Episode 31:
Walk-In Primary Care

A new model of on-demand health care is emerging with the potential to confuse urgent care patients and create competition for urgent care centers.

In recent years, urgent care has proven resilient against emerging technologies like telemedicine, new delivery models like retail clinics located in food, drug, and mass stores, and today on Just Checking In we’ll explore the latest challenge for urgent care – walk-in primary care.

Good evening! This is Alan Ayers and I am Just Checking In from Chicago. So, when we think of urgent care, we typically think of a retail location near patients’ home and work. We think of extended evening and weekend hours. We think of walk-in service – the ability to see a physician for a minor illness or injury without an appointment. And we think of lower co-pays and lower total cost than, say, the hospital emergency room.

Well, here in Chicago I noticed a street-facing medical facility operated by Rush University Medical Center in the busy business and tourist area downtown. It offers walk-in, no appointment convenience, and it has x-ray and lab services on-site, and it can treat a wide range of illness and injury. Now if a center walks like an urgent care, talks like an urgent care, and quacks like an urgent care, it must be an urgent care center right? Well, not necessarily! In this case, Rush is not offering urgent care, but rather walk-in primary care services. The location is retail and there’s even the convenience of online appointments and web or kiosk check-in.

Now from a consumer perspective, while this center can treat the same basic urgent care conditions, there are fairly significant differences, and the first goes to co-pay. Because it’s primary care, the co-pay is less in most insurance plans than urgent care. So an office visit co-pay is typically $10-25, while in many insurance plans an urgent care co-pay can be as high as $50-75 or more. Well, when I inquired of this center of their pricing for a basic urgent care condition like a sore throat, they told me that if I chose not to use insurance, the fee for walk-in primary care would be $50. If I chose to use my out-of-network insurance, the insurance would be billed $130. Now as a comparison, I walked two blocks down the street to the Northwestern Memorial Immediate Care Center, which is a full service urgent care center. When I inquired of their pricing for a sore throat, I was quoted a price from anywhere between $150-350, depending on what the doctor found. Well, from a consumer perspective, that’s a blind transaction. What consumer is comfortable walking into a transaction where the variance in pricing is up to 200%? Outside of medicine that is really somewhat unheard of.

So, not only does walk-in primary care bring a pricing advantage over urgent care, it’s also integrated with the health system. So, a medical center, or an integrated health system like Rush can justify a facility like this if it will generate revenue elsewhere in the system. So, hospitals like Rush are looking to fill hospital beds, they’re looking to fill specialist appointments, and they’re looking to drive patients to their affiliated facilities for services like diagnostic imaging, lab, and physical therapy. Hospitals love facilities that generate downstream revenue elsewhere for the system.

Now, if I were using Rush for other medical services, not only could I pull up my walk-in primary care visits on their “My Chart Patient Portal”, but along with my walk-in primary care visits I could see my specialist visits, my hospital visits. So, from a consumer’s perspective, there are certain advantages to continuity of care and integration of care that really doesn’t exist for free-standing or one-off urgent care centers that are not tied to a larger system.

Now, I’ve heard from a number of clients around the country – their concerns about these walk-in primary care models. We’re seeing this elsewhere where either hospital-affiliated primary care groups or large multi-specialty groups open their primary care practices to walk-in hours at the lower co-pay, really somewhat, I believe, in an attempt for these groups to prevent leakage of their patients to urgent care. But fact-of-the-matter, it’s offering a service that is directly competitive to urgent care.

Well, I don’t have firm answers tonight, but in the coming weeks I’m going to be exploring this issue in far more detail. Until that time, this is Alan Ayers Just Checking In from Chicago.