Urgent care centers are effective for overcoming patient care access issues in medically underserved areas, according to the American Hospital Association (AHA).
As a part of its Task Force on Ensuring Access in Vulnerable Communities, AHA recently explored how urgent care centers can fill care access gaps in regions where access to treatment is sparse.
“The urgent care center (UCC) strategy would allow hospitals that may be struggling, for a variety of reasons, to maintain an access point for urgent medical conditions that can be treated on an outpatient basis, without having to maintain emergency medical services or inpatient acute care services,” AHA explained in a guidebook.
Urgent care centers attend to emergency medical situations that are not life-threatening, such as a laceration, broken bone, or sprain. Most urgent care centers deliver care for:
- Accidents and falls
- Sprains and strains
- Moderate back problems
- Bleeding/cuts that are not bleeding profusely but still require stitches
- Diagnostic services (including X-rays and laboratory tests)
- Fever or flu
- Vomiting, diarrhea, or dehydration
- Severe sore throat or cough
- Minor broken bones and fractures
Urgent care centers can also serve as primary care or medical home centers for patients living in rural or medically underserved areas. These health facilities are sustainable in underserved areas because they are typically less expensive to run than a hospital emergency department, but can meet common medical needs.
AHA largely offered national policy solutions for strengthening urgent care center usage and deployment. These policy changes could lead to more effective adoption of urgent care centers.
For example, an urgent care center demonstration program would help overcome reimbursement challenges that urgent care centers currently face.
“Federal reimbursement methodologies may not be sufficient to account for the low volume or other challenges UCCs in vulnerable rural and urban communities would face,” AHA explained.
Currently, urgent care centers are billed similarly to primary care practices under parts of Medicare Part B, including the physician fee schedule. Private payer reimbursement varies depending on urgent care center agreements, the organization wrote.
These reimbursement structures may have adverse effects if an urgent care center does not have high utilization in its area.
“Under these reimbursement methodologies, the Urgent Care Association of America estimates that the break-even point for an urgent care clinic is approximately 25 visits per day,” AHA explained.
“However, UCCs in vulnerable rural and urban communities may not be able to maintain this volume, making additional financing necessary to ensure they have adequate reimbursement to cover costs and the resources necessary to meet the needs of their community.”
AHA recommended a Congress-sponsored urgent care center demonstration program that would test different payment models for the offices.
“AHA will urge Congress and the Centers for Medicare & Medicaid Services to develop a demonstration program to test different payment rates for UCCs in order to ensure access to urgent care services in all vulnerable communities,” AHA wrote.
The organization said the program would be available to hospitals in vulnerable rural and urban communities, and should test three or more methodologies for urgent care center reimbursement. Those methodologies should include:
- Medicare PFS rates plus an additional facility payment to cover standby costs
- A new fee schedule for urgent care centers
- Rates of 110 percent of reasonable costs for urgent care center services
AHA also published a toolkit for hospitals considering opening an urgent care center. The toolkit seeks to answer the question of whether an urgent care center is the right fit for a community’s health needs.
“The decision to convert to a UCC is a complex undertaking that would have a critical impact on a hospital and its community,” AHA explained.
The toolkit breaks down the process by which hospitals can determine how – and if – they will open an urgent care center.
Organizations should first evaluate community health needs. Communities that experience several non-life-threatening medical events may benefit from an urgent care center. Likewise, communities with numerous individuals seeking care outside of traditional office hours may benefit from an urgent care center.
Additionally, healthcare organizations should assess their emergency department utilization trends. Considering ED visits that could have been served by an urgent care center can help decision-makers determine whether an urgent care center is appropriate.
Following a community health needs assessment, organizations should assess the financial sustainability within a certain region. As noted above, most urgent care centers need at least 25 visits daily to break even. Organizations should look at likely center utilization and other regional forces – predicted population growth, for example – to determine whether organizations can meet that metric.
AHA also recommended organizations consider the following:
- The Medicare Cost Report, which includes data and information on services offered, specifically worksheets A, B Part 1, and C Part 1
- Population estimates, available from the US Census Bureau
- AHA also maintains data related to the geocodes for all US hospitals, which could offer insights as entities map out the landscape for urgent care services in their geographic market.
Organizations should also consider staffing needs, including the impacts of clinician shortages across the country. Entities need to consider if the urgent care center will be able to adequately recruit clinicians as well.
Additionally, organizations must consider their ability to meet accreditation standards and to maintain their community relationships. It is integral that the community is welcoming of this new healthcare facility.
These guides came as a part of AHA’s year-long efforts to support better patient care access in vulnerable rural and urban communities. AHA has also published tools about community health partnerships, the social determinants of health, and access under the Indian Health Services (IHS).