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Be sure and watch for insights from UCAOA CEO Laurel Stoimenoff, PT, CHC. Each month, Laurel shares insights on our industry, activities affecting urgent care, and information on UCAOA advocacy efforts and other events.

 

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UCAOA Membership Just Keeps Getting Better: Seize the Opportunities & Resources

Posted By Laurel Stoimenoff, PT, CHC, 19 hours ago

Amid all the industry changes and uncertainties, healthcare leaders are taking full advantage of any and all resources available to them to better navigate the complexities of the evolving healthcare landscape.  Urgent care clinicians, centers, practice managers and vendors are looking to improve performance and differentiate their organizations from the competition.

The Urgent Care Association of America is the established voice of the urgent care industry, actively advocating for clinicians and centers at the state and national level, while providing thought leadership to media, the public and other colleagues in healthcare. One simple way to rise up in the industry is by joining UCAOA and optimizing all of the benefits that come with membership.

Why Choose UCAOA?
Any membership to a professional healthcare organization comes with its perks. What sets UCAOA apart is the specific focus on the urgent care industry in all educational programs, professional opportunities, business networks and management resources. As host to two of the most comprehensive and well-attended urgent care conferences each year and its ongoing education programs, UCAOA brings together industry leaders to share research and brainstorm with colleagues on how to advance the industry as well as the performance of the individual center.

By joining UCAOA, urgent care professionals can stay up-to-date on the latest trends and best practices in the industry, connect with colleagues and thought leaders, reach key decision-makers and strengthen their bottom lines. UCAOA continually creates exclusive resources and opportunities for members to meet the specific needs of the on-demand medical practice.

For Clinicians
Individual clinician members have access to an extensive list of CME opportunities and education programs – which include both in-person events and online courses to ensure accessibility for any schedule. These resources are designed by both urgent care and specialty leaders for urgent care professionals, providing unique industry insights that help elevate skills and advance your career.

For Centers
Urgent care center members can learn how to improve negotiations and contracts with payers through a growing library of data and best practices found on the Payer Relations page of the UCAOA website. Members can review the latest tips from industry thought leaders on how to demonstrate the value of urgent care to payers. In fact, many payers are calling on centers to achieve urgent care-specific accreditation or certification. UCAOA can help you succeed through a variety of targeted resources.

For Practice Managers
Practice manager members can improve their recruitment and retention efforts with a discounted rate for posting job opportunities on the UCAOA Career Center, an urgent care-specific jobs center. In addition, practice managers can utilize a growing number of free or discounted industry resources and toolkits that provide instant assistance in areas such as marketing and staffing. Look for the policy of the month and UC Prac*toids to benchmark or enhance your center’s performance and stay current with the mercurial state of healthcare.

For Vendors/Suppliers
Vendor members enjoy priority access to urgent care centers across the country through sponsorship opportunities at the leading industry events, as well as direct list mail rental options. Through the list rental program, vendors can educate the industry by sharing their data and resources via mail or email, or showcase the latest products and/or services available that are designed to enhance urgent care operations. They get their name in front of the targeted audience, which drives efficiency and results.

These are just a few of the benefits enjoyed by UCAOA members. For a complete list of benefits available with membership, please visit the UCAOA website’s Members section: ucaoa.org/benefits. We cannot advocate and advance our important agenda without your support. We do our work, so you can focus on yours!

 

 

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Tags:  CEO  clinical  Membership  on-demand services  payer  practice management  UCAOA  urgent care center 

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UCAOA Representatives Take to the Hill to Meet with Congressional Offices

Posted By Camille S. Bonta, MHS, Thursday, July 13, 2017

Members of the Urgent Care Association of America (UCAOA) turned citizen advocates on May 3 as they traveled to Capitol Hill to educate lawmakers and their staff about the important role of urgent care in the health care continuum.

 

The “day on the Hill” coincided with UCAOA’s Urgent Care Convention & Expo and included the participation of 15 UCAOA representatives who met with 75 congressional offices, including with staff on committees with jurisdiction over Medicaid and veteran’s health care.

