Delivering Primary Care in an Urgent Care Clinic

Primary Care in an Urgent Care Clinic

Like all business enterprises, healthcare has its niches—at Experity, we call them specialties. There was a time when urgent care was considered a niche market, an alternative to traditional primary or emergency room care. No one could imagine that urgent cares would become the dynamic, essential industry it is today.

Accelerated by the coronavirus outbreak, healthcare consumers are choosing the convenience of urgent care to avoid waiting rooms and long lines, and to be tested for the virus. An untapped resource at the onset of the pandemic, urgent care clinics are now seeing record-breaking visit volume that surpasses the busiest days of flu season.

Living and working with the pandemic ushers in a new norm for urgent care clinics that includes delivering primary care and scheduled services, telemedicine, and occupational medicine, in addition to non-emergent acute care.

Many primary care physicians may be surprised by how many of their regular patients choose urgent care for its convenience. This migration is a reflection of today’s consumer, who wants non-emergency healthcare to be as handy as picking up coffee at the drive-through window.

Though this is an exaggeration, it’s not far from the truth. While patients want their clinic to provide quality care for their families, they also want it to fit their schedule with as little life-disruption as possible. This is especially true in a world where risks are high, and everything seems disrupted.

Urgent care is the best solution—and clinics across the country are offering testing, follow-up care, telehealth services, and primary care for returning patients. They have responded to the demand with flexibility and ingenuity, which is how urgent care continues to evolve.

If your clinic is looking for ways to meet the changing demands of the new normal, now is the time to expand your clinic with ancillary services like primary care.

Making Room for Primary Care

As it turns out, urgent care clinics have many of the tools they need to deliver primary care services, with the exception of the one thing: software to accommodate this new category of patients and the workflows associated with them.

Because urgent cares handle predominantly episodic visits, many clinics do not have access to high-level overviews of patients’ visit histories or active problem summaries for patients with chronic conditions. This makes it hard to appropriately assess the condition of primary care patients and treat longer-term conditions.

To treat primary care patients in addition to your urgent care patients, you also need solutions that allow you to easily review active problem summaries and document chronic problems without leaving the patient’s chart. If you choose to offer primary care, you also need solutions that allow practitioners to view past labs and track graph analytes. The ability to track and graph previous height and weight values and growth charts is also important. Having the right information at your fingertips removes the common roadblocks that keep clinics from seeing primary care patients quickly and efficiently.

But the availability of face sheet information isn’t enough. One of the keys to urgent care success is efficiency. Switching from one workflow for urgent care to another for primary care slows down processes and decreases efficiency. To increase your efficiency, you need a solution that allows you to document urgent care and primary care visits side-by-side within a single system.

Even with these resources in place, you have another challenge to overcome—improving scheduling and referrals. Unlike episodic visits, you need to be able to manage primary care patients for recurring visits and follow-ups, as well as refer patients to specialists as part of your regular process. Your solution should accommodate this without adding time-consuming activities to your staff’s workload.

Integrated Online Scheduling

While offering online visit scheduling is common practice for urgent care, it becomes even more important for handling primary care patients.

Many marketplace solutions offer online scheduling software that lists your clinic—and all their other client clinics near you— when people search for a doctor close-by or your clinic name. If you choose this solution, you won’t have to make any changes to your website—but you will have to compete with other physicians using the same solution.

To have more control over your online appointment interactions, you can choose an alternative “white label” solution (like Experity Engagement) and a partner that offers software that integrates with your website offering scheduling directly on your clinic’s home page. This makes it convenient for your primary care patients to schedule their care, keeping urgent care patients happy and shortening their door-to-door time.

Patient Queues

To take the next step in becoming a primary care provider, transparent patient queuing helps you keep all patients aware of their place in line. With visibility into a real-time queue that notifies them if there are any delays, patients can adjust their schedule and avoid waiting.

Patients should be able to see the queue online for the current estimated wait time. Information for all patients, whether they scheduled in advance or just saved their spot in line, should be integrated into one queue so the estimated wait times are accurate.

This is an ideal solution for patients who are loyal to a specific clinic. Not only do they get to see a provider at a facility they prefer, but they can do it without waiting in a crowded waiting room. The upside is that all your patients benefit—even those that made their appointment by phone can check wait times to see if they should hurry or can take their time.

What About Billing and Contracts for Primary Care?

If you’re considering adding primary care to your urgent care offerings, you may be asking yourself if it makes sense to change your contracts. As a first step, it’s important to get information on contract rates and billing to understand how contracting as a primary care provider might affect your revenue cycle and reimbursement.

According to Tammy Mallow, Experity’s expert on contracting and credentialing, every clinic is different. She says that most reports show average revenue per user for primary care is lower than in urgent care.

The difference is not necessarily because urgent care providers are offered a better fee schedule or rates, but because of the way an urgent care operates. Urgent care providers see more new patients, perform more procedures and other ancillary services, and see more high acuity patients which typically results in higher E/M and other codes that generate higher reimbursement.

On the flip side, primary care providers see more established patients, generally lower acuity ( for example, fewer accidents, injuries, or episodic illnesses), and more nurse-level and follow-up visits that result in lower E/M codes, fewer ancillary codes, and consequently, lower reimbursement.

It can be possible to operate like an urgent care clinic under a primary care contract. A final consideration for reviewing contracts is evaluating your flat or global rates. While these are more common in urgent care clinics, Tammy notes that she has never seen them offered to primary care providers. Using a flat-rate reimbursement schedule, urgent care rates will be different from primary care rates regardless of the way a clinic operates.

Is Primary Care a Good Choice for You?

While healthcare professionals tend to see urgent care and primary care as very different ways to provide healthcare, patients don’t. They want the same level of service from their urgent care provider as they get at their regular doctor’s office (and vice-versa).

The healthcare market is going through big changes such as mergers and acquisitions, partnerships between urgent cares and health systems, and the need for additional resources due to COVID-19. At the same time, the needs of patients continue to evolve. On this dynamic landscape, the new normal pushes all clinics to evaluate the way they do business. The right technology solutions make it possible to evolve your clinic to meet these needs.

At Experity, we’re committed to helping you evolve with the market. Our software and services help you to treat primary care patients alongside urgent care patients smoothly and efficiently. Our consulting team can work with you to help you find navigate change and make the best decisions for your business.

Interested in learning more? Schedule a demo!