Do New Data Reflect Acuity Degradation in Urgent Care?

New data from the Peterson-KFF Health System Tracker show that healthcare facilities, in general, are filing for higher-complexity care than in years past—but that urgent care providers buck the trend by filing such claims at a lower rate than their counterparts in the emergency room and traditional physician practices. Looking at claims for outpatient visits between 2004 and 2021 from the Merative MarketScan Commercial Claims and Encounters database for nonelderly people, researchers determined that providers in the ED are outpacing their counterparts in primary care and urgent care when it comes to billing for higher-level visits, with level 4 and 5 codes now accounting for the majority of claims. In fact, as of 2021 level 5 claims now account for a quarter of ED visits, compared with just 8% in 2004. Physician offices are also filing higher-level claims than in the past, though the greatest growth there was in level 4 claims. Perhaps counterintuitively, given the capability of most urgent care centers to perform more complex procedures, UCC claims grew most in levels 1 through 3, with a decrease in level 4 claims. The yin-and-yang of this is that while urgent care continues to establish itself as a more cost-effective option for immediate care, at often-comparable acuity, it appears that many UCCs are actually practicing at a level similar to primary care practices. The latter is a growing concern in the industry. For an analysis of that concern—as well as possible solutions—read How Urgent Care Can Address Its Degrading Scope of Practice in the JUCM archive.