Urgent message: As this year’s flu season arrives, urgent care providers must take stock of their individual capabilities, then develop a comprehensive strategy that addresses employee and patient flu vaccinations, marketing campaigns, competing with retail flu shot providers, and handling the increased seasonal influx of flu patients.

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.

The end of summer and first days of autumn not only usher in cooler days and fall colors, but also the start to the annual flu season. And if this year’s flu season is anything like the last couple, healthcare providers nationwide will soon be faced with lobbies and exam rooms overflowing with flu-stricken patients.

According to U.S. Centers for Disease Control and Prevention (CDC) estimates, the 2017-2018 flu season was the worst since the 2009 swine flu epidemic that sickened over 60 million people. The 2017-2018 flu season was estimated to have sickened 48.8 million people, led 22.7 million to a healthcare provider for treatment, caused 959,000 to be hospitalized, and resulted in 79,400 deaths. Last year’s flu season—from October 1, 2018 through May 4, 2019—likewise is estimated to have sickened up to 42.9 million people, led to up to 20.1 million medical visits, required up to 647,000 hospitalizations, and resulted in up to 61,200 flu deaths (with the final numbers still not tallied).

As the severity of a flu season is the number-one driver of urgent care visits, urgent care providers are often on the front lines of flu epidemics across the country. With that in mind, the following sections will look at the key aspects of a comprehensive and effective urgent care flu season strategy, including:

  • The much-debated topic of whether urgent care should even administer flu vaccines
  • Flu shot marketing tactics
  • Developing an in-center “fast track” for flu shots
  • Designating a “flu center” area within the urgent care for treating flu patients
  • Administering flu vaccines to urgent care staff
  • Dealing with antibiotic requests during flu season

The Flu Shot Conundrum

Even as urgent care has grown into a vital and integral player in the nation’s healthcare system, with a key role in combating and treating the flu, there is a growing debate as to whether urgent care should administer flu vaccinations at all. Those in favor of urgent care giving flu shots cite the following reasons:

  • Providing a Vital Community Service Toward Promoting Public Health The CDC asserts that the best way to avoid contracting the flu is to get a flu shot; hence, they recommend everyone over the age of 6 months get an annual vaccination. Flu-related healthcare expenses (hospitalizations and direct outpatient expenses) in the United States are estimated at $10.4 billion annually, and that number doesn’t factor in the financial cost employers incur due to the resulting absenteeism and lost productivity. The CDC and the larger healthcare community therefore strongly promotes and pushes communities to employ every available avenue for vaccinations, including local event venues, grassroots events, and workplace clinics. It makes sense then for urgent care—already an ideal setting for administering flu shots—to join the effort and play its part in promoting public health and increasing immunization rates.
  • Marketing and Promoting the Urgent Care Center – Given that urgent care players in saturated markets struggle with establishing strong brand loyalty, centers must continually employ tactics to stay top-of-mind with consumers. By offering flu vaccines, engaging in community outreach, and hosting grassroots vaccination clinics, urgent care centers can raise awareness of their services to the community. When a well-executed flu vaccination campaign results in center use by new patients, those same patients will return for additional visits for unrelated illnesses and injuries in subsequent months when there is an episodic need.
  • Urgent Care Centers Are Ideally Equipped to Offer Flu Shots Flu shots can be easily administered by medical assistants, so urgent care patients who present for unrelated injury or illness (but not an active case of flu) can get the shot without needing to necessarily see a physician. Given that many urgent care patients don’t have a primary care provider, struggle to get a timely PCP appointment during the busy autumn season, or can’t take the time off work, the urgent care is well-equipped to fill the gap.

Indeed, urgent care seems to be a great option for dispensing flu shots to the surrounding community and helping combat the fight against this potentially deadly virus. However, many in the healthcare space strongly question whether urgent care should even be in the flu shot business for the following reasons:

  • Urgent Care Struggles to Get Reimbursement for Flu Shots At the heart of the matter for those who oppose urgent care flu vaccinations is the issue of simply getting paid. The default position of most payers is that a flu shot is a “preventive service”—not the typical episodic injury/illness that urgent care treats—and should be only offered by PCPs. And it doesn’t matter whether the payer contract is a case-rate or fee-for-service; the difficulty in urgent care getting reimbursed is the same. Case rate or flat-fee contracts pay one price for all services administered in a visit, and there must be an E/M code indicating that the patient saw a provider for sickness or injury. A flu vaccination doesn’t not fall under this category, and “carveouts” in insurance contracts for flu shots are rare. For fee-for-service contracts, payers routinely deny reimbursement for flu vaccine administration and vaccine codes if there is no accompanying E/M code or if the “place of service” is labeled urgent care. This difficulty in getting reimbursed by insurance forces the urgent care to either absorb the cost of flu shots into its overhead—resulting in a financial loss on those visits—or charge patients cash. This of course leads to reluctant patients unwilling to pay out of pocket for something they consider to be “free” from their insurance provider.

