Urgent message: The critical role of rapid COVID-19 testing in keeping Americans working presents a unique, time-limited opportunity for urgent care centers to develop relationships with local employers.
Alan A. Ayers, MBA, MAcc is Chief Executive Officer of Velocity Urgent Care
Online news magazine Vox recently reported data from the Urgent Care Association that urgent care centers were performing 725,000 tests per week as of late October, which amounted to 10% of the nation’s total testing at that time.1 While the precise number of urgent care centers offering rapid testing is not readily available, we’re hearing that many urgent cares are seeing record volume driven by rapid testing.
Rapid antigen testing is typically performed on-site at the urgent care center using a countertop analyzer on a nasal swab specimen, with results available to patients in 15–20 minutes. (Examples of analyzers include the Quidel Sofia 2 and BD Veritor devices.) The advantage of rapid testing is that patients leave the center with documented results in hand, which can then be used to return to work, return to school, travel, or for other needs. For the patient and their employer, the availability of a same-day result is essential in minimizing time in quarantine and, thus, time away from productivity while supporting the safety of the workforce.
Employers Are Primarily Concerned About Turnaround Time for Results
To assess employer perspectives on COVID-19 testing, Experity recently interviewed 40 human resources executives concerning their COVID-19 testing concerns. The most salient response is that urgent care centers offering rapid testing are well-positioned to meet employer needs through a business model already built around on-demand access and neighborhood convenience.
Because turnaround time is essential to minimizing time away from work, unless a PCR test that has to be sent out to a lab with complex capabilities is required for a specific purpose (which can take several days), it can be assumed rapid antigen testing accommodates the requisite turnaround time. Reliability data are available for the leading rapid testing platforms, which have received FDA emergency use authorization. So this leaves scheduling availability and geographical convenience—both hallmarks of the urgent care delivery model focused on same-day access.
In short, urgent care is ideally positioned to address employer concerns around testing.
| Table 1. COVID-19 Employer Concerns Around Testing* | |
| Rank | Item |
| 1 | Turnaround time for test results |
| 2 | Reliability or accuracy of test results |
| 3 | Scheduling availability at testing facilities |
| 4 | Geographical convenience of testing facilities |
| 5 | Employee communication of the testing process |
| 6 | Method of receiving test results |
| 7 | Privacy of employee data |
| 8 | Lack of resources to conduct on-site testing |
| 9 | Managing multiple testing vendors |
| 10 | Employees responsible for their own testing |
| 11 | Lack of control over the testing process |
| 12 | Reliance on health insurance for reimbursement |
Rapid Testing Constitutes Less Than 1/3 of Employer Testing
Despite the advantage of rapid testing in keeping employees working and minimizing time out for quarantine awaiting test results, only 29% of the employers interviewed are currently utilizing rapid testing—either at a medical facility or on site. This means that employers are unnecessarily incurring lost productivity when symptomatic or exposed employees are put on quarantine awaiting test results. Turnaround times on send-out lab tests can range from 2 to 10 days. In some cases, employees may complete quarantine before receiving their test results. The adverse impact of an employer being short-staffed is reduced revenue in the form of impaired service levels and missed production, as well as increased costs in the form of overtime or redundant staffing to cover employees who are out. Thus, a reliable rapid COVID-19 test program can contribute straight to an employer’s bottom line.
| Table 2. COVID-19 Testing Processes Utilized* | |
| Testing process | Average % |
| Specimen collected at a medical facility and sent to a laboratory | 49% |
| Rapid test performed instantly at a medical facility | 19% |
| Specimen collected at the employer worksite and sent to a laboratory | 17% |
| Rapid test performed instantly at the employer worksite | 10% |
| Home test kit patient administers on self | 6% |
| Other (please specify) | 1% |
Employers Require COVID-19 Testing Primarily for Employees With Possible Exposure and/or Symptoms of COVID-19
Of the reasons that employers require a COVID-19 test, most often it’s to prevent the spread of an active infection, such as by an employee who’s been directly exposed to someone who’s tested positive or by an employee who’s showing symptoms. Few employers routinely test all employees, but when they do it’s typically related to specific risk, including travel, or when the testing is done on site at an employer facility. This episodic testing means that employers need somewhere to send employees where they can be seen and receive results the same day.
