Telemedicine: A Friend or Foe to the Urgent Care Industry?

Telemedicine has dominated headlines this week as the American Telemedicine Association (ATA) conference convenes in Minneapolis. And the question popping into the minds of urgent care operators nationwide remains: How does telehealth fit into the urgent care market?

The simple answer is that urgent care centers can’t ignore the telemedicine trend.

Telemedicine, or telehealth, is an umbrella term encompassing many different services and technologies. But the main appeal is the convenience it can provide for “at-home” consultations and faster service.

Nationwide the average wait time to get in for primary care appointments was 19.5 days, the 2014 Merritt Hawkins’ survey of physician appointment wait times found.  That is one of the main drivers for urgent care traffic—but it’s also a main driver for many employers, and even insurance carriers, to adopt telemedicine technology.

UnitedHealthcare started offering video visits through Doctor on Demand and American Well about six months ago. Representatives from all three companies spoke at an ATA conference this week and shared some early data, as reported by mobihealthnews.com:

• UnitedHealthcare is expecting 20 million users of the technology in 2016.
• The average video visit user is a 31-year-old female.
• 90 percent of the employers UnitedHealthcare covers are interested in offering the capability.

Telemedicine is on the verge of rapid, widespread growth and adoption as the forces that have fueled its rise so far—mainly the growth of value-based care and patient convenient access— continue to gain momentum. Additional drivers are poised to push telemedicine’s expansion beyond what we’ve seen to date. The global telemedicine market is expected to expand at a compound annual growth rate of 14.3% over the next five years, eventually reaching $36.2 billion, compared to $14.3 billion in 2014.

If urgent care clinics don’t adopt the technology in some form in the coming years, they’re likely to lose a portion of their client base. Telemedicine could even put some urgent care clinics out of business. But there are many reasons why telemedicine should be embraced, not feared, by urgent care providers.

“Telemedicine has the capability to improve outcomes through improving access. So if urgent care successfully incorporates with telemedicine that could potentially be a way for urgent care centers to expand their business by bringing in those additional patients,” Kit Sandstrom, FNP at ZoomCare, said in a 2014 Journal of Urgent Care Medicine article.

At that time, Sandstrom cited reimbursement from private insurers as one of the biggest obstacles slowing the expansion of telemedicine. But given buy-in from companies like UnitedHealthcare and Blue Cross Blue Shield, who started ramping up reimbursement for telehealth last fall, the obstacle seems to be shrinking.

Dr. Roy Shoenberg, cofounder and CEO of American Well, said at the ATA conference this week: “We’ve got to stop thinking of telehealth as a monolithic product to give patients quick access to urgent care. Telehealth has a role to play that spans from urgent care all the way to the end of life. – We’re beginning to understand that we are at the very beginning of this journey.”

The Cleveland Clinic partnered with American Well in 2015 to add a 24-hour online statewide telemedicine service. Express Care Online allows patients to see a medical professional for urgent care via computer or smartphone at any time of day or night. Patients pay a $49 fee by credit card at time of service and access the service through a free app. Providers can then evaluate, diagnose, treat an ailment, and, if needed, prescribe medication. The service is aimed at helping people with acute health symptoms such as cough, urinary tract infection, abdominal pain, diarrhea, fever, and headaches.

“The whole point is to provide better access, another option for care,” said Matthew Stanton, director of distance health for Cleveland Clinic, in a news release.

Rather than being seen as a threat to the urgent care industry, here are some reasons to consider telemedicine as a growth opportunity for immediate care facilities:

• Urgent care providers can grow patient volume during early months of operation, perhaps even before opening the clinic doors.
• The patient pool for the urgent care center can be expanded from those who live within a 3-5 mile radius to a much larger geographic base.
• Providers could use telemedicine for follow-up visits to create stronger patient relationships and encourage repeat customers.
• The technology can help urgent care center compete in the rapidly growing employer-based health and wellness service market.

Ultimately telemedicine might help push urgent care higher on the acuity scale, positioning it just short of hospital emergency rooms in terms of the depth and breadth of services offered.  In recent years, due to factors like flat fee reimbursement and the integration of nurse practitioners and physician assistants, we’ve seen a degradation in acuity of urgent care cases such that many centers now see a majority of their cases in sinusitis, upper respiratory infections, allergic rhinitis, and other conditions that can be treated for lower cost in retail clinics or via telemedicine.

Should telemedicine start to chip away at some of urgent care’s “base,” the opportunity is for urgent care to return to focusing on higher-acuity procedures that require an in-person consultation at a physical facility and should reimburse higher than telemedicine visits.