How to Beat Acuity Degradation Trends in Injury Care
Urgent cares are leading greater access to lower-acuity healthcare, thereby freeing up emergency departments (ED) to take on more serious cases. This often means fewer expensive ED visits, which can be up to ten times more expensive compared to urgent care visits.
However, a growing trend of acuity degradation is undermining the effectiveness of urgent cares and affecting their profitability as a result. Communities, employers, and patients want to know that their urgent care will treat large lacerations, puncture wounds, minor fractures and similar indications without requiring them to make a costly ED visit. But with a higher trend of referrals for these cases, patients and payers alike are beginning to question if urgent cares can provide the injury care they need.
In a recent UptimeHealth webinar with Dr. John Koehler, editor-in-chief of OccDocOne, a web-based injury management platform, we discussed these issues at length, including the risks that acuity degradation poses to urgent cares and how to beat the growing trend.
Dr. Koehler is the founder of Physicians Immediate Care, an Occupational Medicine/Urgent Care hybrid clinic now with 50+ clinics in IL, IN, and WI. He is board-certified in Occupational Medicine (Occ Med) and a founding member of the Urgent Care Association.
What is acuity degradation and how does it occur?
Acuity degradation manifests as a reluctance of urgent cares to treat injuries and indications that should fall within their competence. While urgent cares are not ordinarily designed or equipped to handle higher-acuity injuries, various other indications like rust rings, dislocations, and minor fractures should be within their capacity.
Yet, as Dr. Koehler notes, many of these cases are increasingly referred to EDs, leading to dwindling perceptions about the capacity of urgent cares and an undeserved reputation of urgent cares as little more than “glorified triage” centers.
He points out several factors that contribute to the trend of acuity degradation in injury care. These include:
- Training: Training can often vary with the residency programs, the types of rotations, and the involvement of these rotations that medical providers and nurse practitioners are engaging in. While some obtain the background knowledge for roles in trauma, orthopedic, and ophthalmology, some programs are simply not long enough to cover sufficient training in injury management.
- Specialization: With a higher degree of specialization, certain urgent cares are operating with refined focus on specific practice areas. For instance, within the orthopedic practice alone we might have the shoulder orthopod, the knee orthopod, the foot and ankle orthopod, and other bifurcated specialties. While specialization does help build expertise, it tends to create a more referral-oriented approach to indications that do not fall squarely within the practice.
- Low experience: Without the extended training and practice orientation towards broad injury care, providers typically come out with a lower experience level. They are not comfortable with treating many cases they would ordinarily have, and this perpetuates the trend of acuity degradation.
Urgent cares that are not equipped to treat large lacerations, shoulder dislocations, and similar injuries start to exhibit low confidence levels about these indications. This in turn leads to high referral rates because they want to find those “goldilocks” cases that sit right where they’re most confident.
The impact on patient care and financial performance
Although acuity degradation begins as a mostly internal matter for urgent cares, it can quickly spawn into a more significant issue. Some of the consequences it can bring include the following:
- Employer concerns: Employers want to have a reliable partner for their work compensation issues. They don’t want a triage center – they could have a nurse in their factory doing that if they wanted. Instead, they want a one-stop shop that provides real injury treatment because they know when it’s referred to other venues such as ED or a specialist, costs go up, OSHA recordability goes up, time off work goes up. Employers want to get the cost savings of urgent cares without needing to go to the ED. If they don’t find it in the injury care services you provide, they’ll go elsewhere.
- Community experience: Communities know what you treat and what you don’t treat. If you keep referring all those cases out they’ll just go straight to orthopedic specialists or the ED next time they come down with sports injuries, sprains, or fractures. Since they cannot tell what is within your competence, they’ll simply assume you don’t treat those cases, or even worse, mix up cases that you do treat with those you don’t. Either way, you end up losing those cases that should come from the community you serve.
- Spawning orthopedic direct urgent cares: The more you refer these cases out, the more likely it is that your patients will just go direct to the ED and large orthopedic groups. Importantly, your patients don’t want to have to come to you and learn that they still need to go to the ED or an ortho specialist to get boots, ace wraps, or other treatment. Therefore, be referring these cases you’re spawning ortho direct cases and creating competition against yourself, especially if those ortho groups also have their orthopedic urgent cares.
