URGENT MESSAGE: Urgent care centers are subject to myriad oversight by individual states, accrediting bodies, Medicare/Medicaid, and private insurance companies. Still, the patchwork nature of state regulatory and legislative trends impacting urgent care in 2015 raises questions—and expectations—for what might be coming next year.
Alan A. Ayers, MBA, MAcc is Practice Management Editor of The Journal of Urgent Care Medicine, a member of the Board of Directors of the Urgent Care Association, and Vice President of Strategic Initiatives for Practice Velocity, LLC.
Urgent care may no longer be an enigmatic concept to the general public seeking quality care at a moment’s notice (as evidenced by the explosive growth we’ve detailed here previously), but that doesn’t mean state regulators are any closer to nailing down their take on the industry.
Historically, regulation of physician practices—which urgent care centers are considered, as opposed to outpatient facilities—has focused on physician conduct and licensure, with oversight provided by state medical boards. By contrast, facility regulation falls under state departments of health oversight, which is often driven by a certificate of need, requires accreditation, and/or entails intense scrutiny of the physical facility, scope of clinical services, personnel, and governing policies.
Urgent care still presents a conundrum for regulators because the practice model ranges widely from the single office “doc-in-a-box” to more complex practices offering extended hours and walk-in service that is integrated with a hospital or multispecialty group, to private equity-backed “chains” establishing regional and national retail footprints. In some regards, urgent care centers are an extension of the physician practice and thus do not require the same infrastructure as emergency rooms, surgical centers, and other regulated facilities. But the size and reach of growing organizations have operational complexity far beyond the typical “physician’s office.”
To date, state regulation has focused primarily on defining “urgent care” via naming conventions, clarity and explanation of included services, and accreditation standards.
State Regulation in Place
At least ten states have adopted some legislation or regulation specific to urgent care. A sampling of these includes:
- Arizona: Urgent care centers are licensed as “outpatient treatment centers,” a process that includes architectural standards; facility survey and inspection; standards for governing body, policies and procedures; and information posting requirements (eg, rates, patient rights, and NP/PA w/no physician on-site).
- Florida: “Urgent care” is defined by the state as providing immediate but not emergent care, which includes accepting patients without appointment. Urgent care centers are required to be licensed as “healthcare clinics” and to post the price of the center’s 50 most common services charged to uninsured individuals.
- Delaware: Use of the term “urgent care” in signage or advertising identifies a facility to be a freestanding emergency center that treats all life-threatening emergencies.
- New Hampshire: “Non-emergency walk-in care centers” are subject to extensive regulation, including licensure, specific physical plant requirements (including approval of changes, renovations, and expansions), and posting the scope and types of services offered.
- Kentucky: Urgent care centers must make a course on recognition and prevention of pediatric abusive head trauma available once every two years.
- Vermont: Urgent care centers are required to accept patients regardless of their insurance status or type of health coverage.
Maryland, Minnesota, and Utah have also passed legislation that defines “urgent care.”
Trends in Legislative Activity
If there has been any trend in state regulation of urgent care across the nation in 2015, it’s that individual states continue to work on their own definitions of—and regulatory approaches to—urgent care.
Connecticut, for instance, heard testimony regarding proposed legislation that would define “urgent care clinics” and “establish a duty for urgent care centers to provide charity care.” The state’s hospital association, advocacy groups for the uninsured, and individual clinic owners provided their perspectives, but the Connecticut legislation has not proceeded beyond committee thus far.
The Louisiana legislature authorized a task force to examine policies that could expand capacity of urgent care centers to meet the needs of the underserved, in light of the closure of several state-funded healthcare facilities. Also, Louisiana is considering revoking a current exemption for urgent care centers that treat chronic pain, which would now require their licensure as pain management clinics.
Somewhat contrarian, Illinois actually reversed a law on its books that had restricted use of the terms “urgi-“ and “urgent care” center to emergency departments only, enabling urgent care centers to now legally use the term “urgent care.”
In October 2015, New York Attorney General Eric Schneiderman reached agreements with four New York urgent care centers to provide detailed information to consumers about health plan participation and in-network vs out-of-network coverage. It’s the first enforcement action of the state’s recently adopted Surprise Bill Law, enacted to protect consumers from unexpected medical billings and to help patients make informed choices when selecting a provider. In 2014, the New York Department of Health, Public Health and Health Planning Council (PHHPC) considered—but eventually dropped—several potential regulatory schemes for urgent care in the Empire State.
Perhaps most significant is a Pennsylvania bill currently in committee that would amend the definition of a healthcare facility to include urgent care centers. Specifically, the proposed legislation states that urgent care centers would no longer be considered private physician practices, but instead within one year would be subject to special facility licensure addressing fire and safety standards, personnel and equipment, and quality assurance procedures.
Overall, as these states demonstrate, urgent care represents a patchwork of legislative activity with no common theme. Looking at similar healthcare delivery models, Texas currently regulates freestanding emergency centers but specifically exempts urgent care centers. Seventeen other states regulate limited scope health clinics located in food/drug/mass retail stores. So it’s not insignificant that urgent care has been on the legislative agenda of so many states.
Looking to the Year Ahead
That urgent care centers are growing in number and visibility will certainly continue to attract the attention of lawmakers and regulators. Some policymakers will focus on the ways that urgent care can improve provider access and reduce costs, particularly as hospitals continue to grapple with rising nonemergent use of their EDs and as government and private payers move to value-based reimbursement. Other policymakers will focus on issues like quality of care and access for Medicaid populations, as many urgent care centers target more affluent, privately insured populations in their locations, billing, and marketing.