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URGENT CARE: BRINGING OUR VALUE PROPOSITION TO THE PAYER COMMUNITY

Posted By Laurel Stoimenoff, PT, CHC, Thursday, February 9, 2017

UCAOA’ s most recent Benchmarking Report data indicated the median number of patient visits per day in an urgent care center was thirty-two, down slightly from the prior year; however, based on the current database of urgent care centers in the United States, this would translate to urgent care centers caring for nearly 85 million visits per year.  According to a 2012 data reported by the CDC’s National Ambulatory Medical Care Survey (NAMCS),[1] outpatient physician office visits were reported as follows:

  • Total visits: 928.6M
  • Visits per 100 persons: 300.8
  • Percentage of visits made to primary care physicians: 54.6% 

Therefore, assuming ambulatory care visits remained consistent with activity reported in 2012 and primary care visits represent 54.6% of all visits (or 507 million) urgent care would represent over 16% of all primary care visits and over 9% of all outpatient physician visits.  Statistically, it would seem that urgent care has earned its seat at the table as we discuss reform. 

Recent studies conducted in Massachusetts and Colorado concluded that 40 percent of emergency department visits were for non-emergent conditions that could be more appropriately and cost-effectively cared for in less acute settings, including urgent care centers.  The study published by the Massachusetts Health Policy Commission illustrated that emergency department visits per 1000 residents were reduced by 30 percent[2] in those markets where urgent care centers or retail clinics had a presence.

It would seem that all this would be cause for great optimism yet our phones ring with members pleading for help. The contracting and credentialing process has become so protracted that it threatens the viability of many start-ups, particularly if they did not have the foresight to begin the process early in their development plans.  Networks are being narrowed in many areas principally by denying access to new entrants. Contract language specific to urgent care centers now often dictates staffing models, hours of operation and places limitations on wellness and follow-up care despite the fact that many of our patients are geographically displaced from their primary care provider, cannot access their PCP or simply do not have one.  These new rules of participation extend far beyond those of state medical boards charged with public protection.  Established urgent care organizations may being exhaling a sigh of relief that this isn’t their problem; but, what happens when that contract comes up for renewal? 

We all have a responsibility to demonstrate our worth.  While UCAOA will continue to have dialogue at a national level, most payer negotiations are at the state or regional level, which is why the industry needs the support of our members and we need to provide tools to support you.  So what can we you do whether on the outside looking in or sitting on an existing contract?

  • Be relentless in your attempts to secure an audience with payers in your community. Demonstrate how you are innovating and how your organization’s strategies align with those of the payer.
  • Integrate with the greater healthcare community.  If the patient has a PCP, work to establish reasonable communication methods that ultimately reduce costs, eliminate redundant testing and improve health.  Operating in silos is dead.
  • Demonstrate how your center is prepared to support ED diversion strategies.
  • Provide data.  The payer community has access to an immense amount of data but the urgent care center has the unique opportunity to provide relevant information that they either don’t have access to, or haven’t thought to collect.  How many of their members report to you that they do not have a PCP? If they have a PCP, was he or she accessible when care was needed? How many of their members sought care after 5:00 PM during the week or on weekends and what savings from an E.D. visit was therefore realized? How many of their members received radiography, lab or other services often delivered outside of the office visit as part of the payers global fee?
  • Use the data to educate payer representatives on the value your center(s) bring to the equation and seek opportunities for improvement.
  • Share your successes and best practices as well as barriers with UCAOA’s Payer Relations Committee.  It has strategic agenda to advance on behalf of our members.

Our voice deserves to be heard. The payer community is tasked with implementing tremendous change. Let us all ensure that the message we deliver offers solutions.


Laurel Stoimenoff, PT, CHC, is chief executive officer of the Urgent Care Association of America

Read more of Laurel's insights in her CEO column in the February issue of the Journal of Urgent Care Medicine.


[1] Source: http://www.cdc.gov/nchs/fastats/physician-visits.htm:

[2] Massachusetts Health Policy Commission 2015 Cost Trends Report, Emergency Department Utilization

Tags:  contracting  credentialing  payers 

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