Founder & CEO @ UCP Merchant Medicine & Intellivisit Solutions | Healthcare Administration MBA
Doing primary care in an economically viable way is challenging. Here are five reasons why this model is difficult to sustain when compared to urgent care, as Walgreens has learned all too well. Firstly, the visit length for primary care is longer than urgent care visits. Providers spend an average of 14-24 minutes with patients in primary care, compared to 6-10 minutes in urgent care. This means providers can see 4-5 patients in an hour at urgent care but only 2-3 in primary care. Secondly, urgent care is reimbursed far better than traditional primary care, resulting in a revenue difference of $135 versus $100 per visit. Thirdly, primary care requires physicians to manage the many complexities of patients, which drives up the cost structure from urgent care APP cost of $65-$75 per hour to primary care physician cost of $125-200 per hour. Fourthly, there is a growing primary care physician shortage, making it difficult to sustain a care delivery model based on physicians. Lastly, practice patterns vary in primary care, which can make building a reliable brand and offering almost impossible. To summarize, 50% less volume capacity, 25% less reimbursement per visit, 100% more provider costs, unsustainable staffing models, and variation in practice. It’s tough folks… really tough. This is much of the reason why the average employed primary care physician losses $350k per year for the corporate entity. Read more about Walgreens' experience with this model here:
"This is much of the reason why the average employed primary care physician losses $350k per year for the corporate entity." this isn't just true of "corporate" entities ... hospitals also lose money on primary care ... but they own all the downstream revenue ... although they don't lose $350k ... more like $150k each the quality of provider in private practice VS. hospital employed VS. corporate employed is also VASTLY different
April Gillam
4mo
So, what are the options to solve for this if someone still wants to see primary care in urgent care? 1) Understand that UCC’s will continue to see episodic primary care visits, as we always have, but bill as urgent care. Don’t pursue chronic care as a service line in urgent care. 2) Advocate for primary care rate increases, which will be a huge uphill battle and not viable in the current market conditions. (Proceed to scream into pillow.) 3) Understand at the end of the day, putting primary care in urgent care is essentially starting a multi-specialty practice with two businesses in one building. They must have two Tax ID’s to be able to bill towards POS 11 and POS 20, and to Brandon’s point they have fundamentally different visit velocities, reimbursement structures, and patient management styles.
Bruce Carlson
4mo
the only possible model is the extra spending at the store. If the patient from Village MD stays in the store and buys an energy drink and an overpriced granola bar, or a box of cereal, and if/if/if they wouldn't have done that anyway, that's money to Walgreens. My sense, without being privy to Walgreens' books, is that this extra spend number never reached the hopes they had. Or it's not being calculated well enough which would require some surveying or watching. The pharmacy business, they were probably getting that anyway, whether the doc is in the building or not. And as far as the extra stuff, probably it's not enough -too much "get your drugs and run." Or worse, do your visit and get in the car. Separate doors? That's a no-no.
Hans Wiik
4mo
Closing in Indiana and Illinois as well. Getting primary care to work effectively and efficiently for managing chronic disease is not an easy journey - team based primary care with community support and collaboration is critical.
It is an ahha that acute care hospitals have had when they get into the business of primary care. It is sad that keeping patients well through primary care doesn’t pay. Healthcare margins are difficult at its best and impossible at its worst. Brandon J. Robertson thanks for this article.
Pete Schramm
4mo
That’s changing the game quite a bit Brandon J. Robertson Look forward to catch up soon! Byron C. Wade Mark Weber Robert (Bo) Brabo, SPHR you’ve also felt this and you may like knowing what Brandon is up to
Carl Angel
4mo
They should learn to use nurse practitioners.
Emergency & Urgent Care Physician | Clinical Ultrasound Expert | Board of Directors Northeast Regional UCA | Ultrasound Guided Injections for Sports Medicine | International Educator | Consultant
4moThat’s all true. The thing is, our urgent care services have nothing to do with primary care or Walgreens. City MD delivers exceptional urgent care and is likely the most well run and most profitable UC in the country. We average 60-70 visits per 12 hour shift across 170 offices in the NJ/NY region. So while the companies are under one roof, our urgent care business has not missed a step. Probably need to understand our business a little better before posting this. During peak times I can see 8-10 visits per hour. I am an emergency physician. Find me an urgent care that does this. I’ll wait.