Urgentcareexpands across Connecticut amid calls for greater oversight

Jul. 31—Walsh said he thinks he has found one part of the solution: The brand-new GoHealthMedical urgent care center in West Haven, where he gave a tour on a recent morning. The center opened in June at 1 Cellini Place in West Haven's Allingtown section, part of a mixed-used development called Park View. HartfordHealthcare doctors' offices are located a few doors down.

Although the GoHealthMedical storefront offers instant access to patient medical records across health systems and amenities like a portable X-ray machine that can be wheeled into a treatment room, bills at the center range from one-fifth to one-tenth of what they would be if a patient visited an emergency room for a minor ailment.

"Urgent cares are really necessary in the grand scheme of health care for the United States of America," Walsh said. With the ability to set up in suburbs as well as urban areas, the urgent care model can bring medical care into underserved communities at a reasonable price, he added.

"I think urgent care has the ability to be an equalizer for the healthcare system," Walsh said. "I think it creates a kind of a new level of safety net in the system, for people to quickly be able to get access."

Nonprofit and for-profit chains expand

Hospital systems and private companies have gotten the message on urgent care: More than 14,382 urgent care centers currently operate in the U.S., according to industry group the Urgent Care Association, with patient volume surging 60 percent since 2019.

The shift away from emergency rooms is reflected in data from the state Office of Health Strategy: "Avoidable visits" for minor ailments to the emergency room dropped from 40 percent in 2016 to 33 percent in 2021.

From 2016 to 2021, emergency room use in Connecticut declined by about 15 percent, from nearly 1.6 million visits in 2016 to about 1.3 million in 2021. Visits remained below pre-pandemic levels after the worst COVID-19 surges.

The number of centers has surged: Hartford HealthCare with partner GoHealthMedical runs 26 urgent care centers across the state, with plans to open more said Dr. James Cardon, executive vice president and chief clinical integration officer. The two companies first teamed up in 2017, opening 15 centers in their first two years of partnership.

Urgent care centers are part of Hartford HealthCare's overall strategy to improve the quality, access, affordability and equity of medical care in the state, Cardon said.

"If we're actually going to continue to deliver the value of health care to what we feel the communities deserve, and what we hold ourselves accountable to, we're going to have to transform the system substantially," Cardon said.

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Moving health care out of hospitals and into settings that are lower cost and easier to access while maintaining standards is fundamental to the shift, Cardon said. "It shouldn't matter where we are, we're going to deliver the exact same experience and hold ourselves to the same sort of metrics, if you will, around quality and experience," he said.

Yale New Haven Health operates two of its own urgent care centers in Milford and Fairfield, along with 20 centers in partnership with PhysicianOne Urgent Care in Connecticut and lower Westchester County. PhysicanOne opened its newest location in June at 236 Boston Post Road in Orange.

The state's largest health systems, Hartford HealthCare (HHC) and Yale New Haven Health seem to be opening more urgent care centers in each other's backyards.

Hartford HealthCare's new West Haven complex is only 1.4 miles from Yale New Haven Hospital, its competitor's flagship. A Yale New Haven Health-affiliated PhysicianOne center operates about 6 miles from HHC flagship Hartford Hospital.

Trinity Health of New England operates four urgent care locations and has three more in the planning phases, according to a spokesperson. The newest Trinity Health urgent care center is scheduled to open next month in a plaza on Cottage Grove Road in Bloomfield — about a mile down the road from Hartford HealthCare medical offices.

For-profit urgent care companies have also moved into the state in force, drawn by Connecticut's well-insured and aging population.

Franchised American Family Care urgent care clinics operate in Danbury, Torrington, Newtown, Enfield, New Britain, Vernon and West Hartford, Fairfield, Norwalk, Shelton and Stamford.

Based in Birmingham, Ala., American Family Care operates more than 300 urgent care centers in 30 states. The chain opened 43 new locations in 2022 and announced it intended to open more than 60 in 2023, although growth seems to have slowed since the death of the company founder in April.

Another statewide chain, DOCS Urgent Care, operates more than 20 centers, including a Docs Now location on the New Haven Green. DOCS owner Dr. Jasdeep Sidana agreed to a $4.2 million settlement late last year over allegations that false claims were submitted to Medicare and the state's Medicaid program.

Lawmakers call for scrutiny

But even as urgent care centers pop up in strip malls, downtowns and rural areas across Connecticut, state lawmakers are struggling to figure out who should be keeping an eye on the industry.

Urgent care centers are lumped in with school health centers and community health centers as "facilities licensed as outpatient clinics" in state data and operate under the license of individual providers. The urgent care center is also just one facet of the burgeoning "retail health" industry, which includes clinics in pharmacies and companies like One Medical that provide medical care on a membership or subscription basis.

Hartford HealthCare announced a partnership with One Medical in 2022, citing the potential to increase access to primary care and telehealth.

"This is a great example of how we are working to advance consumer-driven, coordinated care," Hartford HealthCare CEO Jeff Flaks said in a statement at the time.

One Medical opened its first retail location in Connecticut at the Darien Commons shopping center this June.

The proliferation of urgent care centers and other retail operations in the wealthier areas of the state with a "better payer mix," or higher percentage of insured patients, is no coincidence, said state Sen. Saud Anwar, a physician at Manchester Memorial and Rockville General Hospital who is active in legislative efforts around health care.

The growth of urgent care reflects the strains on the state's primary care providers, Anwar said. Primary care teams provide the best care but are being squeezed by insurers and doctor shortages, he said.

"I think the solution for us long-term would be to strengthen the primary care in our state, improve the access in our state, but also make sure that these urgent care centers are not only getting focused on the areas where the payer mix is good," Anwar said.

Anwar said he and other lawmakers are considering more regulation of the urgent care industry in the state and want to assess its impact on health care costs.

"I think it's worthy for us to start to look at this because if the patterns and processes are going to be part of the health care system and the cost of health care is going to be negatively impacted, we need to have a look at that," Anwar said.

Even as some lawmakers call for more regulation of the centers, others seek to push hospitals to open more urgent care outlets as alternatives to emergency rooms.

A trained nurse anesthetist, state Rep. Keith Denning of Fairfield County introduced a bill in January that would require hospitals to open 24-7 urgent care centers near their downtown emergency rooms to handle less serious cases.

"The more access that we can grant people, whether it be telehealth, whether it can be urgent cares... is the way that we can help decrease the cost of health care in the country, I believe," Denning said. Urgent care centers need to be open later and located in urban areas, he added. "We need to expand their hours. We need to expand our availability."

Denning's bill was referred to the Joint Committee on Public Health and he said he intended to revisit the measure in the next session.

Growth eyed for the future

However the industry ends up being regulated, experts like Walsh of GoHealthMedical and Hartford HealthCare see even more growth for urgent care centers in the future. Adoption of urgent care visits is rising in all age groups, but younger patients are most drawn to the model, he said.

"There's a generation of 20- and 30-somethings... they really don't even want the connection to primary care," Walsh said. "They just want on-demand access. If they twist their ankle playing rugby, they want to come in to be taken care of. They don't want all the other stuff."

Cardon of Hartford HealthCare said a shift to urgent care is part of a rapidly changing health landscape.

"We've got to continue to challenge ourselves as we look at when we're building the care models, how do we design that to really hit the needs, not necessarily anchor ourselves to historically, the way things have been done," Cardon said. "We have to think differently if we expect to make any progress."