Visit volume has always been a key measure of success. But while urgent care clinicians have become super-efficient at managing upper respiratory cases over the last few years, it has come at a cost. Clinics are treating fewer high acuity patients, leading to lower reimbursement — which is especially detrimental when visit volume is low or at historical averages.
Increasing patient acuity means more patients, higher reimbursement, and more stability as an industry. Let’s look at what this means, why it’s such an issue, and how to resolve it.
In medicine, acuity level refers to the severity of a patient’s illness or medical conditions. So a high or low level of acuity care refers to the complexity of the necessary treatment, and therefore, the skillset required to deliver the care.
In other words, high acuity care generally requires a more advanced level of skills. Lower acuity care is typically what a nurse practitioner or physician’s assistant can administer without additional or advanced training, which is why this is such a relevant topic in urgent care.
Twenty years ago, the differentiator that popularized urgent care was keeping non-emergent patients out of the emergency department. This included a lot of higher acuity patients, like those needing laceration repairs, casting, EKGs, fluid hydration, and other “complex” procedures. So what happened? Let’s look at contributing factors to acuity degradation.
The degradation in the urgent care scope over the last decade led to a shift away from fee-for-service payer contracts to case rates offering a flat fee. This new type of reimbursement was based on a weighted average of all services for each visit. In response, the industry started to focus on cases that could be treated most efficiently. Patients per hour per provider became the most important metric in urgent care. Clinics began to see fewer patients that needed high complexity treatments.
The arrival of COVID-19 in 2020 exacerbated the problem. Patients hoping to see a provider for stitches, ankle injuries, or other traditional non-emergent treatments could be seen sooner at the ED of the hospital than waiting behind dozens of people wanting a COVID-19 test at their go-to urgent care.
Finally, ER doctors providing urgent care were being replaced advance practice providers (APPs) – a more available and less expensive option for clinics. Today, 84 percent of providers working in urgent care are APPs, which is up from 30 percent in 2009.
In most cases, nurse practitioners and physician assistants have a narrower skillset than physicians. They need additional training to perform more complex procedures like reading x-rays and EKGs, or laceration repair. With no one to perform these procedures, patients were often referred to an ER or back to a primary care doctor for treatment – which goes against the very nature of urgent care’s original purpose.
Want to see the data related to acuity like historic E/M weights and procedure codes? They’re in the April 2023 issue of Urgent Care Quarterly (UCQ.) Sign up to receive the publication.
Moving away from high-acuity cases, combined with the case rate reimbursement model has created a troubling trend for urgent care practices. As urgent care clinics attempt to recover lost revenue by increasing efficiency, they take on more low acuity cases, and the cycle continues.
For urgent care to remain competitive, the industry must retain its acuity edge.
To make this work, providers must be confident in offering more complex services, and urgent care centers must find a way to be reimbursed properly.
Training is a great place to start. While APPs do generally have a narrower procedure skillset, they can easily be trained for laceration repair and other more complex visits. With more trained providers, clinics can stop turning higher acuity cases over to the emergency department and provide the care urgent care patients are looking for instead of sending them to the ER or a specialist.
Revive radiology (and other higher acuity services). Be sure your community knows the services you provide, it’s convenient and efficient, and it saves time and money versus an ER visit.
Clinics must identify the opportunities for expansion of services by reviewing historical data, communicating these opportunities to providers, providing the appropriate training and resources, and developing an actionable plan.
With a commitment to your plan, the number of high-acuity cases increases — especially among established patients — and reimbursement will also begin to increase.
Learn more about how to address the degrading scope of practice in this JUCM article.
Experity puts out a quarterly publication that explains trends and backs them with data. Stay current on what’s happening in the industry and compare stats against your own benchmarks. Sign up for Urgent Care Quarterly — it’s free!
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