Broke in Philly

Urgent cares are suddenly everywhere in Philly. Can they help boost the city’s health?

Over the past four years, Vybe has doubled Philadelphia’s stock of walk-in clinics.

Vybe has opened 11 urgent cares in the Philly area since 2016

Vybe has opened 11 urgent cares in the Philly area since 2016

Michaela Winberg / Billy Penn
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Urgent care centers have been opening at a rapid clip in Philadelphia. Likelihood is you’ve seen at least one Vybe-branded storefront on your last walk around town.

The boom is part of a nationwide trend as people try to fill a void in the health care system, filling a useful middle ground between a long-lead doctor’s appointment and a costly visit to the emergency room.

Walk-in clinics have existed for decades within Philly hospital systems like Jefferson, Temple and Penn. But the expansion by a private company is relatively new.

Roxborough-based Vybe was founded in 2016. Since then, it has opened three suburban locations and eight city storefronts, including in Port Richmond, University City and South Philly. There are two in Center City, one in Spring Garden and more on the way: CEO Peter Hotz is currently planning launches in Cobbs Creek and on North Broad.

Put it together and over the past four years, Hotz has essentially doubled Philadelphia’s stock of urgent care centers. They join a local heath care landscape tattered by a major hospital closing last year and varying access to primary care depending on where you live.

“I’ve been struck by the disparities in access to health care in this city,” Hotz told Billy Penn. “Life expectancy changes from one zip code to another.”

His statement refers to a report released last summer by the city Health Department showing how life expectancy correlates with neighborhood.

On average, men from Nicetown die before age 64, while men from Center City East usually make it to 82. And while women in Upper Kensington reach 71 years, those in Center City West have an average life expectancy of 84.

Can urgent care help even the disparities?

An exam room at the UCity Vybe

An exam room at the UCity Vybe

Michaela Winberg / Billy Penn

Why primary care is important

In 2018, Philly’s health department calculated there’s one primary care doctor for every 1,243 residents, and an average wait time of nine to 16 days for an appointment.

That’s actually slightly better than the national average — but disparities here are intense. Parts of Port Richmond, Northeast, West and South Philly have one doctor per roughly 10,000 residents.

Latanya Williams lives in Philly’s Feltonville neighborhood, which records lower access to primary care than the city’s average. She popped into the Port Richmond Vybe one Thursday afternoon with three of her five kids in tow. She scooped them up from school when the nurse called, informing her they all had stomach aches.

“They’re not feeling well,” said Williams, 33. “I’m just coming in to be sure.”

It’s her third time at the Aramingo Avenue health center. She has a primary care doctor for her kids too, and she takes them there every year — but she keeps coming back to urgent care. “I like it here because it’s quick,” she said. “No one wants to sit for all that time. This is a lot better.”

Research on how quick-stop medical centers impact communities in Philadelphia is sparse, according to Philly Health Department spokesperson Jim Garrow.

Some data suggest the appearance of clinics like Vybe can keep folks from going to a regular doctor. Nationwide research shows a trend away from primary care and toward urgent care — which can be worrisome, because skipping a regular relationship with a medical doctor makes it harder to detect and diagnose signs of deteriorating health over time.

“There’s a time and a place for urgent care, just like there’s a time and a place for primary care and for the ER and for the hospital,” said Dr. Margot Savoy, a primary care doctor and family medicine professor at Temple. “I’m not sure people always pick the right location for what they need. Sometimes I think we can do a better job helping them get where they need to be.”

More than half of Vybe’s patients report that they don’t have a primary care doctor at all, according to Hotz.

It’s common, per Vybe’s medical director Geoff Winkley, for young people to come in with general fatigue, or high blood pressure — conditions that would really benefit from a regular relationship with a primary care doctor. Sometimes, folks will come into Vybe for a physical exam.

“Physicals are a big business for urgent cares across the whole country,” Winkley said. “It’s just the reality of primary care. It’s stretched thin.”

Philadelphia Health Commissioner Thomas Farley said trying to give people better access to primary care is still essential.

“It is too early to determine the impact [of urgent care] on Philadelphia’s health system or the health of residents,” Farley said, “but they are not a substitute for an ongoing relationship with a strong primary care provider.”

The Vybe urgent care at 36th and Market

The Vybe urgent care at 36th and Market

Michaela Winberg / Billy Penn

People walk in with gunshot wounds

Savoy, the Temple doctor, has plenty of experience with situations of people who’ve substituted urgent care for primary care.

A patient came in last month assuming they were in tip-top shape, since they’d visited urgent care docs and specialists a bunch in the last few years. But Savoy immediately flagged that their mammogram was late, and they hadn’t gotten some necessary vaccines.

On site, Vybe can perform x-rays and fill some non-narcotic prescriptions. Each site has a closet full of orthopedic wraps and boots, flu shots and rapid-response tests for pregnancy and illnesses like strep and mono.

Vybe accepts Medicaid, and if you don’t have insurance, the centers offer a basic visit for just $125. But sometimes things go too far in the other direction — with people relying on the urgent cares when they really need to head to the ER.

“Up at Port Richmond, somebody walked in and said, ‘I got shot,'” CEO Hotz said. “And the team said, ‘Well, when did you get shot?'” And he said, ‘About a week ago, but it’s starting to turn green.'”

That happens at the University City location too.

“About a week and a half ago, actually, we just worked a heart rate of 180 that we couldn’t break here in the clinic,” said Howard Neil, Vybe’s West Philly clinical team lead. “That’s a problem because your heart is starved for oxygen, among other things.”

Roughly 2% of his patients are in situations like those, Neil said. In those cases, he’ll call an ambulance.

Each Vybe urgent care also has a procedure room for more serious issues — like cuts that require stitches

Each Vybe urgent care also has a procedure room for more serious issues — like cuts that require stitches

Michaela Winberg / Billy Penn

Urgent cares = access, but also profit

Why’s Vybe expanding so rapidly in Philly? For one thing, the CEO’s from the area.

Hotz grew up in the suburbs and was always struck by the area’s lack of urgent care centers. In 2010, the region only had a couple freestanding facilities, plus a couple within larger hospital systems like Temple and Jefferson.

“We looked at Phoenix, which is really close to Philly from a population standpoint,” Hotz said. “And it had about four times the number of urgent cares per capita that Philadelphia had.”

Hotz tapped into a lucrative industry. Set at the corner of retail and health care, urgent cares are massively profitable — since they get similar payout from insurance companies, but operate on a model of squeezing in as many patients as they can.

Vybe earned big investments in 2018 from the Philadelphia College of Osteopathic Medicine and NewSpring Health Capital, which helped the company bloom.

With 11 Vybe sites already open — and more coming — each location has six exam rooms staffed by two clinicians. There’s a procedure room, reserved for more serious medical issues, like heart problems or wounds that need stitches.

Port Richmond is the company’s most popular site, seeing 80 patients per day. The newer University City location clocks 30 daily visits on average, with a high of 48 patients.

“People begin to rely upon us,” said Winkley, Vybe’s medical director. “At least for that, you know, take a first look and see what you think is going on, even if you think I need to go somewhere else.”

He said he doesn’t want to fill the role of a primary care doctor, but instead provide another access point to health care entirely. That’s why, if their patients say they don’t have a regular doc, Vybe provides a list of them in the neighborhood

“I don’t think urgent cares are bad,” said Savoy, of Temple. “Sometimes you need to be seen and your doctor isn’t available. The part where I worry about people sometimes is, are you really getting the care you’re supposed to be getting?”

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