Facts all Urgent Care Clinics Need to Know to Keep Ahead of Their Competition

March 17, 2023
March 17, 2023

Urgent Care Trends: A Growing Segment in the Healthcare Market

It’s an exciting time to be working in the urgent care industry. Recent data suggests that Urgent Care Centers are attracting 89 million patient visits each year, including more than 29% of all primary care visits in the US, and nearly 15% of all outpatient physician visits. This activity has caused the number of urgent care facilities to increase from 6,400 in 2014 to 8,100 in 2018.

Urgent Care Centers have grown in popularity over recent years for many reasons. Patient demand, cost, and convenience being the biggest ones. Patients are able to get same-day care without the emergency room sticker shock, or lengthy wait times—it’s no wonder urgent care centers are becoming their provider of choice.

Key factors Driving Growth in the Urgent Care Sector:

  • Cost: Today’s population seeks a cheaper alternative to hospital visits. A 2016 study in the Annals of Emergency Medicine found that ER treatment costs averaged $2,200, where that same treatment averaged about $168 in urgent care centers.
  • Convenience: Patients seeking medical care don’t want to wait. Overall, 85% of patients in urgent care are seen and taken care of in under an hour.
  • Expanded Services: Urgent Care Centers are now offering physical therapy services, weight loss services, pediatric services, sports medicine and more.
  • Current Events: Many people are reluctant to go to hospitals today because of the pandemic. They don’t want to go to an emergency department, but they will go to urgent care. They are also attracted to the telehealth services offered by an increasing number of urgent care centers.

"Urgent care isn’t booming only because of physicians seeking a better work-life balance. Other factors driving the industry’s growth include patient demand, convenience, and costs. Patients seeking medical care don’t want to wait."

Medical Economics

Becoming an Urgent Care Center of Choice

Although the Urgent Care Association of America and the American Academy of Urgent Care Medicine have criteria for urgent care clinics, there are limited regulations or state licensing requirements. Criteria may run the gamut between requiring that the facility be open seven days a week to requiring urgent care centers have a privileging/credentialing system in place.

One way your urgent care center can maintain compliance with state requirements and stand out from the crowd is by achieving accreditation. Accreditation proves that your organization meets the requirements needed to provide high-quality care. The process itself will help you maintain compliance with healthcare laws and regulations and keep up to date with industry standards. Accreditation can also help you meet payment requirements as many payors require accreditation/ certification in order to contract or stay in network. This trend began in early 2017, when Empire BlueCross BlueShield of New York and Blue Cross BlueShield of Georgia started requiring urgent care centers be accredited in order to be in network, and this requirement continues to expand.

When it comes to accreditation, Urgent Care Centers can choose several routes including pursuing accreditation with:

When you look at the number of freestanding urgent care clinics, you’ll see overwhelmingly that the Urgent Care Association (UCA) is the largest and most commonly used organization for accreditation. The UCA is dedicated to representing the growing urgent care industry, and is most popular due to its many member offerings. UCA members are able to access educational resources, listservs to aid in networking, exclusive vendor relationships, as well as a robust network of applicant and employer postings to aid in career development.

All Accrediting Organizations Have Requirements in Place Around Credentialing and Privileging

Credentialing is an umbrella term used by many organizations to summarize the process of obtaining, verifying, and assessing the qualifications of a practitioner to provide care or services in or for a healthcare organization. Privileging is a subset of the credentialing process whereby a healthcare practitioner is authorized to provide a specific scope of patient care services based on an evaluation of the individual’s credentials and performance.

All accrediting organizations have requirements in place around credentialing and privileging, which can require excessive resources to manage due to the amount of provider data that must be collected and managed. Requirements include:

  • Creating and obtaining complete applications
  • Creating and obtaining signed attestations
  • Collecting a long list of documents including a CV, and copies of certificates of insurance, collaborative agreements (when required by the State), etc.
  • Creating and obtaining privilege forms that include core privileges plus ability to add additional non-core procedures
  • Obtaining and storing primary/secondary sources to verify credentials and competency (education/training, previous affiliations, NPDB, OIG, peer references, etc.)
  • Routing completed credential files for review and decision-making and storing documentation of decisions made and privileges granted
  • Managing items that expire and/or need to be updated (for example, licensure)
  • Tracking completion of items required for initial and annual orientation (part of accreditation process) – policies, procedures, etc.

Managing health status items, such as TB testing, flu shots, etc. Urgent Care Centers must also go a step beyond by credentialing their entity and enrolling both their providers and their facility with payors. The total time to credential and enroll a new facility and provider(s) averages 4.5 months. This does not include the time to negotiate contracts which can average 120 days or more per contract. The bottom-line is that it takes a long time to complete the process of getting in network with all the payors you want to work with. Many urgent care centers are managing this process with a mix of spreadsheets and paper, which isn’t sustainable.

Seeing patients and speeding time to revenue

We’re all aware that the climate for healthcare organizations is a challenging one, especially considering healthcare costs are trending upward. Between tighter compliance regulations, increased competition, and tighter budgets, healthcare providers have to do everything possible to reduce costs and streamline healthcare processes as a whole.

One way to do that is through automation which can be used to reduce staffing costs, improve compliance, and significantly speed up the billing and payment cycle. With improved revenue flow and a reduction in non-payment, your urgent care center can spend more time focusing on patient care, not administrative tasks.

Some areas today’s Urgent Care Centers are using technology to decrease expenditure and improving efficiency with are:

  • Automated scheduling and process mapping: allows organizations to maximize care capacity
  • Automated appointment reminders: prevents last-minute cancelations, which equal around $1.5 million in savings annually
  • Automated credentialing, privileging and enrollment: helps with:
    • Completing and tracking the paperwork submitted to payors
    • Managing roster submissions and updates if/when delegated with payors. Many require quarterly updates
    • Tracking contracts in place and acting when plan renewals are required ~ Tracking and submitting required updates with multiple payors; like a provider name change, an entity name change, or a change to your tax ID

Leverage technology to increase patient volume and satisfaction

If you have any doubt at all about your organization’s ability to perform proper credentialing and privileging, then it’s time to reevaluate your current system. Your path to urgent care competency begins with automated procedures that set your organization up to deliver with speed, consistency, and certainty.

CredentialStream has everything your urgent care center needs to request, gather, and validate information about a provider. With a continuously updated platform, best-practice content libraries, and industry-leading data sets, CredentialStream is the most comprehensive provider lifecycle management solution available. Most importantly, the solution is built to grow with your organization; based on your needs you can add functionality to assist with credentialing, privileging, enrollment, onboarding, evaluation, and network management.

Accreditation & Automation = Financial Benefits

On average, an urgent care contract pays approximately 30% more than a primary care contract. Typically, urgent care facilities bill 82% as urgent care, 14% as primary care, and 4% as a combination of both. As areas become more saturated with urgent care options and primary care provider shortages increase, it’s getting harder to contract as urgent care. With a robust automation system in place, you can facilitate accreditation and ensure your urgent care center is approved by payors.

In Summary

As more and more urgent care centers enter the marketplace, the competition to secure contracts and patients will heat up. Achieving accreditation can position you as an urgent care center of choice. This requires a first-rate credentialing and privileging process which can be difficult to impossible to achieve without automation. If you’re not certain about your organization’s ability to perform proper credentialing and privileging, now is the time to act. Implementing automated credentialing and privileging is easier than you think, and better yet, VerityStream is here to help make sure everything runs smoothly.