Will Trending of Urgent Care Utilization as Primary Care Overthrow the Objectives of Value based care?
With an increase in public demand, longer hour availability and walk-in appointments, the cost and time effective convenience of urgent care clinics is experiencing a rise in utilization. According to a 2017 Merritt Hawkins survey on physician appointment times, the waiting period for new patient primary care appointments in large metro markets was 24.1 days while in mid-sized markets it reached 32 days (Team, 2017). If patients must decide between waiting 24+ days to see their primary care physician or a same-day urgent care walk-in appointment, primary care physicians will continue to lose the ability to effectively manage the care for their patient populations.
How can clinicians and organizations manage patient complexity and outcomes when the trend is frequent urgent care facility visits becoming the new healthcare model? For example, if a patient enters an urgent care clinic with a chief complaint of dizziness and an outcome of high blood pressure the urgent care clinic may prescribe a new blood pressure medication. Without the patient’s full medication history, a possible medication interaction could send that patient to the Emergency Department resulting in a much larger healthcare incident that also shoots utilization costs through the roof. Even without immediate negative results, the primary care physician is completely unaware of the significant change to this patient’s health status and cannot ensure proper care management needs will be met at the time of the visit or in follow-up protocols for such a change. The inherent objectives of Value-Based Care are improvement in the quality and cost of healthcare in the US. From point-of-care models like that of the Merit-Based Incentive Payment System (MIPS) to Alternative Payment Models that hold practices and clinicians responsible for the general health of their patient populations; these models serve to meet the objectives of Value-Based Care. If the immediate state of our healthcare system is pushing patients to utilize urgent care as their new Primary Care due to high cost and physician availability, the efforts to advance Value-Based Care to improve the quality and cost of the U.S. healthcare system, may be at significant risk.