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The GOP’s tax bill goes into effect today. That might not seem all that newsworthy in the urgent care space, but entrepreneurial urgent care providers will recognize that the repeal of the Affordable Care Act’s individual mandate as a part of the tax bill places the urgent care industry in a prime position to grow – if urgent care providers are strategic.

By having a sensible self-pay policy and building strong relationships with primary care physicians, urgent care providers can take advantage of this provision to drive these newly uninsured patients right through their doors.

How the GOP Tax Bill Impacts the Health Care Industry

The tax bill eliminates the ACA’s individual mandate that penalizes U.S. residents who don’t have health insurance. What will this do? The Congressional Budget Office (CBO) estimates that, unless other legislation is passed in its stead, this will lead to about 13 million more uninsured Americans by 2027.

According to the Advisory Board, this is bad news for primary care physicians. “While estimates of magnitude vary widely, the fact that repealing the mandate will increase the uninsured rate is undisputed,” says Yulan Egan with the Advisory Board. “…provider organizations are already grappling with a range of margin pressures—increases in bad debt, declines in utilization growth, and downward pressure on reimbursement—that make weathering even small increases in uncompensated care extremely challenging.”

Primary care physicians’ financial challenges from the tax bill won’t be limited to the individual market, either. The CBO estimates that by 2025:

  • 5 million fewer people will have non-group coverage,
  • 5 million fewer people will have Medicaid coverage and
  • 3 million fewer people will have employer-sponsored coverage.

This leaves primary care physicians challenged with an increasing number of self-pay patients, making it even harder for primary care physicians to avoid delays in necessary care or unnecessary ED visits.

And that’s where urgent care providers come in.

How Urgent Care Providers are Poised to Grow

Urgent care providers are in a prime position to grow their practices if they use this provision strategically. As a retail, consumer-focused, accessible health care channel, urgent care is the natural complement to primary care, and as the impacts of this provision take effect, urgent care providers should have processes and systems in place that appeal to cash-pay patients to widen health care access to the newly uninsured population.

By building relationships with primary care physicians, urgent care providers can help primary care physicians load-balance their episodic, urgent cases so primary care physicians can focus on wellness checks, follow-up care and caring for patients with chronic conditions, which will help primary care practices avoid unnecessary ED visits. This isn’t just a one-sided relationship, however. Urgent cares benefit from this type of arrangement because primary care offices drive that patient traffic to urgent care centers when primary care offices are closed or overloaded.

With a solid self-pay policy in place, urgent care providers will be prepared to help the influx of patients who no longer have insurance to cover their health care needs. For urgent care providers, this is good news. Self-pay typically expedites the urgent care billing process because there’s no need to submit anything to the insurance company; payment is collected at the point-of-service. Not only does this have the potential to grow patient volume, but being prepared to do self-pay can:

  • Improve a center’s cash flow
  • Result in a savings of $10-$15 per claim in billing, collections and posting costs
  • Save a center’s accounts receivable carrying costs
  • Save a center’s bad debt write-offs
  • Eliminate the need for insurance verification

The GOP tax bill may not appear to have a direct impact on the urgent care industry, but entrepreneurial urgent care operators will take advantage of the opportunity to evaluate their self-pay policies and to build relationships that will help their practices grow.

PV Billing’s urgent care billing specialists are trained to code, process, monitor and collect urgent care claims so they can provide you with end-to-end revenue cycle management.

This resource was first published prior to the 2019 merger between DocuTAP and Practice Velocity. The content reflects our legacy brands.

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