BILL NUMBER:S4493

TITLE  OF  BILL:   An act in relation to directing the commissioner of
health to conduct a study of the effectiveness and  safety  of  urgent
care  centers  and  to  deliver a report of the study's results to the
governor, the speaker of the assembly,  the  minority  leader  of  the
assembly,  the  temporary  president  of  the  senate and the minority
leader of the senate

SUMMARY OF PROVISIONS:

This Act shall be known as "The Urgent Care Center Study Act"

Section 2 of the bill states that the Commissioner  of  the  New  York
State   Department   of  Health  shall  conduct  a  study  which  will
concentrate on the scope, effectiveness, safety and quality of care of
urgent care centers along with demographic disparities in the  quality
of care in urgent care centers across the state.

The  Commissioner  of  Health  shall report his or her findings to the
Governor, the Speaker of the Assembly,  the  Minority  Leader  of  the
Assembly,  the  Temporary  President  of  the  Senate and the Minority
Leader of the Senate  within  one  year  of  this  legislation  taking
effect.

EXISTING LAW:
              

New law.

JUSTIFICATION:

Trends  in the health care marketplace, including shortages of primary
care  physicians  in  many  communities  and  a  shrinking  number  of
hospitals  and  emergency  rooms,  have  led  to  the proliferation of
so-called Urgent Care Centers (UCCs), which are positioned as a viable
alternative  to  traditional  medical  facilities.  Yet  the  law  and
regulations  that  cover  UCCs are vague at best and medical consumers
are susceptible  to  confusion  about  when  such  facilities  are  an
appropriate health care option. Indeed in New York, as in most states,
UCCs are licensed in the same way as typical physician practices.

The  "The  Urgent  Care  Center  Study Act" requires the Department of
Health to conduct  a  study  which  will  concentrate  on  the  scope,
effectiveness,   safety  and  quality  of  care  of  UCCs  along  with
demographic disparities in the quality of  care  in  UCCs  across  the
state.  The outcome of the study will provide valuable information for
health care consumers and  establish  whether  there  is  a  need  for
further regulatory action.

The  growth  of  the urgent care sector is undeniable. The Urgent Care
Association  of  America's  (UCAOA)   "2011   Urgent   Care   Industry
Information Kit" reported the existence of approximately 8,700 UCCs in
the  United  States, 47% of which had been operating for five years or
less. The centers had an average of 342 patient visits  per  week  and
were  found  in all geographic settings: 25% in urban, 55% in suburban
and 20% in rural locations.


According to UCAOA, UCCs "provide walk-in, extended  hour  access  for
acute  illness  and  injury  care  that  is either beyond the scope or
availability of the typical primary care practice or retail clinic."

The  American  Academy  of  Urgent  Care Medicine (AAUCM) notes on its
website that "An urgent  care  center  is  a  convenient  option  when
someone's regular physician is on vacation or unable to offer a timely
appointment. Or, when illness strikes outside of regular office hours,
urgent  care  offers an alternative to waiting for hours in a hospital
Emergency Room."

However, what these centers provide and how they are staffed varies. A
September 2011, UCAOA-funded white paper "The Case  for  Urgent  Care"
noted  that  "The  majority of urgent care centers provide services in
episodic primary care, occupational  medicine,  routine  immunizations
and  school physicals, and at least half of them (4,000+) also provide
lab tests, x-rays,  fracture  and  laceration  care,  and  intravenous
fluids."   They   "are   typically   staffed   with  physicians,  with
approximately half  also  employing  physician  assistants  and  nurse
practitioners as additional providers."

And  while UCCs are sometimes positioned as an alternative to hospital
emergency rooms, as the  AAUCM  notes.  "UCM  [Urgent  Care  Medicine]
specialists have expertise evaluating and treating these patients with
only simple office-based laboratory tests (e.g., urinalysis, pregnancy
test,  rapid  strep  assay) and X-ray. There is no immediate access to
extensive laboratory testing or advanced imaging  (e.g.,  CT  scanning
and  ultrasound).  Those  who present to an urgent care center who, in
the judgment of the UCM specialist, require this, are transferred to a
hospital emergency department."

If a patient needs to be  transferred  from  a  UCC  to  an  emergency
department  he  or  she could lose time that is critical to his or her
outcome before receiving the necessary care. Further he  or  she  will
likely  be  billed  by  both the UCC and the emergency department. And
unlike hospital emergency departments, UCCs are not required by law to
assess and, if necessary, stabilize everyone who arrives regardless of
ability to pay.

The UCAOA-funded white paper "The Case for Urgent Care" cited  studies
that  found  the average cost of an urgent care visit is slightly less
than the average primary care visit and  significantly  less  than  an
emergency  department visit for the same diagnosis. However, the value
proposition is undermined if the patient is using urgent care in  lieu
of  establishing  a relationship with a Patient Centered Medical Home,
or as noted above, if he or she presents with a condition that the UCC
is not equipped to treat.

In light of inconsistencies in  the  services  UCCs  provide  and  the
potential  for  confusion  among health care consumers about when UCCs
are the appropriate health  care  option,  there  is  a  clear  public
benefit  in  a  Department  of  Health  study  that  will  both inform
consumers and establish any need for further regulatory action .

LEGISLATIVE HISTORY:

New bill


FISCAL IMPLICATIONS:

Minimal

EFFECTIVE DATE:

This act shall take effect immediately.