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Urgent Care Association Publishes Official Position Statement Regarding Payer Reimbursement


 

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. 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 (CDC) National Ambulatory Medical Care Survey (NAMCS), 85.1% of adults and 93.6% 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%

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% of all primary care visits and 13.4% 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 Position on Reimbursement Will Favorably Impact Population Health

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% of patients seeking care in a UCC are unaffiliated with a primary care physician (PCP) or medical home.

"The 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."

To view the full position statement, along with other position statements that have been published by UCA, please visitwww.ucaoa.org/Statements.

 
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