- Rad tech dissatisfaction: Less high acuity means less x-rays and work for your radiology technicians. If your injury care goes down far enough as a result of employers and the community seeing you as being unprepared or unwilling to treat injuries, you will likely lose injury volume and rad tech volume. That’s a problem for you because rad techs are already so difficult to hire and if they’re not getting the work they want to do, they’ll eventually move on.
Apart from these consequences, acuity degradation trends in injury care will create other margin challenges that make it hard to continue operating. These include:
- Wage inflation: You need to be able to offer wage raises yearly so you can stay competitive, but lost cases won’t make up for this.
- Injury-related revenue loss: Lost cases will result in direct revenue shortfalls. Indirect revenues losses will also occur due to bypassing in community, dropped case rates, and lower visit volumes.
- Payer response: Payers are noticing this acuity degradation and are seeking solutions that protect them from the higher fees that referrals eventually bring. Payers like Humana have stopped contracting with urgent cares, choosing instead to work with telephonic nurse triage and multi-specialty groups.
- Case rates: Since payers want to save money on rising referrals, they’re more likely to offer case rates that eliminate compensation for laceration repair, fracture care, dislocations etc. Do not sign these rates and if you have to sign, at least make it three-tiered and include carve-outs for x-rays.
- Rad tech pay: With increasingly thinner margins, it will get harder to retain rad techs and the risk is that these techs will receive competitive offers from elsewhere.
Considering the unavoidable implications that these margin challenges bring, it’s important for urgent cares to begin prospecting where they can mitigate. Dr. Koehler identifies a number of strategies that urgent care centers can implement to improve injury management.
- Culture: Establish a culture that embraces and encourages multiple procedures. Let it be clear that you want to be a one-stop shop. Also work to foster that positive attitude towards procedures in your staff.
- Hiring: Hire for aptitude, experience and, critically, desire for procedures. No matter how great your can-do injury management culture is, you’re unlikely to achieve much without medical providers who can and want to do procedures.
- Provide training and support tools: Where you identify gaps in skill level or experience amongst your providers, you need to work to fill those gaps. You can do this by giving them the opportunity to become familiar with procedures through lab work like sewing pig legs, drilling soap bars or hard-boiled eggs. Tools like OccDocOne can also come in handy here with the detailed guides and instructions they provide.
- Clarify your expectations upfront: You don’t want your providers coming in and then finding out they have to do procedures they’re not confident with. You need to make it clear from the start that you intend to get elbow deep into injury management and you intend to become a one-stop shop.
- Provide incentives: Rewarding your people for doing procedures provides an incentive to take on more cases. This is a win-win for you since you’re only paying incentives out of money you’ve already earned.
- Regulate referrals and review referral charts: You need to regulate how cases are being referred out of your practice. Have your senior physicians take calls and provide a second opinion before authorizing referrals. Also be certain to periodically review your referral charts to make sure cases are being referred out for the proper indications.
- Negotiate with payers: Be firm in your negotiation with payers. Do not accept case rates, but if you do, be certain to carve out your x-rays. Also, it is important to capture your codes with each payment so the next time you’re negotiating with payers you can bring up hard data to show the numbers you’ve done.
- Create a brand for injury care: Put it out there that you do injuries and have a thriving practice that includes procedures. When your community and employers know they can rely on you to take care of the urgent injury management they need, you’ll find consistent, profitable business.
- Properly monetize by providing DME: Durable medical equipment (DME) products and devices such as hot/cold packs, crutches, braces, splints and slings provide the perfect opportunity to upsell, cross-sell, and create more revenue.
Leverage the right tools to standardize injury management and enhance provider performance
In addition to the strategies we’ve shared above, you can further build out your injury management practice by leveraging tools like UptimeHealth and OccDocOne.
OccDocOne is a robust web-based injury management platform with more than 300 diagnosis-specific, visit-by-visit, best practices guidelines designed to improve and standardize injury management performance. The tool was developed specifically to support Occ Med practices, and to this end, it comes complete with validation steps and procedures that employers will love.
UptimeHealth equips urgent cares with a single integrated platform where they can track their medical equipment, maintain compliance logs, and produce the level of organization that payers love.
Email Brendan Morris at email@example.com for a demo today!