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As the urgent care industry moves forward, other specialties seek to get on board by establishing niche markets within the urgent care industry. Across the United States, subspecialty urgent care such as orthopedic urgent care, pediatric urgent care, and psychiatric urgent care, etc. are already trying to establishing themselves within the urgent care industry. As these facilities become more specialized and exclusive, the question must be asked: Are these subspecialty facilities urgent care—or just marketing themselves as such?
According to UCA Certification Standards, an urgent care facility must be led by a physician, and its staff must be capable of treating walk-in patients for a broad spectrum of illnesses, injuries, or diseases during all office hours. Urgent care facilities are required to have:

  • X-ray on site
  • Phlebotomy services on site
  • Licensed provider on site with the appropriate state licenses and resources to:
    • obtain and read an EKG and x-ray on site
    • administer PO, IM, and IV medication/fluids on site
    • perform minor procedures (eg, sutures, cyst removal, incision & drainage, splinting) on site

In addition, the facility must have the following equipment, and staff trained in its use:

  • Automated external defibrillator (AED) (or more advanced device), oxygen, ambu-bag/oral airway
  • Drug cart stocked appropriately for patient population (as determined by the facility)
  • Working phone to dial 911
  • At least two exam rooms, separate waiting area, and restricted access patient restrooms

To meet the standards, each facility must also meet all three of the following criteria for minimum hours of operation:

  • 7 days/week (not including national holidays)
  • ≥4 hours each day
  • ≥3,000 hours per year

Since the initial development and flourish of urgent care, the phrase urgent care has become widely accepted and recognized by consumers. However, since the “grand opening” of subspecialty urgent care facilities, consumers are perplexed about where to visit. While “pediatric urgent care,” for instance, offers this full scope of urgent care services (just focused on a specific age segment), patients utilizing orthopedic urgent care probably do not realize they only provide very basic and narrow services.

Orthopedic urgent care is a subspecialty of urgent care that specializes in prevention or correction of injuries or disorders within the skeletal system and associated muscles, joints, and ligaments. The title “orthopedic urgent care” is confusing for patients seeking general urgent care needs, but also calls into question the purpose of the facility.
Conventional urgent care was created to reduce the cost of common healthcare by completing the treatment process within the urgent care facility rather than referring to other providers. Orthopedic urgent care, however, presents itself to be a “front door” referring patients to larger, affiliated orthopedic facilities. Thus, the business case for orthopedic urgent care is downstream referrals to the ortho practice.

An occupational medicine salesperson with a leading urgent care provider describes an experience in selling injury care services through a center operated by a large, local orthopedics group. While the conventional urgent care provider approach—an aggressive light-/modified-duty, work-hardening, and physical therapy approach to workplace injuries—resulted in a surgery rate of less than 1% for low back pain, the orthopedic urgent care was constantly on the lookout for opportunities to refer patients to the orthopedic surgeons who owned it. The result was a 10%-15% surgery rate for low back complaints entering the orthopedic urgent care, adding costs for insurance, employers, and government as well as risk and downtime for injured workers.

In addition to ortho urgent care not meeting the clinical definition for urgent care and driving up costs through referrals to orthopedic surgeons, ortho urgent care centers have little (if anything) in common clinically or operationally with true urgent care:

  • Urgent care is staffed by generalists; ortho urgent care is staffed by orthopedists
  • Urgent care should be located in high-traffic, high-visibility retail locations; ortho urgent care sits in the same medical office buildings as their affiliated ortho practices
  • Urgent care uses systems focused on throughput and efficiency; ortho urgent care uses systems designed for the ortho specialty
  • Urgent care contracts with insurance as…urgent care; ortho urgent care is a “specialist office,” requiring the specialist (not urgent care) copay

About the only thing ortho urgent care has in common with conventional urgent care, perhaps, is marketing.
Subspecialty urgent care facilities like orthopedic urgent care are not urgent care because they do not provide treatment for a broad spectrum of illnesses, injuries, or diseases. While urgent care is intended to reduce costs by providing a scope of care in a single location, orthopedic urgent care is intended to capture “downstream referrals,” which by definition increases total healthcare costs.

Aaron Williams
North Central College
Naperville, Illinois

Is Orthopedic Urgent Care Really Urgent Care?