Many patients don’t think about “urgent care” until the moment they need treatment. Likewise, few people think of urgent care when considering a routine check-up at the doctor’s office. 

Perhaps it’s time for that to change. 

The main demographic served by urgent care consists of “working age” adults, 24-54, and their families. Historically, these patients lack a primary care provider (PCP). Whereas children have a pediatrician and seniors in a Medicare plan are likely served by a “medical home,” working adults use urgent care once or twice a year when illness or injury arises.

Many people view this as a fine approach. 

However, from annual wellness exams to routine lab work and preventative care to a relationship with your provider, those without a PCP are missing out on significant pieces of the wellness puzzle. 

Though it may not be the obvious answer, urgent care is well-positioned to help bridge this gap. 

With this in mind, it’s important to consider how primary care services can be integrated into the traditional urgent care model without disrupting your center’s main focus. 

 Why Primary Care Matters

Every segment of the healthcare industry is dealing with a staffing crisis. For primary care, this problem is only getting worse. 

According to data from the Association of American Medical Colleges (AAMC), one in five active physicians will be at retirement age in the next decade.1

Even sooner, by 2024, up to 124,000 physicians will step away from patient care. An estimated 48,000 of those providers work in primary care. 

In underserved communities, the demand for primary care providers is immense. Roughly 180,400 additional providers are needed to serve those areas alone. 

So, what does this mean for urgent care? Opportunity. 

As demand for primary care services grows and provider availability shrinks, consumers will be looking for new ways to get care. Urgent care centers are already strategically positioned to provide easy access to the community. This opens the door for offering primary care services to patients who may not otherwise visit unless they were seeking care for an illness or injury. 

Urgent care has fared better than many healthcare settings during the COVID-19 pandemic. However, the need for growth within the industry remains.2

Adding primary care services to an urgent care center is not a one-size-fits-all endeavor. It might not be right for all clinics. That said, it’s an opportunity to reach new patient populations.

Given the expected demand for primary care as physician shortages increase, urgent care centers should look to take advantage. 

What Primary Care Services Can Urgent Care Offer? 

The term “primary care” is rather vague—especially in the context of what services fall under it. As such, urgent care owner/operators need to evaluate and define which primary care services they want their centers to offer. 

Not all services are viable or appropriate. 

Factors like reimbursement, patient morbidity, and time all dictate whether an urgent care center should offer a primary care service. In a busy urgent care focused on optimizing throughput (measured in patients per hour per provider), there’s not always time to complete a thorough medical history or medication reconciliation. Analyzing and maintaining complex and ongoing medical records is another issue some urgent care centers face.

Fortunately, there are still plenty of primary care services that fit well alongside urgent care. For instance:

  • Physicals (annual, school, work, sports)
  • Men’s/women’s health
  • Chronic disease management (diabetes, hypertension, back pain, etc.)
  • Lab work
  • Illness/injury visits
  • Immunizations
  • Referrals to a specialist 

Benefits of Offering Primary Care Services at Your Urgent Care Center 

As noted, adding primary care services to your urgent care center is a fantastic opportunity for growth. It fosters loyalty with patients who are familiar with your practice’s urgent care offerings and can now visit more frequently for primary care. 

Numerous studies have demonstrated that primary care and preventative services have an overwhelmingly positive impact on public health.3

However, countless Americans don’t have a PCP. 

According to a 2019 Harmony Healthcare IT survey, 71% of the adult population has not seen a primary care provider in the past 5 years or more. This is a personal decision for some. Others struggle to find a PCP in their area or one with appointments sooner than a few months away.4

Alan Ayers, president of Experity Networks and senior editor, practice management of The Journal of Urgent Care Medicine, says improving access to primary care is one of the best ways to increase interest and utilization. Patients will also see your urgent care as a more holistic presence in the community. 

Today’s patients find on-demand care very appealing. Hence, urgent care is viewed as a good option when illness or injury strikes. Making primary care available at conveniently located urgent care centers with flexible hours is appealing to patients with busy lives. 

An on-site PCP doesn’t just attract busy people, though. They attract those looking for primary care services. This includes seniors, families, and those searching for a new provider. Growing and diversifying your patient base is key to ongoing success in urgent care. Primary care offerings get more people through the doors of your clinic. Efficient, high-quality service makes them more likely to return the next time they need care—planned or unplanned. 

Problems with Adding Primary Care Services to Your Urgent Care Center

While there are many benefits to adding primary care services to your urgent care center, doing so doesn’t come without obstacles. 

