Urgent message: Urgent care centers equipped to draw blood and collect other specimens are well positioned to create new revenue streams related to the booming direct-to-consumer lab movement.

Alan A. Ayers, MBA, MAcc is President of Strategic Initiatives at Experity.

People are taking more responsibility for their health than ever before. Whether that means practicing wellness promotion activities or actively seeking care without referrals, today’s healthcare landscape looks much different than it did 20 years ago.

Due to its flexible nature, urgent care is poised to be at the forefront of developing trends in healthcare delivery.

Throughout 2020, the COVID-19 pandemic drove interest in self-care avenues including telehealth and self-diagnosis either because many people were nervous about scheduling unnecessary appointments or providers were closed for nonemergent care. Even after the pandemic ends, these trends won’t go away because consumers value convenient, low-cost healthcare options. As such, the direct-to-consumer (DTC) testing model has been increasingly popular in recent years. Data cited in the Journal Archives of Pathology & Laboratory Medicine estimates that the DTC testing market was worth $352.56 million in 2020 (Figure 1).1 That marks a 17%  increase from the year prior and a whopping 2,207% increase over the past decade.

With this in mind, urgent care owner/operators should be knowledgeable about the benefits and drawbacks of DTC testing as well as the implications for offering it as a service.

What Is Direct-to-Consumer Testing?

Everyone knows that healthcare relies on laboratory testing. Many diagnoses require a confirmation from the lab, while other tests are designed to put the patient’s mind at ease or rule out certain conditions.

In essence, direct-to-consumer testing is what its name suggests: The consumer is able to initiate a lab test without a physician’s order. Once they submit a sample to the testing agency, the results are returned directly to the consumer.

By removing the physician and wider healthcare system from the equation, consumers get their results back faster and often pay less for the service. Although DTC testing doesn’t work with every type of lab test, most of them can be conducted without the need for a primary care visit.

What Is Direct-to-Consumer Testing Used For?

As DTC testing continues to grow in popularity, more types of tests are being supported. Some of the most common include cheek swabs, saliva, urine, hair, blood spots, and blood samples. These samples can be used to run a wide variety of tests.

Consumers can be tested for basic blood chemistries, complete blood counts, thyroid and other hormone levels, drugs, steroids, and lipid panels. Meanwhile, DTC screenings can be performed for things like cancer, sexually transmitted infections, diabetes, celiac or Crohn’s disease, pregnancy, and much more.

Of course, not all DTC tests are used for medical purposes. Consumers can send in a cheek swab or saliva sample for genotyping. This information can then be used for things like uncovering one’s ancestry, allergy testing, and paternity testing.

Why Patients Prefer Direct-to-Consumer Testing

The growth in DTC testing cannot be understated. It is not a coincidence that the sector is growing by millions of dollars every year. Consumers value the benefits of DTC testing, which explains the increase in demand.

A person may seek out a DTC test for many reasons, but cost and convenience are certainly at the top of the list. Following are some of the key benefits of DTC testing:

  • Convenience When a consumer needs a lab test and doesn’t use the DTC model, the first step is typically scheduling an appointment with their primary care provider. They then go to that appointment, get a referral for the test, and then provide a sample either at the office or at another lab facility. Next, the lab performs the test and sends the results back to the provider, who contacts the patient with their results.
    • This process can take several days, if not weeks, to complete. Some patients even balk during that time and don’t follow up with their lab appointments. Removing the physician from the equation significantly decreases waiting times and makes the process more convenient for consumers.
    • Most DTC collection facilities don’t require an appointment, which means consumers can provide a sample on their schedule, when it is most convenient.
  • Lower Cost Interestingly, DTC tests typically aren’t covered by insurance. On the surface, one might assume this makes them more expensive. However, that is not the case. In most cases, the cost of a DTC test is less than the copay for a primary care visit and the required laboratory charges that go with it.
    • On top of this, consumers can often choose which DTC testing company they want to use rather than being forced to work with whoever their insurance company dictates. This allows them to find the best price and greatest convenience.
  • Confidentiality For certain tests, consumers may not want to interact with their primary care provider. Things like STI and drug screenings are highly sensitive and make many consumers uncomfortable. DTC testing provides much more confidentiality since the patient receives their results directly. They aren’t reported to their primary care provider or their insurance company, which makes the entire process more confidential.
  • Empowerment As noted, more and more patients are taking charge of their health. DTC testing allows them to gain knowledge about their health in many ways. Whether they want a genetic test to look for high-risk diseases or a blood panel to provide more insight into their current state of wellness, DTC gives consumers a way to get that information. Having test results in-hand can empower consumers to make healthy lifestyle changes and encourages them to continue getting in touch with their health.
  • Non-Health Testing Another area where DTC testing comes into play is for non─health-related tests. The popularity of at-home DNA test kits has skyrocketed in recent years, in part because more people want to learn about their ancestry. In other cases there are questions of paternity that require a confidential answer. While most people wouldn’t schedule an appointment with their doctor to get a DNA test, DTC testing gives them that option.