| Table 3. Employee Groups Requiring COVID-19 Testing* | ||
| Employees tested | n | % of total |
| Employees exposed to someone who has tested positive | 23 | 77% |
| Employees showing symptoms | 22 | 73% |
| Employees exposed to someone showing symptoms | 15 | 50% |
| Employees returning to work after quarantine | 13 | 43% |
| Employees with a high risk of occupational exposure | 10 | 33% |
| Employees required to travel | 8 | 27% |
| Essential employees | 7 | 23% |
| Employees working in an employer facility | 7 | 23% |
| All employees | 4 | 13% |
| Employees selected randomly | 1 | 3% |
| Employees in an outbreak geography | 1 | 3% |
| No employees | 1 | 3% |
| Employees working from home | 0 | 0% |
| Other (please specify) | 0 | 0% |
Adding COVID-19 as an Employer-Paid Service
Within the realm of “occupational health,” “employer paid services” refers to health-related services procured directly by an employer, as opposed to being obtained using workers compensation insurance or employer-provided health insurance. These services typically include drug screening for new hires and randomly selected employees, when there is cause for suspicion, or when an incident has occurred, as well as physicals for compliance or fit-for-duty. Compliance physicals would include the regulated needs of truck drivers, airline pilots, police officers, firefighters, etc. Results are reported directly to the employer.
| Table 4. Employer Testing Program Summary* | |
| Testing program | Average % |
| Testing at an outside provider of the employee’s choosing, paid by health insurance | 22% |
| Testing at the employer worksite by an outside vendor, paid directly by the employer | 18% |
| Testing at the employer worksite conducted by employees of the company | 18% |
| Testing at an outside provider of the employer’s choosing, paid directly by the employer | 17% |
| Testing at the employer worksite by an outside vendor, paid by health insurance | 13% |
| Testing at an outside provider of the employee’s choosing, employee reimbursed by employer | 9% |
| Testing at an outside provider of the employer’s choosing, paid by health insurance | 3% |
| Other (please specify) | 0% |
*(As ranked by HR executives surveyed by Experity)
Per Table 4, 62% of employers interviewed pay for employee COVID-19 tests directly, while 38% rely on employees using their own health insurance. The “ideal” employer solution is one in which a protocol is established at an urgent care center such that the employee can reserve a time, check-in or enter a queue online, arrive at the center with specific instruction as to where to go and what to do (ie, drive-up, wait in car, etc.), and then receive the test according to the employer’s instruction (with no medical exam required for asymptomatic employees). The employer would receive the results immediately, and be billed for the test.
The issue with relying on employees using their health insurance is that a payer will likely require a medical exam—adding to the cost of employee benefits for self-insured employers—and for some payers or contracts a provider may necessitate use of a third-party lab who will bill insurance for the lab work separately from the medical visit.
As discussed, use of an outside lab vs on-site rapid testing just delays reporting, keeping the employee out of work longer. Additionally, some insurance companies refuse to cover testing for nonmedical purposes, including for all asymptomatic reasons including employment.
Finally, there’s the whole issue of tracking who’s been asked to get a test on their own, issues with employees finding test locations that will accept their insurance, and with employees then submitting results to the company. For the urgent care, insurance billing is accompanied by contractual reductions to charges and a lag in collections, resulting in growing accounts receivable balances. When employers pay directly, however, urgent care centers are known to collect up to $150, $175 or even $200 per rapid test within days, with no provider time invested, because there’s such value to the employer in getting an employee back to work.
Just as COVID-19 has dramatically changed how urgent care centers operate, it’s affecting how all businesses function day-to-day. The opportunity is for urgent care to partner with employers in the community to offer rapid testing to keep their workforces healthy and productive.
References
1. Molla R. COVID-19 is turning urgent care centers into America’s favorite clinics. Vox. Available at: https://www.vox.com/recode/21562230/urgent-care-center-covid-19-testing-vaccine-health-care. Accessed November 23, 2020.