Perhaps the biggest challenges can be attributed to fundamental differences in the operating models of an urgent care center and a PCP office. Throughput is a key metric for the urgent care centers. This isn’t necessarily the case for other areas of healthcare. 

Offering primary care visits, which typically consist of time-consuming activities, in the same system as regular urgent care visits can be a disaster. There is simply too much variability in visit types to account for. Thus, your patients may end up with longer wait times and providers may start to drown in their patient census. 

Urgent care providers may also feel uncomfortable offering certain services to patients they don’t know. Take, for instance, prescribing behavioral health or weight loss medications to a patient they’ve never met before. 

For a PCP who is familiar with their patient and sees them regularly, performing these services wouldn’t be an issue. An urgent care provider who is meeting their patient for the first or second time may feel differently. 

Finally, billing and reimbursement need to be considered. Primary care services are typically billed differently, under different contracts (with different copays) than urgent care services. Wellness physicals, immunizations and other “preventive” services that are core to primary care are often not reimbursable as “urgent care.” The acuity of each patient, types of procedures, and length of visits all vary between the two. Thus, offering both types of services under a single billing model can be a headache. 

Running Primary Care Alongside Your Urgent Care Center

Considering the issues we’ve discussed, offering primary care services in the same flow using the same providers as your urgent care services may not be a wise decision. 

So, how can your urgent care center still utilize primary care as an opportunity for growth? 

Many companies have decided to offer both services in parallel. In other words, your urgent care business is legally and logistically distinct from your primary care business, but both operate under the same roof.

When operating in parallel, “primary care” consists of preventive services and rechecks for chronic concerns, occurring through scheduled appointments. “Urgent care” consists of episodic illness and injury which is unscheduled.

Tammy Mallow, senior director of consulting for Experity, emphasizes that with this method, a new legal entity is formed for the primary care side of the practice, primary care payer contracts are secured, separate fee schedules are agreed to, and providers are credentialed according to the payer requirements.

Payers may also require specific physical components of the building as well as policies outlining how a patient is defined as urgent care or primary care. Each line of business has dedicated providers and teams. This gives the provider more time to spend with each patient and allows them to form better relationships. Likewise, it keeps your other providers free to provide traditional urgent care services for patients who walk in or schedule ahead of time. 

Segmenting your primary care offerings also means giving them a dedicated workflow, appointment schedule, and waiting queue. Operating primary care as a separate business entity also allows you to track revenue cycle management key performance indicators separately from the urgent care, since all billing functions are separate.

Patients coming in for urgent care don’t notice a difference as that side of the center continues to run like normal. Meanwhile, primary care patients benefit from providers having more time to interact with them and easy access to care. 

Your urgent care business gets more visitors and more revenue. You also build trust with the local community and increase your patient volume. 

This system gives you the best of both worlds while avoiding the biggest challenges of adding PCP services to your urgent care center. 

Starting with Primary Care Functionality

Over the past decade, and especially through the pandemic, many patients have discovered the convenience and accessibility of urgent care.

For urgent care centers exploring new growth opportunities in the coming years, few paths look as promising as primary care. The market is wide open thanks to the massive efflux of traditional primary care providers and soaring demand for their services. 

Urgent care owner/operators who want to start offering primary care services should be careful, though. Establishing new services at the cost of your core business is a recipe for disaster. 

Primary care offerings should be run parallel to your urgent care operations—not intermixed with them. This means separate providers, queues, and logistics for your primary care division.

With this strategy, your urgent care center can be even more impactful in the community, enjoy higher visit volumes, and offer more holistic services to patients that aren’t just there for illness or injury. 

References

  1. Association of American Medical Colleges. New AAMC Report Confirms Growing Physician Shortage. Available at: https://www.aamc.org/news-insights/press-releases/new-aamc-report-confirms-growing-physician-shortage. Accessed July 28, 2022.
  2. The Journal of Urgent Care Medicine. Developing Data. Yes, urgent care lost visits during the pandemic—but other settings lost far more. J Urgent Care Med. 2022;16(8):49.
  3. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83(3):457-502.
  4. Harmony Healthcare IT. Survey reveals Millennials’ relationship with health care. Available at: https://www.harmonyhit.com/survey-reveals-millennials-relationship-with-health-care/. Accessed July 28, 2022.
Primed for Growth: Why It’s Time to Consider Adding Primary Care Services to Your Urgent Care Center

Monte Sandler

Executive Vice President, Revenue Cycle Management of Experity (formerly DocuTAP and Practice Velocity ).
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