What Risks Are Involved with DTC Testing?

While the benefits of DTC testing are numerous, it isn’t a perfect solution. There are still some drawbacks. One of the biggest problems is that consumers may receive results that include medical information they don’t understand. Traditionally, the healthcare provider can break down this information to make it more digestible. DTC testing often provides consumers with raw results that are difficult to interpret. This can lead to a great deal of anxiety and confusion.

In some cases, it also causes incorrect self-diagnosis. Consumers may then undergo further testing, take medications, or endure procedures that are unnecessary. On occasion, the consumer may even need to retake the test if their primary care provider orders it, leading to additional costs and overutilization of the healthcare system.

Of course, the opposite is also possible. If a consumer gets their results and doesn’t know how to interpret them, they may not seek out the necessary follow-up care. Or, worse, they may engage in dangerous “alternative” care.

Another downside is the privacy risk that comes with DTC testing. Some test providers, like 23andMe, provide de-identified patient data to pharmaceutical companies for drug research purposes. Since DTC companies aren’t always covered by HIPAA, consumer privacy may not be protected.

How Does DTC Testing Affect Urgent Care?

As noted, urgent care businesses are perfectly positioned to capitalize on the increase in DTC testing. This is true for many reasons, which means that DTC testing can be turned into a profitable, low-overhead revenue stream for most clinics.

In the U.S., there are more than 14,000 urgent care locations. That’s more hypothetical sample collection locations than the two largest DTC companies—Quest and LabCorp—have combined. For many consumers, providing a test sample at an urgent care center is also more convenient, given that they are  located in almost every community.

Moreover, urgent care centers can collect a much wider range of samples than other locations since they are already equipped to do so for other companies. New legislation in some states allows pharmacies to collect specimens and provide point-of-care testing.2,3 However, those locations are limited in what types of tests they can collect. Only basic, noninvasive tests like saliva samples and “fingerpricks” can be done. Urgent care centers are equipped to collect more invasive tests, including blood draws.

From a business standpoint, DTC test collection can be a great way to bring in extra revenue. Nurses and medical assistants who are already on-site can collect patient samples throughout the day. Since there is no need for a physician to be present, lab collections won’t interrupt a clinic’s normal workflow. They also don’t interfere with the physician’s patient-per-hour efficiency. This makes DTC test collection an ideal “cash business” for urgent care companies, as long as they have enough support staff available.

Aside from serving as a collection site for other DTC test providers, urgent care centers can offer tests directly to consumers. Advertising certain lab tests to existing patients is another great way to bring in additional revenue with low overhead costs.

Ultimately, the popularity of DTC testing will continue to grow in the wake of COVID-19 as consumers look for new ways to take control of their health. Urgent care is in a perfect position to capitalize on this trend. Serving as a lab test collection location is a great way for clinics to bring in additional revenue without interrupting their normal operations.

References

  1. Ayala-Lopez N, Nichols JH. Benefits and risks of direct-to-consumer testing. Arch Pathol Lab Med. 2020;144(10:1193-1198.
  2. JUCM News. Is Florida looking to case pharmacists as primary care providers? Available at: https://www.jucm.com/is-florida-looking-to-cast-pharmacists-as-primary-care-providers/. Accessed April 13, 2021.
  3. Ayers AA. Prescribing pharmacists: cheaper and more accessible than urgent care? J Urgent Care Med. 2020;14(7):41-45.
Understanding the Benefits and Risks of Direct-to-Consumer Testing 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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