Urgent message: The critical role of rapid COVID-19 testing in keeping Americans working presents a unique, time-limited opportunity for urgent care centers to develop relationships with local employers.

Alan A. Ayers, MBA, MAcc is Chief Executive Officer of Velocity Urgent Care

Online news magazine Vox recently reported data from the Urgent Care Association that urgent care centers were performing 725,000 tests per week as of late October, which amounted to 10% of the nation’s total testing at that time.1 While the precise number of urgent care centers offering rapid testing is not readily available, we’re hearing that many urgent cares are seeing record volume driven by rapid testing.

Rapid antigen testing is typically performed on-site at the urgent care center using a countertop analyzer on a nasal swab specimen, with results available to patients in 15–20 minutes. (Examples of analyzers include the Quidel Sofia 2 and BD Veritor devices.) The advantage of rapid testing is that patients leave the center with documented results in hand, which can then be used to return to work, return to school, travel, or for other needs. For the patient and their employer, the availability of a same-day result is essential in minimizing time in quarantine and, thus, time away from productivity while supporting the safety of the workforce.

Employers Are Primarily Concerned About Turnaround Time for Results

To assess employer perspectives on COVID-19 testing, Experity recently interviewed 40 human resources executives concerning their COVID-19 testing concerns. The most salient response is that urgent care centers offering rapid testing are well-positioned to meet employer needs through a business model already built around on-demand access and neighborhood convenience.

 Because turnaround time is essential to minimizing time away from work, unless a PCR test that has to be sent out to a lab with complex capabilities is required for a specific purpose (which can take several days), it can be assumed rapid antigen testing accommodates the requisite turnaround time. Reliability data are available for the leading rapid testing platforms, which have received FDA emergency use authorization. So this leaves scheduling availability and geographical convenience—both hallmarks of the urgent care delivery model focused on same-day access.

In short, urgent care is ideally positioned to address employer concerns around testing.

Table 1. COVID-19 Employer Concerns Around Testing*
RankItem
1Turnaround time for test results
2Reliability or accuracy of test results
3Scheduling availability at testing facilities
4Geographical convenience of testing facilities
5Employee communication of the testing process
6Method of receiving test results
7Privacy of employee data
8Lack of resources to conduct on-site testing
9Managing multiple testing vendors
10Employees responsible for their own testing
11Lack of control over the testing process
12Reliance on health insurance for reimbursement
*(As ranked by HR executives surveyed by Experity)

Rapid Testing Constitutes Less Than 1/3 of Employer Testing

Despite the advantage of rapid testing in keeping employees working and minimizing time out for quarantine awaiting test results, only 29% of the employers interviewed are currently utilizing rapid testing—either at a medical facility or on site. This means that employers are unnecessarily incurring lost productivity when symptomatic or exposed employees are put on quarantine awaiting test results. Turnaround times on send-out lab tests can range from 2 to 10 days. In some cases, employees may complete quarantine before receiving their test results. The adverse impact of an employer being short-staffed is reduced revenue in the form of impaired service levels and missed production, as well as increased costs in the form of overtime or redundant staffing to cover employees who are out. Thus, a reliable rapid COVID-19 test program can contribute straight to an employer’s bottom line.

Table 2. COVID-19 Testing Processes Utilized*
Testing processAverage %
Specimen collected at a medical facility and sent to a laboratory49%
Rapid test performed instantly at a medical facility19%
Specimen collected at the employer worksite and sent to a laboratory17%
Rapid test performed instantly at the employer worksite10%
Home test kit patient administers on self6%
Other (please specify)1%
*(As ranked by HR executives surveyed by Experity)

Employers Require COVID-19 Testing Primarily for Employees With Possible Exposure and/or Symptoms of COVID-19

Of the reasons that employers require a COVID-19 test, most often it’s to prevent the spread of an active infection, such as by an employee who’s been directly exposed to someone who’s tested positive or by an employee who’s showing symptoms. Few employers routinely test all employees, but when they do it’s typically related to specific risk, including travel, or when the testing is done on site at an employer facility. This episodic testing means that employers need somewhere to send employees where they can be seen and receive results the same day.