 

Beyond providing lawmakers and their staff a basic education of urgent care centers, UCAOA members solicited the support for soon-to-be-introduced legislation that would require the Veteran’s Administration to cover healthcare services provided to veterans in urgent care centers. Sen. Bill Cassidy (R-LA) will lead introduction of the legislation in the Senate, and the introduction of bipartisan companion legislation in the House is expected.

 

Similar to the enactment of federal legislation in 2016 that requires TRICARE — the health insurance program for uniformed service members, retirees and their families to cover urgent care visits without prior authorization, legislation to improve veterans’ access to urgent care centers is important to UCAOA’s broader efforts to educate payers about urgent care’s value proposition.

 

UCAOA representatives were on the Hill the day before the House of Representatives passed the GOP American Health Care Act. It is unclear the extent to which Republicans will ultimately be successful at dismantling Obamacare this year.  No doubt, however, that states will seek greater flexibility with their Medicaid programs. 

 

Thirty-one states and the District of Columbia have expanded Medicaid. These states are very nervous because in almost each one of the expansion states, enrollment projections are higher than expected, which is putting a squeeze on state budgets.  Urgent care centers have the capacity to meet the nonemergency medical care needs of the Medicaid population at a fraction of what it costs to care for these patients in hospital emergency departments.  Yet, in many states, Medicaid rates for urgent care services are insufficient.  Because urgent care centers cannot provide healthcare services to Medicaid patients at a financial loss, states cannot establish a healthcare delivery infrastructure that encourages and supports lower costs sites of service for this population of patients until Medicaid rates are improved.

 

Improving Medicaid rates so they are on par with Medicare was another request to lawmakers. While budgetary considerations, including the failure of the Office of Management and Budget to conduct dynamic scoring that would count savings from shifting care out of the hospital emergency department into urgent care centers, make achieving Medicaid payment parity difficult, key congressional staff, during their meetings with UCAOA representatives, seemed genuinely interested in policy barriers urgent care centers face in caring for this patient population.

 

UCAOA’s “day on the Hill” constitutes just one component of the organization’s overall advocacy efforts, but an important component that UCAOA hopes to replicate and grow in the future.  A 2015 survey of congressional staff found that 94 percent note that “in-person visits from constituents” have some or a lot of influence on an undecided lawmaker a finding that has been consistent for more than a decade according to a report released this year by the Congressional Management Foundation.[1]

 

The survey also found that in-person meetings in which legislators and staff have opportunities to interact and develop relationships with constituents are very important for understanding constituents views, and that constituents meeting or getting to know legislative assistants

and district and state directors is a good way to build those relationships.

 

Contrary to what many UCAOA members may believe, they can use their voices to make a difference on policy issues important to the urgent care industry. UCAOA hopes its members will engage in advocacy efforts when called upon and, in the meantime, will use UCAOA resources made available to them to communicate and build relationships with their state and federal lawmakers, as well as with representatives of the payer community. 

 

To learn more about UCAOA’s advocacy activities, visit  ucaoa.org and look for “advocacy" in the menu bar.

Camille Bonta is the founder and principal of Summit Health Care Consulting in Breckenridge, CO focused on the lobbying, regulatory and advocacy efforts of national healthcare organizations, including UCAOA. 

 

 

 

 



[1] Citizen-Centric Advocacy: The Untapped Power of Constituent Engagement ∙ © Congressional Management Foundation CongressFoundation.org

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Tags:  Advocacy  AHCA  health  healthcare  payer  UCAOA  urgent care  veterans 

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Next Steps to Success: Distinguishing Your Center with Accreditation or Certification

Posted By Laurel Stoimenoff, Wednesday, June 28, 2017

The on-demand healthcare industry is in a state of growth and diversification. Increasing competition and choices make it difficult for patients to know where to go for the best care. One way to differentiate from the rest in terms of excellence is by achieving accreditation.

UCAOA Accreditation was developed by urgent care professionals with the nuances and uniqueness of the urgent care center in mind. It is the only accreditation that also recognizes and requires a distinct urgent care scope of services. UCAOA also offers certification for urgent care centers, either exclusively or for those on the path toward accreditation. Certification is based solely on the scope of services available to the community. UCAOA has recently expanded its certification options from traditional and pediatric certification to recognize the seasonal-, rural- and occupational medicine-focused urgent care centers. 

