In recent years, the urgent care industry has emerged as a vital component of the U.S. healthcare system, providing convenient and timely care for non-life-threatening conditions. Urgent care centers have bridged the gap between primary care and emergency departments, offering affordable and convenient healthcare options in the communities they serve.
The Urgent Care Association (UCA) estimates that urgent care centers prevent around 24.5 million emergency room visits annually, reducing the burden on emergency rooms and saving patients and the healthcare system valuable time and money. In the United States, an emergency room visit costs $2,200 on average, according to UnitedHealthcare.
However, urgent care centers are grappling with a complex reimbursement system that fails to adequately recognize the value they bring to patients and the broader healthcare system. In many cases, we are seeing urgent cares getting reimbursed from insurance companies at rates that are less than years ago. We even have one case where an insurance company decreased reimbursement rates for WellNow Urgent Care by almost 30 percent from what it was close to 10 years ago. It’s widely known that the cost to deliver care has increased significantly – employee costs at our centers have increased more than 20 percent over the past two years with some insurance companies not providing reimbursement increases in more than five years.
The persistent issue of low reimbursements by insurance companies to urgent care centers poses a real threat to the survival of these critical healthcare facilities. Center closures across the country have already begun. If left unaddressed, this crisis may lead to further closures, which will restrict access to medical care, exacerbating the already strained healthcare landscape.
Impact on access to care
The consequences of low reimbursement rates for urgent care centers are far-reaching and pose a significant threat to access to healthcare services. This is especially true in rural and tertiary markets – the fastest growing segment of urgent care because so many rural hospitals have closed.
Unfortunately, closures of urgent care centers are becoming common headlines. Baystate Health, Shields Health and Ascension Medical Group have all announced plans to close some of their urgent care centers. MedExpress, one of the largest urgent care companies in the country, has closed multiple locations in many states over the past few years. Even WellNow Urgent Care has made the tough decision to close some of our locations.
As centers struggle to cover their costs and maintain quality care standards, closures become an unfortunate reality. This jeopardizes access to timely medical attention for millions of patients, particularly in underserved communities where urgent care centers may be the only viable option for non-emergency healthcare needs.
The closure of urgent cares also potentially burden already overwhelmed emergency departments. In areas without urgent cares and no primary care options, patients seeking care for non-life-threatening conditions are left with no choice but to turn to emergency departments, which leads to increased wait times, higher costs and compromised patient outcomes.
This is not a demand issue. There are plenty of patients who need our help in all our communities. This is an economics issue, which is impacting our ability to treat patients.
Solving for an impending crisis
Addressing the issue of low reimbursement in urgent care requires a collaborative effort among insurance companies, policymakers, healthcare providers and patient advocacy groups.
I would like to invite insurance companies to engage in meaningful dialogue with urgent care providers to understand the challenges they face and explore fair reimbursement models that reflect the value they bring to patients.
We must ask insurance companies to recognize the value and critical role played by urgent care centers in our healthcare ecosystem. Fair reimbursement is not just a matter of financial sustainability for these centers; it directly impacts patients’ ability to access high-quality, cost-effective care in a timely manner. Reimbursement rates must reflect the value of services rendered, the convenience provided, and the potential cost savings achieved by diverting patients from emergency departments.
Policymakers must also recognize the importance of urgent care centers and support initiatives that incentivize fair reimbursement. This could include regulatory measures, legislative actions, and the promotion of value-based care models that incentivize outcomes and patient satisfaction rather than simply volume.
Immediate action is needed to address this crisis to ensure that patients continue to have convenient access to non-emergency care and to prevent further strain on emergency departments. By recognizing the value of urgent care centers and providing fair reimbursement, we can preserve access to healthcare and uphold the principles of a truly patient-centered system. The time for action is now, for the health and well-being of our communities depend on it.
Photo: champc, Getty Images
