The Future Has Never Looked Brighter—or More Lucrative—for Rural Urgent Care Operators

With many urgent care centers seeing net revenue of $120 per visit or less, case rate (flat fee) reimbursement disincentivizing a high level of care, and Medicaid reimbursement at less than $100 in most states, emerging changes in reimbursements for rural health clinics could be a powerful argument for looking at expansion in underserved “country” communities. The recently enacted Consolidated Appropriations Act includes updates to reimbursements for Rural Health Clinics (RHCs), defined by the Centers for Medicare and Medicaid Services as a facility “located in a rural area designated as a shortage area, [that] is not a rehabilitation agency or a facility primarily for the care and treatment of mental diseases,” while also meeting certain other criteria. The highlight is that reimbursement rates are to increase steadily throughout the next several years, maxing out at $190 per visit in 2028. This applies to all new RHCs, as well, including freestanding clinics “owned by a provider or a provider entity.” More than half of independent RHCs (as opposed to those owned by a healthcare system) are owned by clinicians. Interestingly, given the growing influence of physician assistants and nurse practitioners in the urgent care center, RHC staff must by definition include one or more PA or NP, with that person