With health care costs climbing and emergency rooms overwhelmed, one potential solution is gathering steam across Eastern Massachusetts: urgent care centers that see patients on weekends and at night.
A national company, Doctors Express, said it plans to open 19 urgent care centers in Eastern Massachusetts by the beginning of 2014, following the success of its first two centers in Springfield over the past 18 months. The first three are scheduled for Braintree in May, Saugus in June, and Natick in July.
In a separate venture, two longtime Cape Cod Hospital emergency room physicians opened a large urgent care center in a Weymouth strip mall on Thursday. A growing number of hospitals are also starting urgent care centers, like the Brigham and Women’s/Mass General Health Center next to Gillette Stadium in Foxborough.
Urgent care centers run by entrepreneurs and doctors to treat emergencies that are not life threatening, especially during off hours, have been far less common in Massachusetts than in Florida, California, and some other states. That is partly because health insurers here have typically required many patients to get referrals from their primary care doctor, which would be impractical when trying to get treatment on a weekend for a broken ankle or high fever.
But Blue Cross and Blue Shield of Massachusetts and other insurers have lifted that requirement, helping to pave the way for the urgent care industry to expand.
While some health care leaders caution that these centers have drawbacks - some only treat patients with commercial insurance, for example - many see them as potential money-savers.
Last year, Blue Cross started an urgent care network, which included relaxing the referral policy, that it is marketing to employers who want to cut health care costs by directing employees away from expensive emergency rooms for cuts, minor broken bones, fever, pneumonia, and dehydration.
In its letter to providers, the insurer cited a 2010 state report that concluded that nearly one-half of emergency room visits were considered preventable or avoidable in 2008, amounting to more than $514 million in health care costs.
“We see this as a huge opportunity to avoid unnecessary ER use and want to encourage [urgent care centers] in any way we can,’’ said Blue Cross spokesman Jay McQuaide.
Rick Crews, co-owner of Doctors Express in New England, said his urgent care centers charge insurance about $130 to treat a patient, one-fifth the cost of an emergency room visit.
Dr. Christopher Whelan, co-owner of Health Express in Weymouth, said, “We are trying to fill the true middle ground’’ between the routine care provided by a primary care doctor and treatment for heart attacks, trauma, appendicitis, and other life-threatening emergencies given in the emergency room.
“It’s our contention that people end up in the ER because they can’t get the access they want,’’ he said.
Like Doctors Express, Health Express is open until 8 p.m. weekdays and mornings and afternoons on weekends. They can provide X-rays and lab tests, and generally treat people in an hour or less.
Still, policy makers cautioned that urgent care centers are not a panacea.
“If more people present to urgent care centers, we don’t want to see them become ERs, where there is a demand for higher payments,’’ said Representative Steven Walsh, a Lynn Democrat who is leading the House effort to write legislation to improve care and control costs. “We have to make sure it isn’t all about their return’’ on investment.
One concern is whether these centers will take lower-income patients. Doctors Express, for example, does not take Medicaid, the state and federal insurance program for the poor and disabled, because “from a business perspective it’s a very, very low payer,’’ Crews said. “It would change the business model.’’
And while urgent care center owners said they take pains to send patients’ records to their primary care doctors, health care leaders are pushing providers to better coordinate care and it is unclear how these centers fit in.
If they “are closely linked with the primary care practices that provide patients with the day-to-day care as well as the larger medical centers that provide them tertiary care, then they will contribute to the overall continuity of care for patients, and could very well save money in the long run,’’ Leonard Marcus, director for Health Care Negotiation and Conflict Resolution at the Harvard School of Public Health, wrote in an e-mail.
“However, if they turn into stand-alone care centers divorced from other parts of the system, we will find ourselves left with the inefficiencies of care that is sporadic and not part of an overall strategy to focus on the health of individual patients as well as the health of the population as a whole,’’ he said.
Liz Kowalczyk can be reached at firstname.lastname@example.org.