ACA and Medicare patients, for instance, get free annual flu shots in their healthcare plans. Suppose, for example, urgent care typically bills the payer $50 or more for the flu vaccine and administration. Should the payer reject the claim, perhaps due to an unmet deductible, the patient then gets billed the insurance rate. And receiving a $50 bill for a service you could have purchased in some retail stores for $20 or less makes consumers upset with the urgent care center, having the opposite effect than intended of using flu shots for marketing awareness. And even if patients are willing to pay cash, the urgent care center is still obligated to bill contracted insurance for services performed.

  • Growing Competition from Retailers That Provide Inexpensive Flu Shots – The challenge faced by urgent care centers in offering flu shots is further exacerbated by growing competition from the retail sector. Major chain retailers with an in-store pharmacy, drugstore chains, warehouse clubs, mass merchants, and supermarkets all offer inexpensive or free flu shots. In other cases, they offer coupon books, shopping passes, donations to charity, “free with insurance” promotions, and other incentives to get the flu shot from them. Even if the practice is unprofitable by itself, retailers are more than willing to absorb the loss if the offer drives customers into their stores (where they’ll likely purchase other merchandise). The flu shot in this case acts as a “loss leader,” whereby the service is sold below market value to stimulate the sale of more profitable goods and services. Urgent care centers don’t have shelves lined with profitable products that can offset the loss of providing a discounted or free flu shot—the flu shot must be a profitable, standalone service, urgent care flu shot critics contend.

Additional issues that urgent care flu shot critics raise is the potential upsetting of center throughput and unrecouped marketing expenses. Giving flu shots—particularly to walk-in patients who are there just for the vaccination—can upset flow and throughput. This would result in wait times for the flu shot patient they wouldn’t experience in a retail store, lowering the urgent value proposition. If flu vaccinations are prioritized, this would lead to waits for the sick patients in centers that aren’t equipped to handle the increased seasonal demand.

Then there are costs to the urgent care of marketing flu shots. Whether it’s newspaper and online advertisements or banners attached to the exterior of the building, these expenses will likely not be recouped by the profitability of the flu shot. For the advertising to be truly effective and produce a positive ROI, it must raise awareness of the center as a whole, and not just a place to get flu shots.

Each side of the debate has valid pros and cons, which leaves it up to the individual urgent care operator to decide which approach works best for their center. Much of the debate could be alleviated, though, if payers would carefully study the issue and recognize the immense value that urgent care brings to the overall flu prevention initiative of increasing vaccinations. Only then would payers move to take advantage of urgent care’s traffic, visibility, and accessibility and enable reimbursement—including “carveouts” in flat-fee contracts—for this vital community and public health service.

Urgent Care Flu Shot Marketing

With the abundance of flu vaccination options available to consumers, urgent care centers that decide to offer flu shots must make a concerted effort to increase their visibility and raise awareness of their services. The standard approach consists of hanging exterior flags and banners, creating flyers, and posting signs at the front desk and exam rooms promoting their flu shots. There are additional effective marketing tactics, though, that urgent care should consider and implement when feasible:

  • Employ social media and the center’s website to promote flu shot videos. Online video content garners considerably more engagement than written content, so urgent care centers should post video PSAs to their center’s website and social media pages. These video PSAs should emphasize relevant flu statistics, how convenient getting vaccinated is at their center, and patient testimonials that cover the ease of the process.
  • Sold while on hold. For telephone callers, the urgent care should create and play “on hold” flu promotion messages for callers to listen to on hold as both a reminder and to reinforce the marketing message.
  • Arrange a media interview. Invite a local media outlet to interview your center about flu-related topics and the importance of vaccination. Submitting a guest column on flu topics to a local newspaper or publication can be done, as well, which raises the center’s profile and increases awareness of your flu vaccination services.
  • Train staff to inquire about flu shots during intakes. Front office staff should always ask patients whether they’ve received their annual flu shot upon intake. “Suggestive selling” such as saying “Have you gotten your annual flu shot yet? Well lets you get vaccinated today” has shown to be extremely effective. Providers should also mention flu shot availability during the visit and exam.
  • Promote through digital channels. The urgent care should send email and text reminders to existing patients about flu season and the importance of vaccination. Include any discounts or promotions in the digital message.
  • Community outreach. Educate your staff and leverage them as community ambassadors. They should spread the word about your center’s flu shot vaccinations at recreation leagues, churches, and community organizations they belong to.

Vaccinating Urgent Care Employees

Given that an urgent care will see and treat many flu-stricken patients during flu season, it’s not uncommon for a staff member to contract and become infected with the flu as well. It’s why OSHA acknowledges that healthcare workers are at high risk for contracting influenza through their exposure to high-risk patients, while the CDC has classified healthcare workers as a high-priority group for yearly influenza vaccinations. The CDC therefore recommends that all healthcare workers receive an annual flu vaccine.

