How PCR is Transforming Modern Urgent Cares

While the the COVID-19 pandemic was devastating for many reasons, it revealed the critical role of urgent care facilities in the U.S. healthcare system, mainly for their ability fill gaps in care and act as an intermediary to prevent hospitalizations where they are unnecessary. The Urgent Care Association estimates that urgent cares prevent 24.5 million emergency room visits every single year.

However, it is becoming increasingly difficult to fulfill the obligations of this role in light of challenges related to reimbursement issues, diagnostic errors, and the need for antibiotic stewardship. Ultimately, these issues can impact patient outcomes, a retail clinic’s financial viability, and the quality of care provided to patients. Urgent care operators are looking for better solutions, and one option that is becoming increasingly favored is the integration of polymerase chain reaction (PCR) technology. 

Diagnostic Errors and the Challenge of Empiric Prescribing

It used to be assumed that a certain level of diagnostic error was an expected part of patient care. However, in recent years with the advent of highly sophisticated diagnostics, healthcare facilities and providers are beginning to question that assumption.

As it stands, providers in urgent care settings typically have to make quick decisions based on limited information. While a urinalysis can indicate the presence of an infection, it doesn’t tell you what the infective organism is. Historically, the answer to that has been to prescribe an antibiotic empirically, which relies on targeting the most “common” urinary pathogens and choosing a broad-spectrum antibiotic.

In the past, there was no other option - the lack of rapid diagnostic identification of causative agents forced the hand of the provider to make a “best guess” as to the pathogen they were targeting. There are issues, however, with this approach. One study found that 45.7% of urgent care visits for a respiratory diagnosis inappropriately prescribed antibiotics.¹ Another study that evaluated ambulatory care antibiotic prescribing found that it was performed inappropriately in 30.2% patients that received a script.² 

Antimicrobial Resistance and the Call for Antibiotic Stewardship

A close cousin to diagnostic error is antibiotic resistance - in fact, it it’s the main reason resistance is such a problem in modern patient settings. When antibiotics are over- or inappropriately-prescribed, bacteria develop antimicrobial resistance (AMR) to them. This doesn’t just make infections harder to treat, it causes active harm. The WHO has formally recognized that ​​”AMR was directly responsible for 1.27 million global deaths in 2019 and contributed to 4.95 million deaths.”³

In an article titled, “Antimicrobial resistance will be worse than COVID,” authors Donna Shalala (former U.S. secretary of Health and Human Services) and Dr. Mark McClellan, MD, Ph.D (former administrator of the Centers for Medicare & Medicaid Services and former commissioner of the U.S. Food and Drug Administration), argue that “Health care facilities and clinicians also need to use antibiotics appropriately to prevent the development of resistance and ensure antibiotics remain effective for as long as possible…. Unfortunately, many health care facilities don’t have the resources to fully implement stewardship programs.”⁴ 

In light of this, it is important to develop an antimicrobial stewardship program which is designed from the ground-up with the ability to financially resource its own existence. 

Reimbursements

Despite their clinical utility in the healthcare system, urgent cares often struggle with reimbursement issues. Reimbursement rates appear to be stagnating or even lowering over time, aggravated by the complexity of billing processes, challenges in coding and documentation, and variability in payer requirements. One would think reimbursement would be more streamlined considering that 90% of emergency care visits comprise a short list of 10 clinical diagnoses.⁵

John Radford, founder of WellNow Urgent Care, describes the challenge succinctly:

“In many cases, we are seeing urgent cares getting reimbursed from insurance companies at rates that are less than years ago. We even have one case where an insurance company decreased reimbursement rates for WellNow Urgent Care by almost 30 percent from what it was close to 10 years ago. It’s widely known that the cost to deliver care has increased significantly – employee costs at our centers have increased more than 20 percent over the past two years with some insurance companies not providing reimbursement increases in more than five years.”⁶

How PCR Can Help

While no single solution can solve such complex problems in their entirety, it is important to optimize every part of the urgent care business model in a way that aligns with the outcomes and interests of patients. Polymerase chain reaction (PCR) technology offers much to the modern urgent care as a response to the challenges they face.

1. Improved Accuracy and Speed of Diagnosis

Diagnostic errors are a complex subject, and the ways of addressing it should be multi-pronged. The part the PCR offers to play is in advancing the accurate and specific detection of pathogens. Reduce your dependence on syndrome-based diagnosis by integrating PCR into your providers’ workflows, which can not only detect the presence of multiple infective agents simultaneously, but also their resistance markers. This approach marries clinical expertise with cutting-edge technology to improve diagnostic accuracy.

2. Antibiotic Stewardship

One of the most compelling reasons to integrate PCR is for its potential to encourage responsible prescribing practices. Rather than needing to wait for several days for cultures to result before you can tailor antibiotic therapy to the most targeted drug, PCR allows providers the same pathogenic identification within two hours. Imagine having the first medication a patient receives be the right one, without needing to expose them to a broad-spectrum antibiotic.

3. Enhanced Reimbursement Opportunities

PCR testing enables new revenue streams for clinics. While many urgent cares are aware of this and currently send out PCR testing for this reason, fewer are realizing the additional revenue opportunities made possible by migrating PCR testing to be performed in-house. When urgent cares adopt this model, result times improve and send-out lab costs are drastically reduced.

The Verdict

Despite the tremendous growth of urgent care facilities - especially after the pandemic - they continue to face significant challenges in diagnosing and treating patients efficiently while maintaining financial viability and promoting antibiotic stewardship. PCR technology has the potential to play a powerful part in improving the delivery of higher quality care, reducing diagnostic errors, and optimizing patient outcomes.

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References:

1. Palms DL, Hicks LA, Bartoces M, et al. Comparison of antibiotic prescribing in retail clinics, urgent care centers, emergency departments, and traditional ambulatory care settings in the United States. JAMA Internal Medicine. 2018;178(9):1267. doi:10.1001/jamainternmed.2018.1632 

2. Ohnuma T, Chihara S, Costin B, et al. Association of appropriate empirical antimicrobial therapy with In-Hospital mortality in patients with bloodstream infections in the US. JAMA Network Open. 2023;6(1):e2249353. doi:10.1001/jamanetworkopen.2022.49353 

3. World Health Organization: WHO. Antimicrobial resistance. Published November 21, 2023. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance

4. Abbo DSDrMM and DrL. The Hill. The Hill. https://thehill.com/opinion/healthcare/4052215-antimicrobial-resistance-will-be-worse-than-covid-we-have-to-act-now/. Published June 22, 2023.

5. Mehrotra A, Wang MC, Lave JR, Adams JL, McGlynn EA. Retail clinics, primary care physicians, and emergency departments: a comparison of patients' visits. Health Aff (Millwood). 2008 Sep-Oct;27(5):1272-82. doi: 10.1377/hlthaff.27.5.1272. PMID: 18780911; PMCID: PMC2730172.

6. Radford, J. The urgent care crisis of low reimbursement: a looming threat to accessible healthcare. MedCity News. https://medcitynews.com/2023/07/the-urgent-care-crisis-of-low-reimbursement-a-looming-threat-to-accessible-healthcare/. Published July 27, 2023.