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
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
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 .
This act shall take effect immediately.