When her 15-year-old son injured his foot ski jumping on a recent Saturday, Emily Jones considered several scenarios. She could ask the pediatrician to squeeze Luke in on Monday, though she worried he might risk further injury by waiting. And he would miss school. At the same time, an immediate trip to the emergency room seemed like overkill.
So Jones chose a third option: She drove Luke to a new walk-in urgent care center, next to a Starbucks in Needham. The visit took about 45 minutes, and X-rays taken onsite showed that his right foot, while too painful to walk on, was not fractured.
“It was easier to come here,’’ Jones said.
Though not a new idea, urgent care centers have never been popular in Massachusetts. But that is changing. Since 2012, centers open nights and weekends have been expanding across the state, as health insurers have begun to usher patients toward the clinics, and away from more expensive ERs, for non-life-threatening conditions.
Most insurers no longer require patients to get a referral from their doctor for an urgent care visit to be covered — a rule that was impractical during non-business hours. Insurers also have established urgent care copayments — typically $20 to $40 — that are far lower than the $50 to $200 copayment for an emergency room visit. Some health plans now list the fees on members’ insurance cards to highlight the difference.
“We have removed the barriers to urgent care,’’ said Rick Weisblatt, senior vice president for provider network and health services at Harvard Pilgrim Health Care. “This is a good service and we want to make it available to patients.’’
Propelled by these changes, CareWell Urgent Care, which opened the Needham center last July, plans to start its eighth Massachusetts clinic in two years in Cambridge. Another company, Doctors Express, runs nine urgent care centers and will open two more next month — though the expansion is going slower than the company anticipated because of difficulty securing retail space in high-traffic areas. Health Express, started by two emergency medicine doctors from Cape Cod, soon will add a third urgent care clinic in Plymouth.
“When the insurance companies were not supportive, it was very hard for these urgent care centers to survive, and some of them didn’t,’’ said Dr. Jack Cornwell, medical director for CareWell, which is backed by private investors. “The market has opened up in Massachusetts. I don’t see a gold rush mentality. But is there a need here? There definitely is.’’
Patients like the convenience of urgent care centers — an appointment is not required and a visit usually takes less than an hour. But some doctors worry that consumers won’t understand the differences among the growing options, and could end up without proper treatment.
Another relatively new health care provider is CVS, which has licenses for 51 MinuteClinics in the state and so far has opened 48. Nurse practitioners at the store clinics treat common illnesses, such as strep throat and small burns, but do not provide the more advanced services — treating minor broken bones, for example — that patients receive at an urgent care center. But even urgent care centers differ in their offerings.
Urgent care centers vary in their capabilities, “and it’s not always obvious to a consumer what they are going to get,’’ said Dr. Nathan MacDonald, head of the emergency department at Lowell General Hospital and president of the Massachusetts College of Emergency Physicians.
Some are staffed by doctors and others are not, he said. If they are, the doctor may be a family practitioner, an internist, or an emergency medicine physician, all with varying experience in treating pressing medical problems. Most urgent care centers have X-rays and labs for blood testing onsite, but others may not. And no matter how well-equipped a center, patients with chest pain, stroke symptoms, or trauma from a serious accident should go directly to a hospital ER, he said.
“We just want people to be careful,’’ MacDonald said.
His own hospital is getting into the urgent care business, with plans to open a second center in Westford to supplement one in Lowell. Other hospital networks are doing the same — Massachusetts General Hospital started an urgent care center at its Danvers location several months ago.
One reason is that hospitals and large medical practices are entering “global payment’’ agreements, under which insurers pay them a flat amount of money for caring for a group of patients. As a result, providers are more motivated to care for patients at the least expensive location.
Steven Fox, vice president of network management and communications for Blue Cross Blue Shield of Massachusetts, said the “call to action’’ about urgent care came in 2010, when a state report found that one-quarter of patients in ERs didn’t need to be there, because they had sore throats, back pain or other non-emergency conditions.
As a result, Blue Cross decided to develop its own urgent care network, which now has 40 providers, many with multiple locations. Over the past two years, the number of Blue Cross payments to urgent care centers has doubled, indicating that more patients are using them. The insurer hopes the shift will save money: Blue Cross pays an ER about three times as much to treat a sprained ankle, for example, as it pays an urgent care center, Fox said.
But it will be hard for insurers to determine whether they are succeeding at controlling costs, he added. Some patients may not have gone to the ER if they did not have access to an urgent care center; they may have simply waited to see their doctor.
Jones said that if she had not had an urgent care center nearby, she probably would have just taken her son to the doctor Monday.
But if she had, there are other costs to the health care system to consider. Luke’s pediatrician refers patients for X-rays to the local hospital, which likely charges more than an urgent care center.
CareWell’s Dr. Arnold Soslow sent a summary of Luke’s appointment and a copy of his X-ray to his pediatrician. And other urgent care clinics said they are conscientious about communicating with primary care physicians, an effort to quell concern that the centers would create disjointed care.
One major drawback of urgent care centers is that most don’t accept Medicaid — the program pays lower fees than private insurers. That, too, is changing, which is particularly relevant because Medicaid enrollees are heavy ER users.
Neighborhood Health Plan, which insures 215,000 Medicaid patients, signed a contract with CareWell last month. Network Health, with 191,000 Medicaid members, now covers visits to CareWell and MinuteClinic.
Liz Kowalczyk can be reached at firstname.lastname@example.org.