Table 3. Employee Groups Requiring COVID-19 Testing*
Employees testedn% of total
Employees exposed to someone who has tested positive2377%
Employees showing symptoms2273%
Employees exposed to someone showing symptoms1550%
Employees returning to work after quarantine1343%
Employees with a high risk of occupational exposure1033%
Employees required to travel827%
Essential employees723%
Employees working in an employer facility723%
All employees413%
Employees selected randomly13%
Employees in an outbreak geography13%
No employees13%
Employees working from home00%
Other (please specify)00%
*(As ranked by HR executives surveyed by Experity)

Adding COVID-19 as an Employer-Paid Service

Within the realm of “occupational health,” “employer paid services” refers to health-related services procured directly by an employer, as opposed to being obtained using workers compensation insurance or employer-provided health insurance. These services typically include drug screening for new hires and randomly selected employees, when there is cause for suspicion, or when an incident has occurred, as well as physicals for compliance or fit-for-duty. Compliance physicals would include the regulated needs of truck drivers, airline pilots, police officers, firefighters, etc. Results are reported directly to the employer.

Table 4. Employer Testing Program Summary*
Testing programAverage %
Testing at an outside provider of the employee’s choosing, paid by health insurance22%
Testing at the employer worksite by an outside vendor, paid directly by the employer18%
Testing at the employer worksite conducted by employees of the company18%
Testing at an outside provider of the employer’s choosing, paid directly by the employer17%
Testing at the employer worksite by an outside vendor, paid by health insurance13%
Testing at an outside provider of the employee’s choosing, employee reimbursed by employer9%
Testing at an outside provider of the employer’s choosing, paid by health insurance3%
Other (please specify)0%

*(As ranked by HR executives surveyed by Experity)

Per Table 4, 62% of employers interviewed pay for employee COVID-19 tests directly, while 38% rely on employees using their own health insurance. The “ideal” employer solution is one in which a protocol is established at an urgent care center such that the employee can reserve a time, check-in or enter a queue online, arrive at the center with specific instruction as to where to go and what to do (ie, drive-up, wait in car, etc.), and then receive the test according to the employer’s instruction (with no medical exam required for asymptomatic employees). The employer would receive the results immediately, and be billed for the test.

The issue with relying on employees using their health insurance is that a payer will likely require a medical exam—adding to the cost of employee benefits for self-insured employers—and for some payers or contracts a provider may necessitate use of a third-party lab who will bill insurance for the lab work separately from the medical visit.

As discussed, use of an outside lab vs on-site rapid testing just delays reporting, keeping the employee out of work longer. Additionally, some insurance companies refuse to cover testing for nonmedical purposes, including for all asymptomatic reasons including employment.

Finally, there’s the whole issue of tracking who’s been asked to get a test on their own, issues with employees finding test locations that will accept their insurance, and with employees then submitting results to the company. For the urgent care, insurance billing is accompanied by contractual reductions to charges and a lag in collections, resulting in growing accounts receivable balances. When employers pay directly, however, urgent care centers are known to collect up to $150, $175 or even $200 per rapid test within days, with no provider time invested, because there’s such value to the employer in getting an employee back to work.

Just as COVID-19 has dramatically changed how urgent care centers operate, it’s affecting how all businesses function day-to-day. The opportunity is for urgent care to partner with employers in the community to offer rapid testing to keep their workforces healthy and productive.

References

1. Molla R. COVID-19 is turning urgent care centers into America’s favorite clinics. Vox. Available at: https://www.vox.com/recode/21562230/urgent-care-center-covid-19-testing-vaccine-health-care. Accessed November 23, 2020.

Employer COVID-19 Testing Needs are Not Fully Met; Rapid Testing is an Unprecedented Opportunity for Urgent Care

Alan A. Ayers, MBA, MAcc

President of Experity Networks and is Practice Management Editor of The Journal of Urgent Care Medicine
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