay the $300 copay. That's not the case here. They have x-rays, they treat me, and to tell you the truth, they call you a few days later to see how you're feeling, which is amazing," Theresa Barr said. "I mean, my doctor's office doesn't even do that."