Urgent Care Update Making a Case for Hospital Urgent Care Urgent message: Availability of hospital-affiliated urgent care can not only lower the burden on overcrowded EDs, but also help capture new business and keep existing patients within the health system. Alan A. Ayers, MBA, MAcc ospitals have operated urgent care centers for over 25 years; today, esti- mates of how many cen- ters are affiliated with hos- pitals range from 15% to 20%. In recent years, hospi- tals grappling with over- crowded emergency rooms and increased competition for outpatient visits have rediscovered urgent care as a way to shift low-acuity cases out of the ED while increasing revenue for af- filiated providers and an- cillary services. H The Cause of Long Emergency Room Waits Over the past 10 years, private and government payors have focused on reducing inpatient hospital stays as a way to curb rising healthcare costs. In response, hospi- tals have invested in new clinical technologies and ele- gant outpatient facilities. These neighborhood facili- ties—often anchored by an ambulatory surgery center—host a myriad of integrated services, including diagnostic imaging, physical rehabilitation, women’s health, occupational medicine, and sleep services. Despite an aging population and deteriorating per- 34 sonal health, the combined efforts of hospitals and pay- ors have been successful in reducing inpatient days per 1,000 approximately 7% between 1999 and 2006, according to the Kaiser Family Health Foundation. Progress, indeed—but with an unintended conse- quence. Up to 40% of hospital emergency departments are overcrowded, the Institute of Medicine reported in 2006. Average wait times in hospi- tal EDs have increased each of the past 10 years; in some cities, the time to be treated and discharged by an emer- gency physician is now eight hours or longer, according to the U.S. Centers for Disease Control and Prevention. The leading cause of emergency room overcrowd- ing is the declining number of inpatient beds due to falling reimbursement and the shift to outpatient fa- cilities, concludes the American College of Emergency Physicians. Without enough inpatient beds, hospitals “board” more patients in their emergency depart- ments—which occupies beds there and increases wait times for new patients. JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | J a n u a r y 2 0 0 9 w w w. j u c m . c o m