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On April 22, 2021, Experity hosted a webinar on key urgent care trends in a post-COVID-19 world. Joining our President of Strategic Initiatives — Alan Ayers — were two highly-respected industry experts: Claudio Varga, Director of Operations at Vital Urgent Care, and Omid Akbari, Executive Director of East County Urgent Care.

During the webinar, we received a lot of great audience questions.  We’ve included those most widely-applicable below for long-term reference.

Primary care

How do you handle the issue of having a higher copay for those having to see the urgent care provider when the primary care side is unable to see them during normal primary care hours?  

Typically, there are firm rules that delineate what’s urgent care and what’s primary care. Primary care is scheduled, wellness, vaccines, etc. Contrarily, urgent care is unscheduled, same-day, episodic. If a scheduled appointment cannot be honored, then it would be re-scheduled the same as in a PCP office. If the patient cannot wait for the PCP appointment and must be seen same day, then that would qualify as urgent care. Copay differentials do become a patient issue in this model, so it is important that a policy be set and stuck to.

Have you had any pushback from primary care physicians getting involved in their sector versus episodic care? We get a lot of referrals from primary care and these referrals may be impacted if we got into their sector.

I think this would depend on the referral dynamics in the community. If a UC is receiving a lot of PCP referrals, then they should consider the value of those relationships before alienating any local PCPs. My experience is that many independent PCPs do not refer to urgent care, and in large medical groups have competing same-day access models.

I looked into adding primary care, and in Texas I was told that you have to have two providers every day you do primary care as the provider cannot see both urgent care and primary care on the same day. Have you come across this?

I have not seen that. Is that a specific payer requirement? Some payers do require hospital admitting privileges and 24/7 on-call availability for PCP — requirements that don’t apply to the urgent care model.

When set up for primary care and urgent care, do you use POS 20 or 11 for billing?

Usually if there are separate contracts, POS 20 would be used for “urgent care” and 11 would be used for “primary care.”

Our urgent care has incorporated primary care at one location. We’ve designed it such that PC care is available two days a week with the same provider. Would you suggest UC billing codes for PC patients seen during extending hours or w/o PC appointment?

I have observed that practices in the dual-model bill unscheduled, after hours, and episodic visits as “urgent care” while they bill scheduled appointments, wellness physicals, vaccines, and preventive services as “primary care.”

In Portland, OR, about 50% of patients we see don’t have a PCP. You said the number was 30%?

The rate is going to vary by area, demographics, availability of primary care, etc. To say 50% without a PCP just means more opportunity for primary care in the community.

Capitation, KPIs, and COVID-19

How do capitated payment models affect these trends?

Capitation, which pays providers a fixed monthly premium for managing a patient’s total health, is tied more to ACOs/HMOs/population health, and other gatekeeper/outcome-based systems. In a capitated system, providers are often “at risk” — meaning, if they spend less than the monthly premium on the patient’s health, they make a profit on the patient. But if they spend more, they lose money on the patient that month. Other than the large integrated health systems (like Kaiser, Geisinger, Henry Ford, and Intermountain,) capitation hasn’t really taken off in the commercial space. Rather, it’s primarily a Medicaid/Medicare/Dual-Eligible (Medicare Advantage) phenomenon. Where there’s a proliferation of Medicare Advantage populations, patients are typically steered to large medical groups, and their health insurance plan design often requires a referral and pre-authorization to even use urgent care. We have seen PCPs get a monthly fee — i.e., two to three dollars — for “carrying the chart” (or being the patient’s gatekeeper PCP), but most of the primary care you’ll find alongside urgent care is fee-for-service. The trend towards more patients in capitated payment models would be a threat to this side-by-side model of primary and urgent care because I’m not currently aware of any successful capitated model in urgent care.

What are the most effective business ops KPIs you use?

Great question! We recently covered this in our webinar “KPIs to Measure in Your Urgent Care.”
You can watch the recording here.

What are your recommendations for implementing COVID-19 vaccinations in urgent care?

I’ve not spoken to anyone doing vaccines in urgent care because UC was largely overlooked in the initial distribution rounds  Omid was offering them for a short period of time until the State of California cut off East County’s supply. The problem for urgent care has just been getting access to vaccine inventory.

When you are doing COVID-19 testing are you doing an E&M visit?

Yes, unless it’s for an employer paid service.

More from Experity

If you haven’t seen the webinar or would like to watch it again, it’s available on-demand:
▶ 4 Emerging Trends for a New Era in Urgent Care

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