Urgent Care Association responds to payer reimbursement policy

Sept. 17, 2019
Urgent care centers play an essential role in the delivery of non-emergent, primary care services and deserve fair reimbursement for the service and access provided

The Urgent Care Association (UCA) has published an official position statement regarding payer reimbursement explaining how urgent care centers (UCCs) play an essential role in the delivery of non-emergent and primary care services to consumers across the country and deserve fair reimbursement for the service and access provided. 

UCA says the arbitrary restrictions placed on the scope of services provided and follow-up care are not in the best interest of the patient’s health and limit clinicians’ ability to provide care consistent with clinical best practices.

“Urgent care centers provide many of the same services offered by primary care providers (PCPs), yet the disparity in co-payments creates disincentives for patients to seek needed care,” said Laurel Stoimenoff, CEO of UCA. “Plan designs should align co-payments with those offered by traditional PCPs.”

According to 2016 data reported by the Centers for Disease Control and Prevention (CDC) National Ambulatory Medical Care Survey (NAMCS), 85.1 percent of adults and 93.6 percent of children within the United States visited a health care professional during the year. Outpatient physician office visits were reported as follows:

• Number of visits: 883.7 million

• Number of visits per 100 persons: 277.9

• Percent of visits made to primary care physicians: 54.5 percent

From this data, the UCA 2018 Benchmarking Report of median daily patient volume and the UCA’s database of U.S.-based urgent care centers, it is estimated that urgent care represents more than 24 percent of all primary care visits and 13.4 percent of all outpatient physician visits.

“Our members are telling us that arbitrary contractual barriers are limiting them from acting in the best interest of their patients,” said Stoimenoff. “As an example, many patients seek care in the urgent care center when traveling, yet some contracts deny any follow-up care which makes no sense. There seems to be an assumption that everyone has a PCP or they have ready access to their PCP. When the practice of good medicine is at risk, we need to speak up.”

UCA asserts that urgent care centers typically offer medical evaluations, treatment and diagnostic services, including onsite radiology and laboratory, rendering them one of the highest value locations to deliver care to consumers; yet, payer contracts oftentimes restrict the scope of practice of UCCs and deny payment for wellness and other services not directly deemed an illness or injury. These restrictive practices fail to consider that 35 percent of patients seeking care in a UCC are unaffiliated with a primary care physician (PCP) or medical home.

“The Association of American Medical Colleges (AAMC) predicts a huge shortfall of primary care physicians by 2030,” said Stoimenoff. “Urgent care centers provide and will continue to deliver a significant amount of the primary care in the country and support PCP practices through easy access to same-day care and collaboration.”