What’s Next for Urgent Care With the End of the PHE?

Ben Barlow, M.D., chief medical officer of Experity

Many changes have been made within the healthcare industry since the COVID-19 pandemic to improve operations and the overall experience: digital health services and their availability accelerated drastically, provider operations have been further streamlined, and the process of finding, receiving, and paying for medical care looks quite different from just a few years ago.

Perhaps most notably, urgent care and urgent care services emerged as a lifeline to accessible healthcare, providing timely medical attention to the broader population and helping to bridge the gap between patients and available providers.

During the public health emergency (PHE), federally regulated health plans were mandated to cover COVID-19-related services, often without cost sharing. This includes deductibles, co-insurance, and copays. For example, telehealth services were expanded for Medicaid and Medicaid Managed Plans. Additionally, states had their own authority to cover telehealth without federal approval. Many states have made or plan to make some of these Medicaid telehealth flexibilities permanent. The PHE also temporarily waived some aspects of state licensure requirements, and the Department of Health and Human Services (HHS) waived penalties for HIPAA violations against healthcare providers who serve patients in good faith through everyday communications. However, these waivers are ending now that the PHE is over, similar to many other coverage adjustments made during the pandemic.

With these changes, the urgent care industry is navigating a shift in healthcare demands and patient needs and must adapt alongside the evolving landscape and population. Now that urgent care clinics are not being primarily utilized as testing centers, as they were during much of the pandemic, there is an urgency to recalibrate their offerings and re-integrate many of the services that were once the norm for urgent care, and even add high-acuity treatments within more advanced, equipped practices. Shifting back to what was once standard for urgent care and looking to expand to meet new needs outside of that, requires an assessment of policies and waivers, required staff training, compliance, and enhanced infection control incorporating the lessons learned from the pandemic. It is important for urgent care clinics to move strategically and thoughtfully for what they have to do to best meet evolving patient needs that will benefit the communities they serve, their businesses and more broadly the urgent care industry in the long-run while still delivering the efficient, varying on-demand care that patients expect.

As PHE assistance draws to a close through incremental changes across the industry, it is essential for all provider organizations, including urgent care leaders, to stay agile and evaluate the impacts that these changes are having on patients and their practices.

Payment concerns

With the end of the PHE comes the loss of Medicaid access for millions of patients, leaving many uninsured as of its official ending this past May. The Families First Coronavirus Response Act (FFCRA) prevented states from involuntarily removing individuals from their Medicaid coverage. Although initially tied to the PHE, it became part of the federal spending bill. As of April 1, 2023, individual states were able to start processing Medicaid redeterminations and disenrolling residents who no longer qualify for Medicaid, leaving plans with 14 months to review the eligibility of their beneficiaries. As a result, denials are suspected to become an increasing problem as these Medicaid changes fall into place, so it is imperative for providers to ensure their practices are thoroughly and carefully checking eligibility as many patients may not even know they lost coverage.

According to a March 2023 report from Public Broadcasting Service (PBS), 40% of US adults say they’re delaying care or go without because of financial costs. Lack of insurance is not the only problem that patients are facing post-pandemic. Changes in insurance coverage, higher deductibles, and the current economic climate are leading patients to avoid seeking care until their condition is critical. This approach to one’s healthcare leads to worsened outcomes, and often lands them in the emergency room (ER) with a more severe stage of the disease requiring high acuity care. Urgent care has the ability to treat many diseases in the early stages and prevent this progression of severity. Urgent care centers commonly treat minor or moderate injuries, infections, rashes, flu-like symptoms, abdominal pain and many others. If left untreated, these conditions can become emergent or have long term health implications, leading to high healthcare costs and/or ER medical bills that could have been avoided with an earlier, less expensive urgent care visit.

Further enhancing care accessibility

With so many changes and uncertainty surrounding coverage, urgent care providers can help patients navigate the complexity of the healthcare system, as urgent care is often a first touchpoint for patients entering the system due to its high accessibility. Urgent care providers can also expand their outreach, engagement and provide education to patients who might otherwise choose an ER for an initial visit to address a non-life-threatening health concern. During the pandemic, urgent care clinics became go-to testing sites within communities, causing typical, and sometimes more complex, visits to drop due to the new high-priority pandemic needs. Adapting urgent care practices, staff, equipment, and offerings to re-integrate these traditional, higher-acuity visits into day-to-day operations will help route patients to the right level of care, reduce inappropriate ER visits, and help patients avoid unnecessary, costly medical bills.

The end of the PHE marks another new chapter in the healthcare industry, with urgent care clinics ready to serve their communities beyond COVID-19 pandemic testing, and back to serving as the daily healthcare access point for the communities. Solutions and lessons learned brought about by the pandemic have transformed the way we deliver care, and providers must continue to adapt with the industry, current policies, and patients. Patients have become accustomed to high levels of convenience, transparency, and accessibility when it comes to healthcare. Urgent care clinics must cater to those changing needs if they are to lead the industry in offering accessible, quality on-demand healthcare. Urgent care has proven its value in expanding healthcare accessibility during a difficult and stressful pandemic. It’s now time to re-evaluate where providers stand to best serve the patients of today and provide high-quality healthcare services in a post-pandemic world.

Benjamin Barlow, M.D., is the chief medical office of Experity, an urgent care company.