What is a free-standing clinic?

    Driving around almost any city in the United States these days, you’re certain to notice a growing number of nonhospital medical facilities. These free-standing facilities, usually called urgent care centers, may be in storefronts, small shopping centers, or standalone buildings on busy streets, and are typically franchises or independent businesses. Designed as an alternative to emergency room visits, urgent care facilities cater to people whose medical condition needs professional attention — colds and fevers, earaches, sprains and simple fractures, vaccinations, basic physical exams, drug testing, and the like — but doesn’t rise to the level of a true emergency.

    Urgent care services are provided by or under the direction of a physician, often board-certified in emergency medicine, urgent care, or family practice, who is assisted by NPs, RNs, or PAs, as appropriate. Urgent care facilities typically offer essential on-site x-ray and laboratory services. The patient/customer may or may not have a primary care provider, but in either case appreciates having a nearby facility that can see them quickly, after hours, and on weekends.

    Retail clinics

    Related but less comprehensive are retail or walk-in clinics, located in major drugstore or big-box chains like CVS, Walgreen’s, Target, or Walmart. Some retail facilities may be sponsored in partnership with major insurance carriers such as Aetna. Typically geared to people who lack insurance and primary care providers, these clinics offer weekend and evening hours and are a highly cost-effective alternative to emergency department care for routine illnesses. These facilities are staffed by NPs or PAs, who diagnose and treat URIs, UTIs, and other noncomplicated conditions, write certain prescriptions, and administer vaccines and preventive care. Some large corporations provide similar on-site facilities for their employees.

    Free-standing emergency departments

    Fee-standing emergency departments are offsite facilities owned and operated by hospital systems or medical corporations. While they lack the full services of a hospital-based ED, their costs are often as high as or higher than those charged by an onsite hospital facility, and many times higher than an urgent care center. A study in the Annals of Emergency Medicine showed that the average price for freestanding EDs in Texas in 2015 was $2259, whereas the average for urgent care centers was only $168.

    Factors for change

    This burgeoning change in health care delivery can be attributed at least in part to a number of factors affecting health care delivery. Modern Healthcare News cites the “2020 AHA Hospital Statistics” report findings that between 2017 and 2018, US hospitals delivered almost one million fewer outpatient visits in 2018 than in the previous year, mostly in emergency room services.

    Cost and convenience are clearly significant drivers of that change. The Urgent Care Association’s “2018 Benchmarking Report” showed that patients’ instincts are in the right place: urgent care fees are significantly lower than they’d pay in an ER, and insurance is accepted. And instead of long waits in hospital emergency departments, urgent care centers initiate most treatment in less than 20 minutes, with almost everyone being seen within a half hour. The vast majority of visits last less than an hour, with no need for diversion to emergency departments or further diagnostic workup.

    Another factor leading to the rise of urgent care facilities is the shrinking number of primary care MDs in the workforce. The reasons for the decline are many and complex, but cumulatively lead to a shifting of primary treatment to nurse practitioners and physician assistants.

    For Freedom Healthcare, in addition to continuing our leadership in hospital staffing, we intend to address the growing demand for RNs, NPs, and PAs in nonhospital settings such as urgent care facilities, retail clinics, and even individual physician practices. Nonhospital medical settings are a vital part of the overall continuum of care, with approximately 89 million patient visits each year and an $18 billion segment of the industry today. The number of retail-based clinics has climbed rapidly just over 2000 since 2013 to nearly 9000 in 2018. This trend is expected to continue as need for urgent care centers is fueled by convenience, cost control, and the growing number of patients without primary care physicians.

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