DPH can regulate, but not marginalize, urgent care centers
In the past decade, especially since the onset of the coronavirus pandemic, urgent care centers have become an integral part of our health-care delivering system.
But inexplicably, these highly popular and rapidly expanding emergency-room alternatives lack standardized oversight by the state, and the top public health official in Massachusetts thinks it’s time for that to change.
Before approving any chances to the status quo, we’d advise the state’s medical establishment to first understand why these medical centers have become the choice for an increasing number of individuals sick and tired of the interminable time spent in hospital emergency rooms.
More and more patients have turned to walk-in appointments at these clinics for common issues that needlessly back up ERS.
“Over the past five years, and certainly during the COVID-19 pandemic, we saw a lot of changes in how health care is accessed, and therefore how it has impacted our health system capacity,” said Katherine Fillo, deputy bureau director for clinical and health care systems quality at the DPH, during a Public Health Council meeting on Jan 10.
“Namely, we’ve seen more urgent care centers opening and more people seeking their health care, both routine and urgent, through emergent care through our urgent care centers and through our emergency departments.”
At the same time, hospital stays have gotten longer, as workforce shortages have limited the number of patients that nurses and doctors can manage. Limited staffing in rehab facilities has also contributed to the backlog in hospitals, as patients stay there longer while awaiting an opening.
Horror stories of all-day waits to be seen in emergency rooms, even in our most prestigious hospitals, have convinced those without a life-threatening illness or injury to opt for an urgent-care center. Even prior to the pandemic, residents seeking care had become turned off by emergency departments, and instead had searched for a viable alternative.
While it would be hard to convince someone who availed themselves of that option, 2019 marked the fourth straight year of decline for the state’s emergency department use rate, which stood at 367 visits per 1,000 residents in 2016, 358 in 2017, and 357 in 2018.
Concurrently, DPH reports that the number of urgent care centers rose from 18 in 2010 to 173 across Massachusetts
by the end of 2021.
The most common therapies sought at urgent-care settings include treatment for respiratory infection, urinary tract infection, pain, rash, bites and stings, according to the department.
Despite the increasing reliance on these centers by the state’s health-care system, inconsistent regulatory oversight has yielded limited information about the centers.
“We do think that there’s a role for the department to play in regulating what is happening, particularly because it would give us access to data, which is really important for us to understand what’s happening across the state,” said DPH Commissioner Robbie Goldstein.
In 2018, only 16 urgent care facilities — about 10% of all the centers in the state at the time — reported data to the U.S. Center of Disease Control, to which the DPH has access. That number has grown to 44 reporting facilities by the end of 2023, an estimated 25%.
Urgent care centers aren’t without some internal oversight. They must be licensed through the state as a clinic or hospital satellite before providing services.
In a presentation to the Public Health Council on Jan.17, Fillo recommended the DPH create a standard licensure to “apply care standards and improve quality of care,” as well as to ensure the state has uniform quality-of-care data coming out of these centers.
“There is a critical role for the department to play in urgent care to make sure we have high quality services at the right cost, available to all residents in the commonwealth,” Goldstein said.
We’d assume that the anecdotal data supported by their overwhelming popularity would suggest that urgent-care centers have filled a significant void in the state’s health-care safety net, and done so in a safe, professional manner.
For all but the most serious health-care issues, like heart attacks, strokes or gunshot wounds, these ER alternatives — often equipped with on-site X-ray capability — should be promoted and supported.
And for individuals without health insurance, they also provide a less costly option as well.
We’d ask the DPH to take all their benefits into account when creating a system regulating their operation.