Those centers who successfully pursue accreditation are dually recognized as Certified (scope) and Accredited (quality & safety) Urgent Care Centers.

Why Pursue UCAOA Accreditation?

Efficiency and Engagement

The accreditation process helps urgent care centers develop and implement consistent procedures across all sites. When meeting the standards become routine practice, centers benefit from unanticipated efficiencies; including staff in the values of quality and safety may develop more engaged, customer-focused employees. Similarly, achieving accreditation requires teamwork that generates a sense of pride and accomplishment.

Examples of key quality and safety procedures required to achieve accreditation include:

·         Verification of patient identity before providing care;

·         Precautions to prevent medical errors;

·         An overarching quality plan;

·         An infection control and prevention plan; and

·         Demonstration of integrated care processes.

Accreditation demonstrates that centers have achieved excellence in eight critical areas:

·         Patient care processes;

·         Patient privacy/rights/responsibilities;

·         Scope of care;

·         Physical environment;

·         Health record management;

·         Quality improvement;

·         Governance; and

·         Human resources.

Marketing

Armed with mobile devices, consumers are more likely to search and select providers based on quality and service perceptions. UCAOA Accreditation is a trustworthy “seal of approval” for patients. Accredited centers undergo site surveys to ensure they meet established and defined standards, giving patients the confidence that the center has demonstrated its commitment to excellence.  Accredited centers market their achievement to payers and networks as well as prospective referral sources such as pharmacists, physicians, school nurses, employers, and risk managers.

Revenue & Profitability Impact

Many payers are requiring accreditation before contracting or as an in-network requirement. As examples, members have notified us that BCBS of Georgia and Empire BCBS in New York now require accreditation for new urgent care centers, while Anthem in Virginia intends to do the same for new and existing centers in the coming year. As a result, applications for accreditation are on the rise.

Medical malpractice insurance carriers are recognizing UCAOA Accreditation for its impact on quality and safety, with some offering organizations a risk management credit of 2.5 to 15 percent once attained.

Not Ready to Commit to Accreditation Right Now? Consider a First Step: UCAOA Certification

While it is most cost-effective to pursue certification at the same time as accreditation, the UCAOA Certified Urgent Care (CUC) program can be a first step on the path to accreditation. It affirms the urgent care center's scope of practice meets UCAOA criteria for easy access and scope of services. In one state, certification allows the urgent care center to receive higher reimbursement through the state’s workers’ compensation fee schedule. 

UCAOA is proud of the number of centers who have successfully attained both certification and accreditation. There are many ways to demonstrate a commitment to quality and safety but we can assure you that these individuals are doing their part to raise the bar! 


Learn more about UCAOA Accreditation and Certification

Tags:  accreditation  bcbs  ceo  certification  payer  quality of care 

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I’m a Germaphobe and Here’s Why

Posted By Laurel Stoimenoff, Wednesday, June 28, 2017

I started my career as a hypochondriac with my Merck Manual always at my fingertips for quick reference but subsequently elected to simplify my phobias and narrowed it down being a germaphobe.  This evolution occurred as I spent the bulk of my patient care years in the hospital setting.  Each year I would go through my mandatory training on infection prevention, receiving instruction on the latest research and best practices. MRSA was the enemy and we were committed to its eradication. I dutifully washed my hands in accordance with policy and donned and doffed personal protective equipment where indicated. Taking the full dose of any prescribed antibiotics was routine so I didn’t risk hosting some superbug for life.  Nonetheless, I was incredibly naïve about the looming crisis that would make even the non-germaphobe shudder. 

Antimicrobial resistance (AMR) is currently believed to be responsible for the deaths of over 700,000 people per year world-wide.  That number is anticipated to grow exponentially to a point where some predict, if unchecked, it will grow to 10 million deaths by 2050[1], exceeding the impact of cancer.  Simple surgeries will be high risk, the disease state will be prolonged and the financial ramifications will be devastating unless radical action is taken by medical and agricultural communities.

