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The future of urgent care: The challenge of sustaining its unique attributes while expanding its scope

The tremendous success of the urgent care model stems from its dissimilarity to traditional healthcare delivery. How does the industry continue to expand and ensure urgent care growth while maintaining the attributes that patients and providers love most?

Industries have been reshaped by consumer demand for convenience, efficiency and flexibility, from banking to travel. Healthcare is no exception, as evidenced by the significant growth in urgent care centers over the past 10 years. The ability to walk into an urgent care clinic without an appointment and access a broad range of services at an affordable price holds tremendous consumer appeal.

In some ways, urgent care was a best-kept secret by Millennials and Generation Z prior to the COVID-19 pandemic. Today, an increasingly broader range of patients have tried urgent care, liked it and will continue to use it. Throughout 2021, there were 11 months where monthly visit volume to urgent care clinics had been higher than in the previous five years.1

Facility owners and operators are seeking to expand their urgent care management expertise to meet the ongoing needs of new patients. Some are expanding their breadth of services, making greater in-roads into primary care, while others are extending into new populations, markets and geographies, including communities underserved by traditional healthcare.

The challenge then becomes, what can urgent care practices do to retain the unique attributes most prized by consumers while continuing to grow? We had the opportunity to speak with Lou Ellen Horwitz, chief executive officer of the Urgent Care Association (UCA).

This is the second in a two-part series of articles featuring insights from Horwitz on the urgent care market.

Urgent care centers and COVID-19 testing

For many Americans, their first experience with urgent care was COVID-19 testing during the first two years of the pandemic. With their adaptable, nimble model, urgent care centers were well-equipped to handle the tremendous demand for testing when hospitals were overwhelmed with virus patients and primary care physician offices restricted their services and availability to stem virus spread.

"The things that make us successful from an unmet need standpoint were heightened by the pandemic when everyone was closed but us," said Horwitz.

Urgent care's role in point-of-care (POC) lab testing can't be underestimated. During the pandemic, urgent care centers have tested a disproportionate share of COVID-19 patients compared with other facilities.2

Today, many urgent care clinics would like to offer more POC testing options, but inadequate reimbursement holds them back, according to Horwitz. With the Centers for Disease Control and Prevention (CDC) adding COVID-19 to the endemic category, the 4-in-1 assay that tests patients for COVID-19, flu A, flu B and RSV is an effective and efficient way to differentiate between these respiratory conditions. But as Horwitz explains, urgent care centers are not reimbursed accordingly for this method of testing.

"The 4-in-1 tests are super-efficient and cause less trauma to the patient, but payers reimburse them as one test even though the cost to run them is higher compared to a single test," she said. "Urgent care clinics must invest money in equipment to run these tests, but the payer rate doesn't align with the cost rate even before they make the investment."

"As long as there is this misalignment, many urgent care facilities cannot afford to offer this testing," Horwitz added. "Clinics can't pass the added cost on to patients, and they can't absorb it. We're hoping for commercial payer support and federal funding to help alleviate the cost burden so urgent care centers can make 4-in-1 tests broadly available to patients."

The push for urgent care as primary care

Today, many urgent care clinics fill the gaps patients feel left by the significant shortage in primary care physicians (estimated to grow to between 54,100 and 139,000 physicians by 2033).3

But Horwitz points out how the urgent care model is not designed to provide this type of ongoing care management. While urgent care can help fill the voids left by primary care – around-the-clock episodic treatment of illness and injury – by design, it offers very different day-to-day medicine compared with a primary care practice.

"Most urgent care centers are not set up to manage people needing ongoing routine care for chronic conditions," said Horwitz. "It's not a 9-to-5 practice where a patient can schedule an  appointment with the same provider and be guaranteed to see them each time. We support having patients where they need to be while receiving care at an affordable cost. Primary care practices do a great job with ongoing care management, and typically urgent cares compliment that through episodic care."

"To be a full-fledged primary care practice, an urgent care center would have to take on responsibilities such as reporting, wellness visits, immunizations and chronic care services," said Horwitz. "Most urgent care centers simply don't have the staffing or resource capacity to provide these services in addition to urgent care services."

The future of urgent care centers depends on them making significant equipment and staffing investments to maintain high acuity treatment capabilities. According to Horwitz, centers that take on a higher volume of routine patient visits, such as those related to chronic disease management, aren't using these resources to their full potential.

Urgent care centers and specialty care

Prior to the COVID-19 pandemic, some urgent care centers began expanding their service offerings into specialty areas, such as women's health, behavioral health and advanced imaging. Since the pandemic hit and patient volumes have soared, Horwitz says she's seen fewer centers pursue specialized care expansion.

"Some got into specialty care to increase volume but that hasn't been a problem since the pandemic," she said. "I'm not sure there will be much experimentation moving forward because the range of services is already so broad. Instead, centers are growing by expanding their services into new geographies."

Urgent care centers and the underserved

Underserved communities present a significant opportunity for urgent care growth. As the American Investment Council states in its 2021 urgent care pitchbook report, "Rural America has a profound health care deficit, and much of that problem boils down to a lack of resources: relatively few providers, less insurance coverage, and fewer health care professionals compared to urban and suburban areas. Urgent cares are a convenient, increasingly popular way for Americans to receive routine and emergency care, but only one percent of urgent care centers operate in rural communities."4

The UCA is currently conducting research on underserved communities to understand the opportunities and roadblocks to promote urgent care growth in these areas.

As Horwitz explains, "We're now in a data-gathering mode to either confirm or dispel some assumptions about these communities. For example, some assume that going into an underserved market means caring for a high percentage of Medicaid patients, which makes it extremely difficult for centers to stay in business without federal funding, but we don't know if that assumption is accurate. Rural areas can also be a challenge from a clinical staffing standpoint. We're just beginning to get our arms around this and develop strategies, including potential partnerships, to make it work."

How UCA can help drive future urgent care success

The UCA has served as a valuable resource for urgent care start-ups, but the association has recently been making significant investments in urgent care management teams, infrastructure and content to support more experienced operators looking for a competitive edge.

The association is also taking a firm stand on defining urgent care.

"There has been voluntary certification for urgent care centers for quite some time, but we feel the industry is now mature enough to draw a line in the sand and define the attributes required of a center to call itself 'urgent care,'" Horowitz says. "This will be the foundation on which we can advocate for change in billing criteria and how our providers gain acknowledgment for our specialty. The idea that if you've seen one urgent care center you've seen urgent care presents an unclear foundation for advocacy and cannot continue."

The UCA is partnering with its sister organization, the College of Urgent Care Medicine, to define urgent care as a specialty, including criteria requirements. The association is also proactively seeking alliances with like-minded organizations, including corporate partners, to collaborate on joint initiatives to progress with critical initiatives faster. This includes work aimed at alleviating the current staffing shortage crisis.

"We had talked about many of these initiatives for a long time, but it's the visibility that we gained during the pandemic that has really positioned us in a way to move this work forward," said Horwitz. "It's become the springboard for progress in the years to come." 

First in this series: The first article in this two-part series featuring insights from Horowitz explores the future of urgent care from the perspectives of patients, providers, investors and payers, as well as potential challenges to growth. Read article >


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