After a long day of meetings in New York’s Upper West Side, I took a walk at the end of the day. Ironically, after a long day of healthcare strategy discussions, what I noticed on that walk was striking evidence of the new direction in primary care. Storefronts that had housed yogurt shops, clothing boutiques and branch offices of banks now were occupied by walk-in urgent care facilities. In fact, I saw competing clinics on opposite street corners, reminiscent of the gas station wars of decades ago.
Most of us understand what’s behind this explosion of readily available healthcare. The Affordable Care Act has brought millions of new patients into the system, and Medicare usage is growing dramatically, thanks to Baby Boomers.. As a result, primary care availability is inadequate. And waiting times at emergency departments have lengthened to the point that most patients can no longer tolerate the wait for care.
The patients’ out of pocket payments are growing at an alarming clip. The Department of Health and Human Services recently issued new rules on employer-sponsored health plan out-of-pocket (OOP) limits just weeks ago. For 2017, the new HHS recommended maximums for out-of-pocket expenditures are $7,150 for individuals and $14,300 for families, up from the existing levels of $6,850 and $13,700 for individuals and families, respectively.
But more is involved than cost. Several consumers surveys have clearly shown that consumers have a keen desire for high-quality care offered with greater cost-efficiency in these settings.
To be clear, cost-efficiency needs to straddle the clinical and business sides of any urgent care operation. Information technology is an enabler of quality care in these settings, although it’s difficult to find technology that’s both affordable and appropriate to urgent care.
For example, electronic health records systems may be overkill in an urgent care setting, so it may be more appropriate for physicians who have banded together to run a chain of centers to make use of a cloud-based solution. Delays at the reception desk hurt patient satisfaction and create a bottleneck in patient flow, operational and financial efficiency, and that’s something that IT can help as well.
In looking at this growing niche, I see more attention being paid to quality care, with less going to cost-efficiency, and that’s a problem. Regardless of who operates the urgent care center, if the consumer has a positive experience, it can all unravel if the proverbial last mile of healthcare looks the same as the time-wasting, frustrating, disheartening experience they have in doctors’ offices, ERs or hospitals. Patients’ bills carry the same shock, especially if they make no sense; particularly given consumers’ large out of pocket portions. That is a guarantee for exasperatingly slow payment.
The service and business opportunities that urgent care represent won’t be fully achieved if, at the end of treatment, a patient gets a statement in the mail that can’t be deciphered—remember, there’s no guarantee of a return visit, which is much more likely with patients who have a regular primary care provider. Realizing the number of consumers served by a chain of urgent care centers each month, and it’s easy to see the cash flow implications. As much as urgent care is considered a growth area within healthcare, the overlooked speed bump is the bill.
Urgent care is breaking new ground in how staff and physicians interact with patients, but it’s following the same costly, error-prone and consumer-unfriendly billing path of the vast majority of other healthcare operations. If urgent care is breaking new ground in how it delivers care why are they not doing the same for billing and payments?
Urgent care center operators need to incorporate new and emerging information technology, to upgrade billing and in other areas that make sense. If these providers want to peg their futures to providing fast, efficient and streamlined care, they’ll need information systems that can truly assist them in delivering on that promise.