By John Koehler MD, ABPM(OM), Editor-in-Chief, OccDocOne
This article is written with the goal of alerting other Urgent Care industry experts to an ominous trend in our industry that we must collectively address or we will face marginalization, maybe even extinction, in the years ahead. This may sound alarmist, but please hear me out.
I opened my first clinic in 1987 when “Urgent Care” was a barely recognized term. I was there when the Urgent Care Association was known as the Urgent Care Association of America and was formed by a small group of my dear friends who had the vision to create a place where we could share ideas and help each other be successful. Their dream has continued to this day, which is why I am particularly motivated to call out this disastrous trend I’ve seen emerging over recent years.
In the eyes of both patients and payers alike, we are increasingly being viewed as “triage centers.” Carriers have actually used that term while negotiating with at least three groups I know of in the last week alone, all while proposing to keep reimbursements flat. Alan Ayers, president of Experity Networks and JUCM’s own senior editor has called the phenomenon “acuity degradation;” I use the term “glorified triage.”
This is not good. But what caused this changed view? Simply put, we refer too many patients out from our Urgent Care centers. We do not “do” enough within our four walls for our patients.
The most glaring example is injury care. We excessively refer injuries to orthopedics or other specialties instead of treating them ourselves. As a result, orthopedic Urgent Care centers have surged in popularity. A local Urgent Care group recently informed me that a large orthopedics group has actually followed their last three clinics by establishing an orthopedic-specific Urgent Care a few doors down and subsequently directly asked them for referrals!
In the Chicago area, for example, there are at least 47 orthopedic Urgent Cares; each of them also advertises worker’s comp care. We are filling surgeons’ schedules with minor fractures, sprains, tendinitis, injections, etc. (ie, non-surgical cases). As a result, surgeons are hiring their own advanced practice providers to ease their burden of nonsurgical cases, and who will ultimately provide a very similar level of care that we had the opportunity to provide definitively.
It is not just simple fractures; we refer to basic eye injuries, long lacerations, minor head injuries, burns, fingertip injuries, etc.—in short, anything that makes us “uncomfortable” or “takes too long to treat.” As a result, we have carriers and communities wondering, What exactly is it that you treat?
Our referral threshold keeps falling as we commoditize and narrow the range of services we provide. Carriers know this because they have the data, and can see the codes and where the patients are sent. Emboldened, they are using our own data against us. How can we blame them? The first volley in this struggle came with the introduction of the “case rate.” If we don’t act soon, we will be reduced to accepting a “triage rate” and then “no rate.”
WHAT CAN URGENT CARE CENTERS DO TO CORRECT THIS TREND?
We can fix this trend, but it will require effort. UCA will be convening a working group to discuss this issue, make recommendations, and possibly create training programs. Please consider these suggestions for ways to dampen this ominous trend within your Urgent Care organization:
• Study your referral data by code
• Start a robust onboarding and mentorship program for any new grad APPs
• Start fracture care, dislocation reduction, injections, and DME training
• Focus a segment of regular chart reviews on referred cases
• Set referral standards for injuries/fractures
• Require clearance from the senior provider prior to referral
• Create a system for senior provider availability for case consultation
• Provide clinical guidelines/occ med guidelines with easy access
• Incentivize providers financially for performing procedures (yes, this is legal)
• Use your data to show you do “real” urgent care
• Avoid signing any case rate contracts
Our destiny is in our own hands. I want to wish you the very best as you consider how this may apply to your group.
