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The Cooperative Model for Urgent Care and Primary Care

by John Kulin, DO, FACEP

Urgent care is viewed by many as a disruptor in health care, an upstart that is changing the status quo by allowing patients to access care at the time and place they choose. Urgent care centers have definitely rattled some cages, prompting some primary care offices to open on weekends and offer extended evening hours just to compete for patient business.

Well wait, don’t emergency rooms already offer this flexible, accommodating access to timely care? Yes and no.

In my former life as medical director of an emergency department, my team and I  took great care of the emergent patients, but I was often frustrated by our inability to get non-emergent patients to care in a timely fashion. We tried multiple approaches to reducing wait time for this patient population and, after a few years, I eventually realized the answer wasn’t in the emergency department. It was in identifying a level of care in between primary care and the hospital – and that’s urgent care.

For many people, urgent care is a perfect entry point into the health care system. It offers a convenient place to receive episodic care, and an excellent opportunity to educate patients about getting into the primary care system. This is important because I have always viewed primary care as the base of the pyramid of health care, where patients should access care on a regular basis. The primary care practice should be the patients’ medical home base.

So where can the relationship between primary and urgent care occur? Most primary care physicians know it is tough to predict the needs for episodic care – in my own urgent care practice, just when you think you understand patient trends, they change and upend any planning you have done. We all know it is tough to schedule regular patient visits months in advance and still leave enough space for urgent needs. This is exactly why primary care shouldn’t see urgent care as a threat, but as an opportunity to improve the care of the larger population. In that same vein, urgent care centers, whether independent or part of a system, need to integrate themselves into their local health care landscape.

I asked a primary care physician I work with about this, and he gave it this perspective: “I lose some cough and cold visits to you, but I gain control over my schedule and no longer have to open my office on weekends to see patients for acute needs. I know they are well cared for by your group, you send me notes for every visit, and I know you send them back to me for follow up and regular care. It has given me my life back.”

For me, this solidified why we take the idea of episodic care so seriously. It enables us to treat patients at times convenient for them, allows us to support primary care physicians and the idea of a Patient-Centered Medical Home, and enhance care – all while keeping emergency departments free to take care of the true emergencies without being clogged up with non-emergent cases. 

I view my relationships with primary care physicians in my community as a step in the right direction, but the opportunities need to be more widespread. Urgent care, primary care and hospital systems across the nation need to figure out how to work together for the benefit of the patient. Giving patients access to episodic care in the proper setting, and entry into the health care system for chronic problems, provides a heck of a roadmap to ensuring healthier patients who feel their needs are really being met.

So, yes, urgent care is a disruptor that is changing the way many patients access care. But far more important, it is joining the larger health care community in getting patients the right care in the right setting. 

Are you a primary care or urgent care provider with a mutually beneficial relationship in your community? Tell us about it. 

Dr. John Kulin is an athenahealth client and CEO of The Urgent Care Group, PA in Manahawkin, New Jersey.



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Comments

Submitted by Robert D. Peterson MD - Tuesday, April 28, 2015

Our local UC work well with my PCMH-styled IM practice. I use a modified open access model so same day appointments are available almost every day I am open, but there are things I don't do, I only do clia-waived labs and have no imaging, so UC provides same day urgent service for things I can't do without patient going to the ER even when I'm open. Key is communication. Our local ER does not call or coordinate care with me unless I call them first, and the UC providers do. It makes a difference.

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