As employers are legally obligated to create a safe work environment for their employees, encouraging flu vaccination for healthcare employees is a key step. To that end, urgent care operators should have in place a policy for workers and vendors who become ill in the workplace. The policy should address procedures and protocols for how to deal with both employees and patients who may be ill with the flu, with the policy being communicated to the entire staff. Staff members who refuse a flu vaccine for medical or personal reasons are afforded certain legal exceptions, but they should be required to wear a face mask while at work for the entirety of flu season. Lastly, employees sick with the flu should always be encouraged to stay home rather than risking passing the infection to their coworkers and the center’s patients.

Prepping Your Urgent Care Facility for Flu Season

The seasonal increase in demand brought on by flu season can place considerable strain on an urgent care facility and its resources, compromising throughput and efficiency while increasing wait times. Further, lobbies and waiting rooms full of flu-stricken patients can lead to otherwise “healthy” patients waiting in the same lobby to become infected—a huge detriment to patient satisfaction and future utilization. For those reasons, urgent care centers should consider designating specific areas of the center for both a flu shot “fast track” for quickly processing flu vaccinations, and a dedicated “flu center” for segregating and treating sick patients, as outlined below:

  • Flu Shot Fast Track – You don’t want your injured and sick patients subjected to excessive waits due to an overflow of standalone flu vaccinations. A flu vaccination-only visit should therefore be treated as non-medical and have its own back-office workflow and separate “track.” The flu shot patient would check in at the kiosk, for instance, and still register with the front desk just like in a typical injury/illness visit. But instead of being sent to an exam room, they would proceed to a “vitals” area for their vaccination to be administered. They would have a $0 copay with insurance, and a maximum of, say, $35 for self-pay with cash. A high dose of flu vaccine would be priced at a maximum of $65. This fast track would allow the center to process flu vaccinations quickly and efficiently and keep wait times in check.
  • Designated Flu “Clinic” – The urgent care center should organize the clinical environment and flow to be able to quickly process, segregate, and treat patients who actually have flu symptoms by taking the following approach:
    • Hand sanitizer, tissue, and face masks should be provided at the clinic entrance for sick patients to avoid spreading germs to other patients and staff.
  • Assign a dedicated staff just for treatment of patients with flu symptoms. Depending on the size of the urgent care center, this might consist of one clearly marked front desk station (with signage) just for patients with flu symptoms, one clinical staff member assigned to treat just flu patients, and, when there is an epidemic or during peak flu season, one provider to treat flu patients.

Patients would be called back and bypass the triage room, going directly to a designated exam room. Triage would then take place in the exam room at a triage stand. Flu swabs would be done in the room, as well, minimizing traffic to and from the lab. An influenza test would be done to confirm or rule out the flu prior to the patient being seen by the physician. The exam would be done by the provider, and a prescription for Tamiflu given if necessary; these could be prewritten based on the weight of the patient to expedite the process. The designated “flu” rooms would have informational materials available discussing such things as symptomatic treatment, and tips for minimizing exposure to family and coworkers, for example.

As far as smaller, single-provider urgent care centers that may not have the space or staff for a designated flu clinic, the most important takeaway is to minimize exposure and perhaps keep flu/symptomatic patients to a maximum of one or two rooms, as well. Patients with flu symptoms could be triaged ahead of others to quickly get them out of the waiting room, thereby minimizing exposure to healthy individuals and vulnerable populations like very young children, sick, and elderly patients.

Antibiotics During Flu Season

Even when it’s not flu season, urgent care staff must regularly contend with patients who demand antibiotics when their presentation clearly doesn’t call for them. So, you can imagine how much these ill-advised and troublesome requests skyrocket during flu season due to misguided patients believing they have “special knowledge” of their body or “past experiences” that assure them that antibiotics are necessary in their case.

As signage and literature are generally not convincing or compelling enough to educate patients on the misuse of antibiotics, it’s up to the provider to communicate compassionately but directly that antibiotics are for bacterial infections and not viral infections like the flu.

If the provider fails to convince a stubborn patient that their condition is viral and they feel the need to relent, they can give the prescription but request the patient wait between 72 and 96 hours to fill it. This way, the patient doesn’t have to worry about multiple copays or a virtual visit to prescribe an antibiotic.

Conclusion

Although flu season can be the most hectic and challenging time of year in an urgent care center, it’s also typically the most profitable given the heightened demand. Urgent care operators must, therefore, ensure all their bases are covered to maximize that profitability and have strategies and workflows in place for driving awareness of their center during flu season, vaccinating employees, preventing the spread of flu between sick and “healthy patients,” and quickly treating flu and non-flu patients to maintain throughput. Combine that with educating the community on the importance of flu vaccinations in as many local venues as possible, and urgent care cannot only reap dividends on the bottom line, but continue to play a key role in helping promote public health.

For urgent care-specific insights on preparing for influenza season on the clinical side, read the following articles in the JUCM archives:

Whether You Fail or Prevail Rests on Your Preparedness for Flu Season—Now

Alan A. Ayers, MBA, MAcc

Chief Executive Officer of Velocity Urgent Care, LLC and is Practice Management Editor of The Journal of Urgent Care Medicine
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