A Partnership is Forged

The Urgent Care Foundation, UCAOA’s 501(c)3 organization, has partnered with the Antibiotic Resistance Action Center (ARAC) at George Washington University.  ARAC secured a grant which is being shared with the Foundation.  Recognizing that antibiotic stewardship and proper prescribing is a complex issue and withholding antibiotic prescribing when indicated can be a patient dissatisfier, ARAC is working with UCAOA to identify best practices without adversely impacting the patient experience.  UCAOA collaborated with ARAC and released a position statement that concludes:

To combat AMR, UCAOA will work with its members and constituents in the following four areas:

1)      Education and training

2)      Clinical decision support

3)      Antibiotic use data collection

4)      Evidence-based practice

Urgent Care Under the Microscope

Top diagnoses in most non-occupational medicine focused urgent care centers have relevance when it comes to antibiotic prescribing.  This may account for the reason UCAOA is seemingly in the crosshairs fielding frequent calls related to ways we might partner to ensure industry-wide antibiotic stewardship. And I have yet to speak to a medical provider who does not lament the oft protracted dialogue with the patient who is expecting antibiotics while other patients await care and the reception area is filling up.  That medical provider may be concerned about personal patient satisfaction scores, throughput time and the fear that the patient who just paid a $75 copayment and, “is not leaving without a prescription”, may be one who frequently posts reviews on YELP.  A recent survey concluded that 41% of people allow social media to impact their choice of a specific doctor, hospital or medical facility[2] so we all know the importance of meeting their expectations. While there is no data indicating urgent care centers are more likely to prescribe antibiotics than any other medical setting, the boards of UCAOA, the College of Urgent Care Medicine and the Urgent Care Foundation acknowledge that we have an obligation to do our part in thwarting the grim prognostications emanating from the CDC, the World Health Organization and other venerable institutions.

Inappropriate prescribing in the medical community is only one piece of a very complex problem. We look forward to our ongoing partnership with ARAC and the urgent care community to influence change, educate our communities, and preserve patient confidence when we do the right thing.  Sean McNeeley, MD, Network Medical Director of University Hospitals’ Urgent Care in Cleveland, Ohio and Chair of the College of Urgent Care Medicine, summarized our responsibility nicely when he stated, “We want to do more than just our part in helping achieve this goal. We want to lead the way.”



[1] Source:  Review on Anti-Microbial Resistance 2014

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Using Patient Engagement Technology to Meet New Expectations in Population Health Management

Posted By Laurel Stoimenoff, Wednesday, June 28, 2017

Population health strategies aim to improve the quality of care for communities, not just our traditional approach of caring for the individual. Urgent care plays a crucial role in population health management by optimizing efficiency, quality and outcomes throughout the continuum of care, while also expanding patient access.

Managing population health brings new financial risks when it comes to patient care, linking the patient experience and outcome directly to payment. In order for urgent care centers to succeed within the financial landscape of these new models of care, patient engagement will be key.

Patient Engagement Technology

Innovative technologies enable management of population health strategies by capturing, tracking and sharing patient data. The role of urgent care providers has evolved to include developing interactive relationships between physicians, patients, ancillary caregivers and technology beyond the exam room. Patient engagement technology can increase patient satisfaction and involvement throughout the continuum of care to improve clinical outcomes.

For urgent care providers, patient engagement technology has many benefits including:

·         Improving care coordination between other providers

·         Supporting a medical model that leverages the role of the urgent care center beyond episodic care

·         Enabling more informed diagnosis and treatment decisions for enhanced quality of care

·         Equipping patients with information to support a more active role in their healthcare management

·         Reducing errors and increasing administrative efficiency throughout the continuum of care

As healthcare becomes an increasingly information-driven, patient-centric industry, it is imperative for urgent care providers to stay on the cutting-edge of patient engagement technology innovations to ensure interoperability with other providers and secure fair, consistent and predictable reimbursement rates. 

Increasing Patient Engagement

According to a 2016 CDW Healthcare survey, 57 percent of patients and 70 percent of providers reported an increase in patient engagement over the past two years. Patients are increasing the frequency of communication with providers and accessing their healthcare information with greater ease. The motivations driving providers to improve engagement include meaningful use requirements, technology advancements, the opportunity to improve clinical outcomes and a more loyal patient population.

