It was the week before Thanksgiving, and lines began to form at 4 AM. In every neighborhood, people shuffled into beleaguered queues reaching far around the block, huddling in winter coats and waiting up to 10 hours for a 10-minute coronavirus testing appointment at a clinic.

This is a New York story but the phenomenon is everywhere. Americans attempting to follow the guidelines to get tested regularly, wear a mask and stay home, have been regularly thwarted by a lack of widely-available testing options. Now, urgent-care clinics are trying to fill that gap—and it’s putting them to the test. 

Urgent-care clinics have been popping up all over the country in the last decade, flourishing in a unique niche in our country’s healthcare system. In a Business of Business article on the rise of urgent-care clinics, James Mattone summarized that, “urgent care centers are the middle ground for acute illnesses (the flu) and injuries that are too severe to wait for a doctor, but not so bad that an ER visit is needed.” Urgent-care clinics fill an important care gap in our country, where patients might have to wait months to see a primary-care doctor, or are overly reliant on expensive emergency room visits to provide necessary primary and emergency care. Now, patients can regularly turn to urgent-care clinics to diagnose illness, offer preventative treatments, and attend to mild injuries. Their convenience, accessibility and consideration for patient-centered practice has allowed them to expand quickly and strategically.

CityMD, one of the largest urgent-care provider networks, was founded in New York City in 2010 by a group of East Coast physicians and it continues to dominate the New York metro region. In the decade since it was established, it’s opened over 110 locations and acquired three other urgent-care chains. The map below shows urgent-care facilities, signified by the dots, and the percentage of people with COVID-19 symptoms per region, signified by shaded the areas.

The industry has seen a major surge in all regions, clustering around urban areas. As of 2018, the urgent care industry was on track to hit $26 billion by 2023, a benchmark that was actually broken in 2019. Experts now predict that the urgent-care industry will have an expected market share of $28.4 billion this year, with expected growth of at least 2.2% this year

Between 2007 and 2016, insurance claims for urgent-care visits increased at 7 times the rate of emergency room visits, suggesting that their availability might be encouraging more people to access healthcare providers when they otherwise wouldn’t have. Urgent-care clinics effectively fit themselves into the cracks of an existing market, and managed to build a new one.

After a sharp round of layoffs in March of this year, nearly all major urgent-care clinics have shifted towards steady increases in hiring to meet the growing demand. NextCare has increased its job listings by 73% since the beginning of 2020. GoHealth's job listings have surged by 145%. Over the last three months, Doctors Care and Cantel Medical have increased listings by 68% and 54% respectively, outfitting their organizations in preparation of COVID’s second wave.

But these centers were never designed to be major testing sites for a highly infectious disease, and while they’ve tried to adapt, they are clearly feeling the strain. According to Vox, “Urgent care centers were doing about 725,000 tests per week in late October, which roughly amounted to 10 percent of the total tests per week in the US at that time.” Demand for testing has accelerated since then, reflecting the virus’s wildfire spread around the country, and the pre-holiday precautions many are taking this winter.

In the week of November 16, leading up to the holiday, weekly page views for CityMD increased by 400% compared to earlier in the year.

Doctors Care's digital queue counted 24,900 people waiting in line for tests on November 23.

Urgent Care Association CEO Lou Ellen Horwitz voiced concerns for the long-term sustainability of urgent-care centers providing coronavirus testing. Insurance providers often pay a flat fee for urgent-care visits regardless of the services provided, a reimbursement that is not always enough to cover the costs of the test, the necessary PPE, the lab work, and the administrative work to communicate follow-up information. The huge volume of patients might not translate to a financially sustainable growth in profits, and Horwitz noted that even the CARES Act which was designed to fill the gaps in revenue is a “struggle in reality.” The insurance gap affects providers and patients, as many people have been hit by surprise bills.

But others have speculated that the high number of visits will translate to future business, as people return for other care needs after their introduction to urgent care during the pandemic. And Horwitz said that urgent-care centers “fully intend to participate” in the distribution of the coronavirus vaccine.

To adequately meet the country’s enormous COVID testing needs, the government will likely need to implement a public system with flexible sites and pandemic-safe infrastructure. Like in San Francisco, where citizens can bike to an outdoors, walk-through, public testing station on a pier, getting swabbed and processed within 10 minutes. Until then, in the rest of the country, urgent-care clinics will be working hard to fill the gaps.

About the Data:

Thinknum tracks companies using the information they post online, jobs, social and web traffic, product sales, and app ratings, and creates data sets that measure factors like hiring, revenue, and foot traffic. Data sets may not be fully comprehensive (they only account for what is available on the web), but they can be used to gauge performance factors like staffing and sales.

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