Alan A. Ayers, MBA, MAcc is Chief Executive Officer of Velocity Urgent Care and is Practice Management Editor of The Journal of Urgent Care Medicine.
Urgent message: To successfully build patient volume, urgent care operators must ensure that their centers continually develop, nurture, and execute mutually beneficial referral relationships with local PCPs, specialists, and health systems.
Among the many reasons hospitals and health systems continue to invest in urgent care is the value urgent care facilities hold in generating lucrative downstream referrals. In addition to the typical primary care provider (PCP) referrals, the dollar value of specialty referrals (especially high-margin specialties like orthopedics)—and the use of imaging facilities and ancillary services such as physical therapy—often generate several times the revenue of the original urgent care service.
Underscoring this point is a 2015 nationwide survey jointly conducted by Minneapolis-based Urgent Care Partners and the University of Minnesota, in which 1,400 urgent care patients were asked about the follow-up care recommendations they received; 66% of those who were given referrals to a specific provider indeed followed up with the recommended provider. The same survey concluded, however, that out of the 76% of urgent care patients advised to seek postvisit follow-up, just 21% were directed to a specific health system or provider.
Developing the Outbound Referral Strategy for Urgent Care
Given that two-thirds of urgent care patients will comply with their clinician’s recommended follow-up provider—yet only about a fifth of patients are advised to do so—an opportunity exists here for independent, non─hospital-affiliated urgent care providers. By clearly illustrating the downstream referral value they can offer to local PCP and health systems, they provide these providers the impetus and motivation to work toward building a mutually beneficial, two-way referral relationship. The referring urgent care, though, must first ensure that its outbound referral strategy is well-optimized.
For example, an urgent care that equips and markets itself as providing services that are “higher acuity” than the frequent “head and chest” presentations will necessarily generate more valuable referrals. Meaning, an urgent care that appeals to the local sports community, performs a multitude of procedures and treatments, or does occupational medicine will see more complicated patients who require follow-up by higher-level specialties such as orthopedic surgeons, physical therapists, and pain management specialists.
Even an urgent care that offers “basic” services will still see many patients in need of ongoing primary care (for instance, pre- or undiagnosed diabetes, hypertension, or bronchitis as a precursor to COPD). These are all patients that require longitudinal care, which is beyond the scope of urgent care but can be referred out to PCPs and specialist.
Additionally, today’s urgent care EMRs have robust referral management capabilities, allowing them to access a directory of preferred providers by specialty, facilitate transmission of medical records, and report on downstream referrals sent. Appointment scheduling capability further assures patient follow-up, vs putting the onus on the patient to promptly contact the specialist, which can of course lead to high “leakage.” And with EMRs increasingly having integration and interoperability with popular hospitals EMRs like Epic or Cerner, health statisticians are better able to track actual usage and place a firm, concrete dollar value on the urgent care referrals to the hospital.
How Referring to Urgent Care Helps PCPs and Health Systems
To be clear, the referral relationship is not a one-way street; inbound referrals not only boost urgent care volume, but help PCPs and health systems in the following ways:
- Urgent care can take on seasonal overflow from overcrowded PCPs, especially during flu season or other epidemic outbreaks.
- Surveys reveal that, typically, only about 29% of PCPs have made prearrangements for their patients’ after-hours care. Urgent care therefore can provide evening and weekend coverage, and cover vacations and holidays when the primary care office is closed.
- Perform x-ray, lab testing, and medical procedures like casting and suturing that are rarely available at the PCP’s office.
Urgent care can also help overcrowded emergency departments by alleviating nonemergent presentations and offering patients a faster, more cost-effective alternative. Further, urgent care provides a more affordable alternative to patients without health insurance, reducing ED uncollectible receivables.Initiating and Marketing the Urgent Care and Developing Relationships
To begin building relationships with local PCPs, the urgent care operator would identify providers within a 10-minute drive of the center. The next step would be to reach out with a phone call and propose a face-to-face breakfast or lunch meeting. The initial call and meeting should be “peer-to-peer,” or doctor-to-doctor, as an invitation from a “sales rep” lacks professional collegiality and would likely be ignored.
During the provider meeting, it’s key to emphasize that urgent care is episodic, and that the center is in no way attempting to steal patients from the PCP. Rather, the interest is in building a trusting, cooperative, and mutually beneficial relationship. This is accomplished by clearly explaining the urgent care value proposition and scope of services, including its capabilities for lab, x-ray and medical procedures, and its ability to steer nonemergent patients from unnecessary ED visits. The meeting would also include a primer on the urgent care’s robust referral management capabilities through its EMR, and how it can help prompt follow-up patients to that provider.
The end goal for the urgent care operator, in exchange for the outbound referrals to the PCP, would be to secure an agreement that the PCP would in turn do the following for the urgent care:
- Display the urgent care’s marketing materials in their waiting rooms, front desk, front door, and lobby areas.
- Set the messaging on their after-hours answering service to steer patients to the urgent care should a need arise.
- Send an email blast notifying their patients to use the urgent care when the PCP office is closed.
As an example of how this could work to everyone’s advantage, one urgent care operator created a marketing package that included a listing of all the center’s services on a laminated card, accompanied by pads of “referral scripts” which resemble Rx pads. One side of the mock Rx pad listed the address and directions to the urgent care and the other side listed common conditions for which patients are typically referred. While not typical, this creative marketing tactic helped demonstrate to PCPs the services urgent care provided, while also giving the PCP’s patients something tangible and official-looking rather than a vague admonition to “go to the urgent care.”
Lastly, whereas there are ample data on the outbound referrals that originate from the urgent care, it’s not as straightforward to track where the patients are coming from insofar as inbound referrals. The urgent care center should therefore diligently request and track responses on the patient intake paperwork, including the name of their PCP and/or the “How did you heard about us?” question on the form.
The average urgent care that sees 40 patients a day might make several thousand outbound referrals in a given year. As urgent care is a proven resource of lucrative referrals for PCPs, hospitals, and health systems, operators must leverage that value toward creating mutually beneficial referral relationships that not only boost their patient volume but help better balance and encourage appropriate facility utilization throughout the larger healthcare community.