To make engagement technology accessible to all patient populations, consider each patient’s unique healthcare journey. Here are some tips:

1.       Develop digital expertise on the engagement options available and select the right technology to meet the needs of your target patient population.

2.       Present the technology with step-by-step instructions, demonstrations and big-picture visual communication tools to demonstrate how it works and its benefits to the patient.

3.       Offer mobile-optimized technology so the patient can access information on-demand from anywhere. Provide patients on-demand access to on-demand caregivers. Access to care has been key for most urgent care centers and it will extend beyond the ability to offer a face-to-face office visit in the future.

4.       Encourage and demonstrate continual use of technology by providing ongoing education and timely responses to patient communication.

5.       Seek feedback at every opportunity to understand where patient pain points are with the technology and how best to improve the experience.  

With a more engaged patient population, technology can help urgent care providers gather useful information for better predictive analytics around patient health, assist in more effective interventions in the future and improve data-driven outcomes as an essential provider in a broader healthcare delivery system. Likewise, patients can utilize the technology to access information and share responsibility in their healthcare, while enjoying a more fluid experience throughout the continuum of care. It’s a win-win.

Tags:  CEO  patient engagement  patient experience  technology 

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Using Patient Engagement Technology to Meet New Expectations in Population Health Management

Posted By Laurel Stoimenoff, PT, CHC, Friday, March 31, 2017

Population health strategies aim to improve the quality of care for communities, not just our traditional approach of caring for the individual. Urgent care plays a crucial role in population health management by optimizing efficiency, quality and outcomes throughout the continuum of care, while also expanding patient access.

Managing population health brings new financial risks when it comes to patient care, linking the patient experience and outcome directly to payment. In order for urgent care centers to succeed within the financial landscape of these new models of care, patient engagement will be key.

Patient Engagement Technology

Innovative technologies enable management of population health strategies by capturing, tracking and sharing patient data. The role of urgent care providers has evolved to include developing interactive relationships between physicians, patients, ancillary caregivers and technology beyond the exam room. Patient engagement technology can increase patient satisfaction and involvement throughout the continuum of care to improve clinical outcomes.

For urgent care providers, patient engagement technology has many benefits including:

·         Improving care coordination between other providers

·         Supporting a medical model that leverages the role of the urgent care center beyond episodic care

·         Enabling more informed diagnosis and treatment decisions for enhanced quality of care

·         Equipping patients with information to support a more active role in their healthcare management

·         Reducing errors and increasing administrative efficiency throughout the continuum of care

As healthcare becomes an increasingly information-driven, patient-centric industry, it is imperative for urgent care providers to stay on the cutting-edge of patient engagement technology innovations to ensure interoperability with other providers and secure fair, consistent and predictable reimbursement rates. 

Increasing Patient Engagement

According to a 2016 CDW Healthcare survey, 57 percent of patients and 70 percent of providers reported an increase in patient engagement over the past two years. Patients are increasing the frequency of communication with providers and accessing their healthcare information with greater ease. The motivations driving providers to improve engagement include meaningful use requirements, technology advancements, the opportunity to improve clinical outcomes and a more loyal patient population.

To make engagement technology accessible to all patient populations, consider each patient’s unique healthcare journey. Here are some tips:

1.       Develop digital expertise on the engagement options available and select the right technology to meet the needs of your target patient population.

2.       Present the technology with step-by-step instructions, demonstrations and big-picture visual communication tools to demonstrate how it works and its benefits to the patient.

3.       Offer mobile-optimized technology so the patient can access information on-demand from anywhere. Provide patients on-demand access to on-demand caregivers. Access to care has been key for most urgent care centers and it will extend beyond the ability to offer a face-to-face office visit in the future.

4.       Encourage and demonstrate continual use of technology by providing ongoing education and timely responses to patient communication.

5.       Seek feedback at every opportunity to understand where patient pain points are with the technology and how best to improve the experience.  

With a more engaged patient population, technology can help urgent care providers gather useful information for better predictive analytics around patient health, assist in more effective interventions in the future and improve data-driven outcomes as an essential provider in a broader healthcare delivery system. Likewise, patients can utilize the technology to access information and share responsibility in their healthcare, while enjoying a more fluid experience throughout the continuum of care. It’s a win-win.

