When Dr. John Johnson opened his first urgent care center, in 1982 in Greenwood, Indiana, he was something of a pioneer.
He had friends with urgent care clinics in downtown Chicago, but that was about it.
Still, he recognized the financial implications of what he was doing.
"ER visits were so expensive, like $300," said Johnson, who worked as an emergency room doctor. "Back then, you could go to urgent care for 60 or 70 bucks. We ended up opening five clinics that year in the Indianapolis market."
When his business, Immediate Care Center, started a Schererville location in 2003, it still was a rarity. Not anymore.
Urgent care centers litter the landscape in Northwest Indiana, an acknowledgement of the growing desire to bend the health care cost curve. Thirty-five years after Johnson launched his first clinic, a trip to the ER now averages $1,700, with an average urgent care visit costing $190, according to UnitedHealthcare.
With health care accounting for nearly a fifth of the U.S. economy, and many Americans still using the ER as their primary care provider, urgent care centers are gaining in popularity as a way to reduce medical spending. The number of urgent care clinics rose to 7,357 in 2016, including 116 in Indiana, a jump of 10 percent from a year prior, according to the latest numbers from the Urgent Care Association of America. Ninety-six percent of centers had more patients in 2015 compared to the year before.
"I think it's lowered health care costs dramatically," said Sangeet Shah, a partner at NWI Urgent Care in Munster and Midwest Express Clinic in Schererville. "Before the whole urgent care boom, your choices were waiting days or weeks for an appointment at your primary care office or spending hours in the ER at a huge cost."
Immediate care also is becoming more specialized in the Region, with orthopedic and dental urgent care clinics opening in recent years. Nationally, there has been a rise in pediatric urgent care centers. Johnson said he's even been approached by a cardiology group looking to enter the market.
A business opportunity
As patients search for cheaper, more convenient medical options, many hospitals, doctor's groups and health care entrepreneurs increasingly see urgent care as a business opportunity.
Hospitals, which are increasingly being incentivized for managing the health of large patient populations, want to get as many patients into their systems as possible.
"This is an opportunity for us to expand our reach and attract individuals to an immediate care environment for people who may not be familiar with Methodist and create loyalty among the patient population there," said Jim Kirchner, vice president of physician integration for Methodist Hospitals, which has immediate care centers in Crown Point and Merrillville, with plans to open several more in the coming years.
Conversely, independent physicians want to remain that way, and view immediate care as a way to divert patients from the hospital systems.
"We're trying to stay independent. The more these big monopolies direct patients to their networks, that just feeds itself and we will not be independent anymore," said Dr. Keith Pitchford, an orthopedist in St. John and Lowell who is a partner in Xpress Ortho Care, located in Dyer. Lakeshore Bone & Joint Institute recently announced it would be opening the Region's second orthopedic urgent care center next month in Portage.
Independent urgent care centers argue that they aren't beholden to any hospital system or physician group, so they can refer patients anywhere. They also note that many hospital-based urgent care clinics charge so-called facility fees though the ones in Northwest Indiana largely don't.
Even safety-net clinics are getting in on the game. NorthShore Health Centers, a federally qualified health center with locations across Northwest Indiana, has urgent care clinics in Hammond, Lake Station and Portage. "People work the same hours that most doctor's offices are open," said Jodi Ortiz, deputy chief administrative officer for NorthShore Health Centers. "We offer that after-hour care for stuff that's not an emergency, for stuff you shouldn't have to go and wait for at the emergency room."
Still, urgent care centers aren't the cheapest option for quick care, according to the data from UnitedHealthcare. Retail clinics, like CVS and Walgreen's, average $65 per visit, while virtual visits, done by video through computers or smartphones, average $40.
Will growth continue?
The growth of urgent care doesn't appear to have stemmed ER use in the Region, hospitals say. For instance, Community Healthcare System, with hospitals in East Chicago, Hobart and Munster, has seen an increase in both its urgent care and emergency room volume, though the ER visits tend to be more acute, meaning patients are seeking a more appropriate level of care, said Dr. Alan Kumar, chief medical officer for the system, which has urgent care centers in Schererville, St. John and Valparaiso.
"With the increase in high deductible health insurance plans, more people are opting for the urgent care instead of the emergency department for minor illnesses or injuries than before," said Janet Doms, northern Indiana operations director for retail services for Franciscan Alliance, which has seven express care clinics in Northwest Indiana.
Kumar doesn't see the upward trend in urgent care slowing down anytime soon.
"The younger generation, millennials, are more geared toward convenience and access," he said. "As this shift occurs, it leads to a preponderance of urgent care, minute clinics, telehealth, electronic visits."
Not everyone thinks urgent care will grow unencumbered, including Johnson, one of the originators of the concept in Indiana.
"I think it's a bubble," he said. "We found we've been running them for so long we have an idea of how to run them."
That's not true of newbies to the business, he said. His company sold seven of its clinics to a hospital system; three of them have since closed, he said, while another sees half the volume it once did.
Still, the gap between the cost of an ER visit and urgent care visit has widened in the three decades since he got into the business, which should drive more Americans to seek cheaper care. Anthem, Indiana's largest insurer, recently announced that it would not cover ER visits that aren't true emergencies.
"It's 10-15-to-1 cost difference now," Johnson said.