Urgent care centers have become a growing phenomenon in the United States thanks to their flexibility. Often called “convenient care,” urgent care centers offer patients more flexible hours, walk-in availability, and are far cheaper than your average emergency room visit. It’s no wonder many Americans are choosing urgent care centers over similar forms of care.
Just last year alone, the number of urgent care centers grew to over 9,000 clinics spread across the United States. With their explosive growth, the medical focus of many urgent care centers has grown too. Not only are urgent care centers treating colds, flus, asthma attacks, and other minor illnesses, they also help out with injuries — patients with broken bones, lacerations, and minor burns. And broader services mean expanded facilities: Many urgent care centers now offer in-house x-rays, lab testing, and even more specialized services such as pediatric care.
Given the growth of urgent care across the country, state and federal-based regulations for the industry have so far lagged behind. Many clinics and healthcare professionals operating urgent care centers have managed to do so with very little legal guidance due to the lack of regulations in place. But, for most, this is merely a problem waiting to happen.
Having so few specific regulations for urgent care clinics does not equate to no rules applying at all. It also doesn’t mean things will stay this way forever. The following provides you with a quick overview of all of the regulatory considerations that you need to take into account when establishing or operating an urgent care center.
One Size Doesn’t Fit All: State Variations of Urgent Care Law
For many states across the nation, there is no single specific license for an urgent care center. That does not mean a license isn’t required, however. If an urgent care center does not require a specific license itself, then it must be operated under an individual physician’s license or under a hospital’s license. Let’s take a look at a few state examples of how this plays out.
Texas
In Texas, no specific guidelines have been established for urgent care centers. Therefore, urgent care centers can be owned and operated under a physician’s license. Urgent care centers in Texas function as an extension of the doctor’s office and, therefore, are monitored by the state licensing board.
California
In California, on the other hand, there is no current licensure for “urgent care centers,” but you could license a similar facility under already existing state-approved licensure. This may be through either a hospital outpatient department, a physician’s office, or another medical facility licensed by the state. In both Texas and California, pre-existing regulations for each license still apply.
New York
Not all states are so simple. Other states have begun to create specific guidelines for individuals interested in opening an urgent care center in their state. New York, for example, allows urgent care centers to operate as a private practice — licensed under an individual physician — but they also provide the option for such facilities to operate as free-standing clinics, also known as Diagnostic and Treatment Centers.
This guidance is provided for under Article 28, section 3401 of the Public Health Law (PHL), and Title 10 of the New York Codes of Rules and Regulations (NYCRR), section 405. But what does all of this legal jargon actually mean? Two things.
First, Diagnostic and Treatment Centers must be separately owned facilities — that is, not owned by a hospital (as opposed to the aptly-named Hospital Extension Clinics). Second, it means these free-standing clinics may offer general outpatient primary care and medical services. They can also obtain federal certification to operate as an ambulatory surgery center or an end-stage renal disease dialysis clinic.
Florida
Florida is perhaps one of the more extreme cases when it comes to variations among state regulations. In Florida, there are specific licensing requirements for convenient care facilities. These requirements include an application process and a physical space review before even being able to operate an urgent care center as a physician.
Under Florida law, the urgent care clinic may either be an off-site facility or a clinic organization that maintains three or more locations under the same name. In either case, the urgent care center will not be able to require patients to make appointments, nor can they present themselves to the public as “emergency medical care.”
As you can see, each state has a wide variety of complex laws and regulations controlling the urgent care industry. It pays to know the specific rules in place in your state when opening or operating an urgent care-type facility.
Additional Requirements for Urgent Care Centers
Many typical services offered in an urgent care center may give rise to additional regulatory requirements. Urgent care centers commonly offer lab, imaging and pharmacy services. To make matters more confusing, some states regulate the difference between an urgent care center and an emergency room.
For example, if an urgent care center in California decides to have on-site laboratory testing, several licenses and certificates will be required. First, the urgent care center must obtain a clinical laboratory license from the California Department of Public Health, as well as a federal Clinical Laboratory Improvements Act (CLIA) certificate from the Centers for Medicare and Medicaid Services (CMS).
Furthermore, if the same urgent care center in the state of California wants to offer other specialized services in the same facility — such as x-ray services or other radiological machines — they will likely need to register these machines with the California State Department of Health. The same problems arise if the clinic wishes to establish an on-site pharmacy: To do so, you will likely need to register with the state’s Board of Pharmacy.
Not only does the mere presence of regulations differ from state to state, but the restrictions themselves can be radically different. For example, many states place explicit restrictions on what you can name an urgent care center. In these areas, it is illegal to conflate emergency rooms with urgent care centers. This rule can play out differently depending on where you happen to live.
New York, for instance, maintains that urgent care centers are not intended to be used as emergency rooms and are, therefore, not subject to the Emergency Medical Treatment and Labor Act (EMTALA). In plain language, this means they are not required to accept all patients regardless of their ability to pay. Since they do not have to accept all patients, the state of New York believes the word “emergency” could be misleading for patients looking to be accepted no matter their level of insurance or cash on hand. That means urgent care centers in New York cannot include the word “emergency” in the name of their facilities.
And what if a facility wishes to receive accreditation from an accrediting organization? Although accreditation is not required in many states, it can provide facilities with a reputable name in the community by meeting the high standards of said accrediting organizations. It is certainly something to consider when starting an urgent care center.
Don’t Forget About the Corporate Practice of Medicine (CPOM)
The corporate practice of medicine (CPOM) is a doctrine that prohibits laypersons, i.e., non-physicians, from owning and operating a medical entity. States such as New York, Texas, and California are all states that adhere to the CPOM doctrine. What this means is that, although laypersons might be able to get involved in the business side of the practice of medicine, there are strict rules regulating how that happens.
When it comes to convenient care, this means that in any one of the above states, an urgent care center must be owned — or at least partly owned — by physicians.
If someone other than a physician is interested in becoming part of (or investing in) an urgent care center, and they are not a licensed provider, there are ways that you can become involved in the business operations of that urgent care facility. The most common solution is a management services organization (MSO) that can legally run the business side of the practice without interfering with the medical side. To learn more about CPOM, check out our five-part Texas Corporate Practice of Medicine Field Guide.
States have numerous and differing regulations for urgent care centers, and several states give little to no guidance at all. With the right help, you can navigate a complicated and ever-evolving regulatory environment with safety and security.
If you have questions about how to remain compliant, schedule a consultation at info@byrdadatto.com.