Join us at the Urgent Care Convention & Expo April 30 – May 3 to learn more about the evolving role of technology in urgent care. 



Laurel Stoimenoff, PT, CHC, is chief executive officer of the Urgent Care Association of America

Read more of Laurel's insights in her CEO column in the April issue of the Journal of Urgent Care Medicine.

Tags:  engagement  patient care  technology 

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Beyond Access: Redefining Your Value Proposition

Posted By Laurel Stoimenoff, PT, CHC, Monday, March 13, 2017

By Laurel Stoimenoff, CEO of Urgent Care Association of America, published in March 2017 JUCM


Urgent care centers were the creators of convenient access to care for non-life and limb-threatening illnesses and injuries. Consumers embraced the convenience and the rest of the world noticed. New delivery models catalyzed by growing expectations for on-demand services have provided those seeking healthcare services more options than ever before.  If you are feeling the impact, it may be a manifestation of the successful model you developed and now others are electing to modify or mirror it. To ensure that urgent care continues to thrive in the new on-demand marketplace, we must ask ourselves what we can do to renew our value proposition.

 Where we begin remains as steadfast as ever: make sure the focus stays on the needs and expectations of the patient.

To do this, we must know what today’s patient is seeking and anticipate what tomorrow’s consumer will expect. With many choices for ready access to care, why choose urgent care?

Convenience is Still Key

More than ever, convenience is a driver for healthcare decision making. Customers seek prompt, quality service that is most easily integrated into their busy lives. Urgent care continues to lead on this main value proposition – the 2016 UCAOA Benchmarking Survey found 92 percent of urgent care patients waited 30 minutes or less to be seen by a practitioner last year, and 90 percent of visits took 60 minutes or less to complete.

While telemedicine, retail and other on-demand services are also finding niche roles in the continuum of care, urgent care remains a necessity due to our combination of broad scope of services, fast delivery of care and great value. Studies indicate this trifecta of convenience will remain extremely important to the customer of the future – the millennials.

A UCAOA survey from 2016 revealed millennials prioritize cost-savings and accessibility when making healthcare purchasing decisions. It is no surprise then that a study from the Health Industry Distribution Association (HIDA) showed 43 percent of millennials reported using an urgent care center in the last year.

Embrace Technology

Technology is no longer a supplement to our business – it is driving our business as connectivity and accessibility are the new normal. And patients now grasp the value of on-demand services and integration of technology to simplify their healthcare services.

Technology can impact the customer experience at every stage of the patient visit. Time-saving check-in processes conducted online are becoming commonplace, as are providing patient alerts when a practitioner is ready to see them. Likewise, many urgent care centers are integrating telemedicine capabilities into their operations to make better use of the medical providers when there are lulls in patient traffic.

Finding ways to improve our customer-centric service is a priority throughout the industry, and will be a continued educational focus at the Urgent Care Convention & Expo in National Harbor, MD, April 29 – May 3. Experts and peers will highlight how technology can help urgent care centers capitalize on new opportunities, and what to expect in the next decade of health innovation. We will discuss how best to cultivate healthy interactions with patients using current technologies, and why this engagement is vital to urgent care’s future growth and success.

Prioritize Patients Over Process

In an effort to stay innovative with the latest technology, urgent care centers often adjust their service model to accommodate the demands of payers, technology providers or other third parties. Allowing these roadblocks to get in the way of delivering the optimum, on-demand care that patients are actively seeking out would betray the foundation urgent care was built on: convenience and accessibility. If the tail is wagging the dog, it’s time to step back and re-evaluate.

Look Back to Move Forward

As the market for on-demand healthcare continues to grow, urgent care must lead the way in efficiency, convenience and a consumer-focused experience.

The upcoming UCAOA Convention & Expo in April will highlight market insights on the state of urgent care now and in the future. We will analyze industry developments over the past year, and brainstorm how they will form the foundation of health service business models as patient needs and expectations continue to evolve.

To ensure our path forward stays the most relevant, we may need to take a step back, identify and eliminate barriers, before pressing forward with a renewed focus on consumer needs and operational efficiency. 

