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Author: UCA Admin/Tuesday, March 03, 2020/Categories: Industry News
This article originally appeared on BenefitsPro written by Laurel Stoimenoff
Urgent care centers are providing an increasing amount of Americans' primary care. Is it time to rethink how we pay for such services?
Today’s urgent care centers provide many of the same services offered by primary care providers, delivering medical evaluations, treatment and diagnostic services – including onsite radiology and laboratory – rendering them one of the highest value locations to deliver care to patients. While traditional primary care services remain the foundation, many centers continue to innovate and expand their services to meet patient trends with offerings that expand the scope of practice, including physical therapy, travel medicine, telehealth, occupational medicine and employer services.
In addition, urgent care centers ensure patients are able to receive care during the evenings, weekends and other times that are convenient for them, helping to alleviate overcrowded emergency departments so their resources can be directed toward treating emergency situations. According to a National Health Statistics Report, among adults aged 18 to 64 who used the emergency department in the past year, 11.8 percent indicated “the doctor’s office or clinic was not open” as the reason for their visit and 7 percent noted a “lack of access to other providers.”
Key to connecting patients to primary care providers through appropriate communication and integration, urgent care centers also serve as the “front door” to primary or specialty services, as 25 percent of patients seeking care in an urgent care are unaffiliated with a primary care physician or medical home, according to the Urgent Care Association’s (UCA) 2019 Benchmarking Report. This is supported by the Kaiser Family Foundation Report indicating that 18 percent of women and 28 percent of adult men have no primary source of health care.
For Americans who do have a regular physician, only 57 percent report having access to same or next-day appointments with that physician. In addition, 63 percent report difficulty getting access to care on nights, weekends or holidays without going to the emergency room, according to the Commonwealth Fund International Health Policy survey.
Data from the Centers for Disease Control and Prevention (CDC) National Ambulatory Medical Care Survey (NAMCS) and the UCA 2019 Benchmarking Report find an estimated 27 percent of all primary care visits and 14.9 percent of all outpatient physician visits take place in urgent care. And the importance of urgent care centers will only grow, as the Association of American Medical Colleges (AAMC) predicts a shortfall between 14,800 and 49,300 primary care physicians by 2030.
Urgent care centers provide and will continue to deliver a significant amount of the primary care in the country and support primary care practices through easy access to same-day care and collaboration. Yet, copayments for urgent care center visits are trending upward, oftentimes higher than those of a specialist.
The fight for fair reimbursements
A recent position statement from UCA explains how the restrictions placed on the scope of services provided and follow-up care offered at urgent care centers, as well as the application of global or fixed reimbursement rates, are not in the best interest of the patient’s health and curb clinicians’ ability to provide care consistent with clinical practices.
Limiting the scope of urgent care services covered by health plans assumes that consumers seeking care at urgent care centers have access to a primary care physician, when many times they do not. Payer contracts may also constrain follow-up care in urgent care centers, including when the patient is either geographically displaced from their primary care physician due to travel or relocation, or unaffiliated with a primary care provider. This policy forces patients to seek care in potentially overcrowded emergency departments, or to go without follow-up despite medical necessity.
For example, many patients seek care in the urgent care center when traveling, yet some contracts deny any follow-up care unless it is with a primary care provider, putting their safety at risk. A 2018 report found approximately 10 percent of patients age 18-64 have delayed or not sought needed or necessary care due to cost. High copayments as part of plan design inhibit patients from pursuing treatment, leaving many to only seek care after their medical condition has worsened.
In addition, payers frequently apply global or fixed rates for urgent care centers, which has an adverse effect on the implementation of new, innovative services to better treat patients.
For example, fixed reimbursement rates stifle many urgent care centers from employing processes and procedures that allow them to better prepare for emergency department diversion of higher acuity cases or applying new diagnostic services. Rather, payers should evaluate each urgent care center’s performance and services when determining reimbursement rates.
One tool many payers are leveraging when establishing requirements for in-network status that evaluates each center on an individual basis is urgent care accreditation. Achieving accreditation is one of the many ways urgent care centers can affirm their commitment to meeting the highest possible standards of care with a commitment to ongoing education and quality improvement.
The value of accreditation
A growing number of urgent care centers demonstrate the high standards of care delivered to both patient and payers by voluntarily undergoing rigorous on-site accreditation surveys from UCA or other accreditors. Accreditation distinguishes urgent care centers that meet national standards for safety, quality and scope of services. The UCA’s accreditation program, for instance, is the only one of its kind to include scope of services. Accreditation also provides additional benefits to a facility’s processes, procedures and staff.
Going through the accreditation process helps urgent care centers develop and implement consistent procedures, making every required standard a routine practice that can lead to unanticipated efficiencies.
Achieving accreditation requires teamwork and generates a sense of pride and accomplishment among clinical teams and staff. Engaging staff in the values of quality and safety often results in more involved, customer-focused employees. Furthermore, accreditation gives patients the peace of mind that a center has demonstrated compliance that meets or exceeds industry best practices.
As a result, an increasing number of payers are recognizing the value of urgent care accreditation by making it a requirement to remain in their network. Accreditation is a valuable point of reference payers can utilize to gauge a center’s dedication to quality and safety as well as provider credentialing, privileging and onboarding, while underscoring their value to patients, providers and payers alike. As a result of UCA’s comprehensive approach and high standards, many medical malpractice insurance carriers are already taking notice of UCA-accredited centers’ dedication to quality and safety, offering organizations a risk management credit of 2.5 percent to 15 percent.
Urgent care centers are and will continue to be integral to the care continuum, playing an important role in population health. More than 1,200 centers have already demonstrated a comprehensive commitment to quality care, clinicians, programs and services by pursuing and attaining UCA accreditation. When establishing its standards for accreditation, UCA gathered and considered many of the network participation survey requirements of payers, hoping that UCA accreditation could also eliminate the need for urgent care providers to participate in multiple surveys.
However, to ensure the valuable on-demand services supplied by urgent care centers remain accessible to patients, payers must extend co-payments on par with those offered to traditional primary care providers.
Laurel Stoimenoff, PT, CHC, has served as chief executive officer of the Urgent Care Association since January 2017. Prior to her role at UCA, Laurel was involved with UCA in multiple capacities, including Chair of the Urgent Care Foundation, UCA Board member and officer, Co-Chair of the Accreditation & Certification Committee, Chair of Health & Public Policy and Payer Relations, and an active member of the Benchmarking, Nominating and Finance Committees. She is also on the editorial Board of the Journal of Urgent Care Medicine.
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