Retail medicine: Explosion of urgent care centers in NJ changes health care landscape

When Joe Castelano was looking to open his first urgent care center in New Jersey, he scouted locations with high traffic, plenty of parking and a floor plan that could easily be converted into a medical facility. He found it in a former bank at a Paramus strip mall just off busy East Ridgewood Avenue.

His second center was even better: A former Kentucky Fried Chicken in a free-standing building on Broadway in Hillsdale.

"It's retail medicine," said Castelano who has helped open more than 30 American Family Care centers in New Jersey. "It's about location. It's about service. It's about making your facility accessible and welcoming. We're not on the fifth floor of a big medical building. We need to be out there so everyone can see us."

For New Jerseyans, it's hard not to.

Urgent care centers — walk-in primary care clinics — are rapidly springing up across New Jersey, from 285 in 2018 to 394 as of October, mirroring a national trend. And plans are set for dozens more in the coming months housed in places as diverse as the American Dream mall and a former Wawa near the Shore.

Easy to open — but competition for doctors?

Urgent care centers have been in New Jersey since at least the 1980s, when practices such as EmergiMed in Cliffside Park and Urgent Care Medical Group in Teaneck began offering walk-in services to patients sick enough to need a doctor but not bad enough to go to an emergency room.

Since then they have slowly become a regular part of New Jersey's health care landscape, whether treating a sick kid whose pediatrician's office is closed or becoming a key resource during the COVID-19 pandemic with people lining up for blocks to get tested.

Operators say they're pretty easy to open. There is no shortage of retail centers in New Jersey. The state Health Department does not require urgent care centers to be licensed, unlike dozens of other medical facilities. And the demand for medical care outside of a hospital during off hours or on weekends and holidays has always existed, experts say.

But family physicians, pediatricians other providers have long had concerns that urgent care centers could siphon off their patients and potential patients. The American Academy of Family Physicians even published an essay for its members: “How to Make Friends With Urgent Care.”

Doctors and even urgent care operators say their facilities should never be substituted for a dedicated primary care physician.

"Urgent care serves an important purpose but it's a Band-Aid approach to medicine," said Dr. Sally Mravcak, president of the New Jersey Academy of Family Physicians. "You need a doctor when you're sick, but you also need a doctor for wellness care. Urgent care is not going to remind you that you need a colonoscopy or a mammogram. They're not going to monitor your heart or do cancer screenings."

Almost every major hospital network in New Jersey runs urgent care centers in their coverage area —and sometimes outside of it — as a way to expand their presence, as Englewood Health did last year when it opened a center in Jersey City.

The expansion comes at a time when primary care may be changing significantly in New Jersey.

Nurses with advanced degrees may soon be able to practice and write prescriptions without doctor supervision, a move that supporters say will cut down on unnecessary delays, shorten wait times for care and help soften the impact of an impending physician shortage.

Doctors are fighting a bill that would grant those rights to nurse practitioners, saying it would water down the level of care to patients and allow employers such as hospitals and urgent care centers to hire nurse practitioners instead of better-trained and better-paid physicians to cut costs.

Medicine at its most retail level

American Family Care, the largest private operator of urgent care centers, has made steady inroads in New Jersey for 13 years, the same way McDonald’s, UPS Stores, Hampton by Hilton and hundreds of other businesses have — through franchising.

Investors buy into the franchise, look for a vacant but prime retail location, convert to medical offices, hire a staff and get rolling. Economies of scale also help with bulk purchasing power of medical equipment, along with recruiting and negotiating standard payments with insurance companies.

The process can be quick. Unlike almost 40 other types of medical facilities, urgent care centers don’t require a license from the state Health Department, said Nancy Kearney, a department spokeswoman. The only common hold-up may be getting a zoning variance from a municipality.

Location is important and New Jersey is built for exactly what urgent care operators want: a densely-populated community, busy location, lots of parking — and emergency rooms that often have long wait times. New Jersey was ranked sixth worst in the nation this year with an average wait time of 191 minutes.

"The number of people who truly need emergency care for serious and life-threatening health issues continues to increase," said Dr. Edward Fog, an executive at AtlantiCare, which runs 11 centers in South Jersey.

Urgent care centers offer at least part of the solution to "the national and global issue of overcrowding of emergency departments, which can have ripple effects to all areas of health care systems and the communities they serve," said Fog.

Choosing urgent care for non-emergency, minor illnesses and injuries helps ensure hospitals have the emergency and critical care resources to care for patients who need hospital-level care.

Like any retail outlet, appearance is just as important as the product or service when it comes to urgent care. It needs to be warm and inviting, have the right lighting and color palette, and have an open front desk with employees who are supposed to stand and promptly greet whoever walks through the door, Castelano said

And — as with with any large retail chain — there is a strong emphasis on uniformity.

"We want to make sure that if you walk into an American Family Care in Paramus or Sarasota, Florida, it feels exactly the same," Castelano said.

Hospitals expand reach

Hospitals have been getting into the urgent care game in recent years as a way to expand their patient base. One of the state's largest health networks — Hackensack Meridian — is poised to open six new urgent care centers within the next few months, adding to the 11 it already has.

The centers take pressure off the emergency departments at Hackensack Meridian’s 17 hospitals. The network is opening "urgent care plus" that can handle bigger emergencies since they're staffed with ER doctors and registered nurses and have more diagnostic capabilities such as ultrasound machines and a CT scan.

The centers also provide entry for patients to Hackensack Meridian's larger network of physicians and services. About 30% of Hackensack Meridian’s urgent care patients don’t have a primary care physician, and they will be encouraged to sign up with one in the network, said Michael Geiger, a senior vice president leading the network’s expansion of urgent and ambulatory care centers.

Urgent care staff will also send patients to network specialists if need be — keeping the care within the network and providing a quick turnaround time for a patient to see a specialist.

“We’ll have a weekend warrior come in with a badly sprained ankle and we’ll have them splinted and sutured with an appointment to see an orthopedist for a follow-up,” Geiger said.

That kind of follow-up — along with tying in a patient's primary care physician — is critical, said Mravcak. "That urgent care provider is probably going to see you once and that's it," she said. "It's your family physician who you go back to again and again, who has built that relationship, who has your medical records, who can continue to monitor your recovery."

As for opening a center at American Dream, Geiger said the mall's central location in the Meadowlands, combined with heavy foot traffic and the occasional injury at the venue's water park and other amusements, makes it a good location for Hackensack Meridian.

"You have some people who get bumps and bruises and that's what we're there for," he said. "Those are the types of patients we'll see."

This article originally appeared on NorthJersey.com: Explosion of urgent care centers in NJ changes health care landscape