Tags:  accessibility  connectivity  on-demand services  patient care  telemedicine 

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URGENT CARE: BRINGING OUR VALUE PROPOSITION TO THE PAYER COMMUNITY

Posted By Laurel Stoimenoff, PT, CHC, Thursday, February 9, 2017

UCAOA’ s most recent Benchmarking Report data indicated the median number of patient visits per day in an urgent care center was thirty-two, down slightly from the prior year; however, based on the current database of urgent care centers in the United States, this would translate to urgent care centers caring for nearly 85 million visits per year.  According to a 2012 data reported by the CDC’s National Ambulatory Medical Care Survey (NAMCS),[1] outpatient physician office visits were reported as follows:

  • Total visits: 928.6M
  • Visits per 100 persons: 300.8
  • Percentage of visits made to primary care physicians: 54.6% 

Therefore, assuming ambulatory care visits remained consistent with activity reported in 2012 and primary care visits represent 54.6% of all visits (or 507 million) urgent care would represent over 16% of all primary care visits and over 9% of all outpatient physician visits.  Statistically, it would seem that urgent care has earned its seat at the table as we discuss reform. 

Recent studies conducted in Massachusetts and Colorado concluded that 40 percent of emergency department visits were for non-emergent conditions that could be more appropriately and cost-effectively cared for in less acute settings, including urgent care centers.  The study published by the Massachusetts Health Policy Commission illustrated that emergency department visits per 1000 residents were reduced by 30 percent[2] in those markets where urgent care centers or retail clinics had a presence.

It would seem that all this would be cause for great optimism yet our phones ring with members pleading for help. The contracting and credentialing process has become so protracted that it threatens the viability of many start-ups, particularly if they did not have the foresight to begin the process early in their development plans.  Networks are being narrowed in many areas principally by denying access to new entrants. Contract language specific to urgent care centers now often dictates staffing models, hours of operation and places limitations on wellness and follow-up care despite the fact that many of our patients are geographically displaced from their primary care provider, cannot access their PCP or simply do not have one.  These new rules of participation extend far beyond those of state medical boards charged with public protection.  Established urgent care organizations may being exhaling a sigh of relief that this isn’t their problem; but, what happens when that contract comes up for renewal? 

We all have a responsibility to demonstrate our worth.  While UCAOA will continue to have dialogue at a national level, most payer negotiations are at the state or regional level, which is why the industry needs the support of our members and we need to provide tools to support you.  So what can we you do whether on the outside looking in or sitting on an existing contract?

  • Be relentless in your attempts to secure an audience with payers in your community. Demonstrate how you are innovating and how your organization’s strategies align with those of the payer.
  • Integrate with the greater healthcare community.  If the patient has a PCP, work to establish reasonable communication methods that ultimately reduce costs, eliminate redundant testing and improve health.  Operating in silos is dead.
  • Demonstrate how your center is prepared to support ED diversion strategies.
  • Provide data.  The payer community has access to an immense amount of data but the urgent care center has the unique opportunity to provide relevant information that they either don’t have access to, or haven’t thought to collect.  How many of their members report to you that they do not have a PCP? If they have a PCP, was he or she accessible when care was needed? How many of their members sought care after 5:00 PM during the week or on weekends and what savings from an E.D. visit was therefore realized? How many of their members received radiography, lab or other services often delivered outside of the office visit as part of the payers global fee?
  • Use the data to educate payer representatives on the value your center(s) bring to the equation and seek opportunities for improvement.
  • Share your successes and best practices as well as barriers with UCAOA’s Payer Relations Committee.  It has strategic agenda to advance on behalf of our members.

Our voice deserves to be heard. The payer community is tasked with implementing tremendous change. Let us all ensure that the message we deliver offers solutions.


Laurel Stoimenoff, PT, CHC, is chief executive officer of the Urgent Care Association of America

Read more of Laurel's insights in her CEO column in the February issue of the Journal of Urgent Care Medicine.


[1] Source: http://www.cdc.gov/nchs/fastats/physician-visits.htm:

[2] Massachusetts Health Policy Commission 2015 Cost Trends Report, Emergency Department Utilization

Tags:  contracting  credentialing  payers 

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