About 15 years ago, Lakewood resident Desiree Sankey-Boutte and her sister went to their local hospital emergency room one night, where they found themselves waiting hours to be seen.

While waiting, someone sitting next to them suggested they head over to the urgent care center nearby.

“We went over and within minutes after we entered this very nice gentleman came out and called us in,” said Sankey-Boutte, a retired law librarian. “They made us feel so comfortable.”

Since then, that urgent care center has been the first place she heads to when sick or needing other care. And the “nice gentleman” who helped them turned out to be Vinson Eugene Allen, who owns Dusk to Dawn Urgent Care, a chain of five urgent care centers in Southern California that has gone through a few twists and turns since he founded it in 2001.

Dusk to Dawn is among a small contingent of Black-owned urgent care chains in the nation. In May, Allen opened his most recent center in Lancaster. The other facilities include the flagship in Paramount and centers in Long Beach, Anaheim and San Diego – all of which combined employ about 110 staff members.

Last year, Dusk to Dawn’s existing urgent care centers had a total of about 21,000 patient visits with a total net patient revenue of nearly $14 million.

As Dusk to Dawn Urgent Care has expanded, Allen has focused on setting up shop in underserved areas. “We like to go into communities that have shortages of urgent care centers,” he said. “Often, local officials ask us to come in.”

Emergency room roots

Allen worked as an emergency room physician for several years in the 1990s at both the former Martin Luther King Jr. Hospital in Willowbrook and at Desert Valley Hospital in Victorville.

He said that often families would bring their children to the emergency room to get a minor abrasion looked at, and they would wait all night as the staff at the overcrowded facilities dealt with more serious traumas, like gunshot wounds or heart attacks.

“I thought to myself, ‘There must be a better way to get these people the treatment they needed without waiting all night,’” he said.

Allen struck out on his own and opened his first urgent care center in Paramount in 2001. He said he named it Dusk to Dawn Urgent Care in reference to the emergency room environment: “Dusk is when the patients would come into the emergency room and dawn is when they would finally get treated.”

His timing was fortuitous. In the late 1990s, urgent care centers began rapidly proliferating to meet this demand for alternatives to the emergency room. Urgent care centers began to occupy the “sweet spot” between the hospital emergency room and all of its demands and the primary care physician who only works with patients who schedule visits days or weeks in advance.

Today, there are about 15,000 urgent care centers nationwide, according to Lou Ellen Horwitz, chief executive of the Washington D.C.-based Urgent Care Association.

“It all traces back to the consumerism of the patient community,” Horwitz said. “We’ve all moved into the mindset that we want care when we need it.”

She added that to her knowledge, she was aware of only one or two other Black-owned urgent care center chains in the nation.

The push for more urgent care centers was helped by a wave of closures of hospital trauma centers in the 1990s. That made for even longer wait times at the emergency rooms that remained open.

Insurers also embraced urgent care centers as a way to treat patients in a less-expensive fashion – without all the overhead that hospitals bring, Allen said.

Growth: Twists and turns

For the first several years, Allen gradually built up his urgent care business. In a common strategy at the time, Allen chose to focus his centers on all three major service levels: emergency-room caliber trauma care; clinic-level care with specialists like pediatric care and cardiologists; and primary physician-level care such as treating a cough or sore throat.

In the ensuing decades, many urgent care centers dropped the more expensive emergency room-level care. But Allen kept that portion of the business going.

“Many urgent care centers don’t do the emergency room-level care, but, because I came from the emergency room side, I felt that was absolutely crucial,” he said.

The only caveat to the emergency-level treatment is that no patient can stay overnight or longer. For that, a trip to the hospital is required.

Dusk to Dawn’s first expansion came two years after its founding with the opening of a second center in Long Beach.

Over the next 15 years, Allen opened five more centers in Lynwood, Gardena, Anaheim, downtown Los Angeles and finally Montebello.

Allen was preparing to open even more centers outside of the Los Angeles basin when the Covid-19 pandemic hit.

“Many of our employees and doctors simply stopped working,” he said.

When the leases came up at the centers in Lynwood, Gardena, downtown Los Angeles and Montebello, Allen said he no longer had the volume to justify renewing those leases and decided to shutter them.

Only three centers remained: the original Paramount location, Long Beach and Anaheim. During the pandemic, all three locations had tents set up in their parking lots to treat patients.

It wasn’t until the end of 2023 that Allen and Dusk to Dawn Urgent Care were ready to resume growth. This time, the focus has been outside the Los Angeles basin. In February of last year, the company opened a center in San Diego. This past May, another center opened in Lancaster.

The biggest challenge with this latest round of openings, Allen said, has been understanding the payor mix between government-funded programs, like Medicare and Medi-Cal, and commercial insurance. For instance, he said, San Diego had more of a focus on Medicare Advantage plans.

Also, with the broader geographic reach, Allen said he’s been relying more on Zoom meetings to manage the more distant centers. And he’s also put people in charge of running the Lancaster and San Diego centers.

Another challenge has been the shift – especially among smaller insurance companies – to a capitated model of payment, with a flat payment amount for each patient treated, regardless of what it actually costs to treat each patient. Allen said that makes it more financially challenging to treat patients who require a higher level of care.

More hurdles ahead

Like all health care providers these days, Dusk to Dawn Urgent Care faces a formidable set of challenges in the months and years ahead. According to Horwitz of the Urgent Care Association, labor and supply costs are rising rapidly, while reimbursements for care, especially from the federal Medicaid program, have not kept pace.

“That spread has gotten ever larger, especially in the last few years,” she said. “Urgent care centers have always been a low-margin business, and these trends are really putting the financial squeeze on many of them.”

Those hardest hit are smaller chains such as Dusk to Dawn, Horowitz added, though overall the ever-increasing demand for urgent care centers has so far offset this cost squeeze.

Allen said he is now very concerned about the impact of cuts to the Medicaid program.

The House budget bill that passed in May would cut nearly $800 billion from the Medicaid program over the next 10 years The Senate budget bill that passed last week would cut about $930 billion over the next decade. The final bill that Congress passed on July 3 appeared to adhere more closely to the bigger cuts in the Senate version, but full details were not available as of press time.

“The Medi-Cal population is the main community I serve,” Allen said, referring to the California-administered Medicaid program. “What happens as you squeeze the cuts on these individuals, you end up seeing sicker patients and it costs more to treat them.”