State seeks to rein in largely unregulated urgent care industry

At ConvenientMD in Weymouth, which opened in December 2018, physician assistant Shannon Sheridan-Geldart assessed Natan DePaula’s congestion symptoms. Pat Greenhouse/Globe Staff/Globe Staff

For years, the urgent care industry has grown rapidly, with walk-in clinics popping up across Massachusetts to treat patients with colds, infections, cuts, sprains, and other common ailments.

Yet the industry remains largely unregulated. Urgent care has become a common term in health care — but it has no state definition in Massachusetts, making these centers difficult if not impossible to monitor, according to state officials.

Now policy makers appear poised to impose new requirements on urgent care centers, but they’re facing resistance from industry executives.

The lack of standards means any provider can market itself as “urgent care,” and patients don’t know what to expect when they walk in the doors, said Marylou Sudders, the state’s secretary of health and human services.

“There is no standardized definition or structure that exists for urgent care,” Sudders said. “In terms of consumer protection, we should define them and regulate them.”

Urgent care was a focus of sweeping health care legislation that Governor Charlie Baker proposed last fall. The Baker administration wants these centers to be licensed as clinics, to provide care to low-income patients who use MassHealth, and to offer some mental health services.

State lawmakers have filed more than a dozen bills pertaining to urgent care centers this session, and both House and Senate are working on additional legislation that is likely to include regulations for the industry.

Operators of urgent care clinics say such regulation could slow growth — or even kill an industry that provides convenient, affordable care. They have been frequent visitors on Beacon Hill, lobbying to try to prevent the passage of legislation that could disrupt their business model.

“Any regulation that increases cost and complexity could be damaging to the industry,” said Shaun Ginter, chief executive of CareWell Urgent Care and a board member of the national Urgent Care Association.

Because there is no definition of urgent care in Massachusetts, some centers are licensed as hospital facilities, some as clinics. But many operate as physician practices, which don’t require a license.

Individual health care providers, such as doctors and nurses, must be licensed to treat patients no matter where they work.

“We should be treated no differently than any other medical office,” Ginter said. “We feel very singled out and pulled out to the side when we shouldn’t be.”

Urgent care executives said it costs from hundreds of thousands to well over $1 million to open a clinic. Licensing requirements would increase those expenses, they said, especially if the state mandates that clinics be built to certain specifications — and such requirements could be devastating for the clinics that are already up and running.

“From a business perspective, nobody would open new centers,” said Lynne Rosen, chief executive of PhysicianOne Urgent Care, which operates four clinics in Massachusetts.

Rosen said the company plans to develop several additional sites, but she’s waiting to see what happens at the State House.

“I can’t sign that lease until I understand [the legislation],” she said. “We’re going to monitor what goes on in the first 90 days of the year. Certainly, it influences our decision-making.”

Urgent care companies are also objecting to the Baker administration’s insistence that they provide certain mental health services. Their centers usually are staffed by providers with backgrounds in primary or emergency care — not mental health care.

“That would require a change in staffing model, potentially,” Rosen said.

Jim Brennan, who owns six American Family Care clinics in Massachusetts, agreed, saying, “There is a need for behavioral health providers, but I’m not certain the urgent care platform is equipped to do that.”

Rather than implement new regulations, industry executives said, the state should lift burdensome requirements that make it difficult for MassHealth patients to seek care at urgent care clinics. Currently, MassHealth requires a referral from a primary care physician before covering urgent-care visits.

Administration officials say they can’t lift these restrictions unless the state first adopts standards for urgent care.

While they don’t have an official state definition, urgent care centers are typically open on nights and weekends when most doctors offices are closed. They generally promise to treat a variety of medical issues — except for life- and limb-threatening emergencies — at a fraction of the cost of hospital emergency rooms.

They offer walk-in service, accept health insurance, and are staffed by physicians, physician assistants, or nurse practitioners.

About 180 urgent care centers have opened in Massachusetts, most of them in the past decade, according to industry and state figures. Much of the growth has come from relatively new for-profit companies, though some traditional health care providers, including nonprofit hospitals, also have centers.

These facilities are distinct from retail clinics such as CVS MinuteClinics, which offer more limited services and are already regulated by the state.

But not everyone has equal access to urgent care centers. They tend to be located in middle-class and affluent communities — not in low-income neighborhoods.

Policy makers have begun to pay more attention to urgent care centers in recent years. In 2018, the Massachusetts House approved legislation to put hefty assessments on the centers. Urgent care companies lashed out at the proposal, which died when House and Senate lawmakers couldn’t agree on compromise legislation.

House majority leader Ronald Mariano, lead author of the 2018 House bill, said he has backed off the assessments but remains concerned that the centers are unregulated. He’s also worried they are “taking money out of” community hospitals, which he wants to protect.

“We should set some standards so we know what these people are doing and who they are servicing,” Mariano said.

The House is likely to take up urgent care this spring as part of a larger health care bill, Mariano said. The Senate is also considering new rules.

“Our goal is to provide high-quality, affordable, and accessible health care to everyone in the Commonwealth,” Senator Cindy F. Friedman, cochair of the Legislature’s Joint Committee on Health Care Financing, said in a statement. “Urgent care centers provide this kind of health care to our residents — so yes, they too should be subject to regulations and oversight.”

Lawmakers have until the July 31 end of the legislative session to compromise, while urgent care companies try to influence the debate.

At least one company, ConvenientMD Urgent Care, has accepted that regulations are probably coming.

ConvenientMD has opened eight centers across Massachusetts in the past 13 months. They are already licensed as clinics, said chief executive Max Puyanic.

“It is very costly to go through the licensing process,” he said. “[But] we assumed it was better to do it up front, assuming it might be required in the future.”