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The Southeast Regional Urgent Care Association (SERUCA) has achieved a significant victory for healthcare professionals and patients in North Carolina. Through determined Grassroots Advocacy, SERUCA successfully convinced Blue Cross and Blue Shield of North Carolina (Blue Cross NC) to rescind a controversial reimbursement policy that imposed a 50% reduction on evaluation and management (E&M) services when performed by the same provider or group practice on the same day as a minor procedure.
Blue Cross NC’s reimbursement policy, which affected all lines of business—including Commercial, Host, State Health Plan (SHP), Federal Employee Program (FEP), and Medicare Advantage—had been a contentious issue among healthcare professionals since its implementation. The policy stipulated that if a provider conducted an E&M service on the same day as a minor procedure, the reimbursement for the E&M service would be cut by half. This decision placed a financial strain on these groups, particularly those in Urgent Care settings, who often perform comprehensive evaluations and necessary minor procedures during a single visit.
Urgent Care centers, which frequently see patients requiring immediate attention for minor injuries or illnesses, found this policy particularly burdensome. The 50% reduction not only affected the financial sustainability of these centers but also risked compromising patient care. Urgent Care was faced with the dilemma of either spreading services over multiple visits, leading to potential delays in care, or absorbing the financial losses, which could jeopardize the viability of their practices.
Recognizing the detrimental impact of this policy, SERUCA launched a robust Advocacy campaign. The association mobilized its members to voice their concerns to Blue Cross NC and state policymakers. SERUCA’s campaign emphasized the importance of fair reimbursement practices to ensure that Urgent Care centers can continue to provide high-quality, timely care to their communities.
SERUCA employed a multifaceted approach to Advocacy, including:
Engaging Stakeholders: SERUCA facilitated discussions between Urgent Care organizations and Blue Cross NC representatives to convey the real-world impacts of the reimbursement policy.
Data and Evidence: SERUCA collected and presented data illustrating the negative financial and operational effects of the policy on Urgent Care centers, highlighting instances where patient care was directly impacted.
Grassroots Mobilization: SERUCA encouraged its members to participate in letter-writing campaigns, phone calls, and meetings with local legislators and Blue Cross NC officials.
Public Awareness: The association leveraged media outlets and social media platforms to raise public awareness about the issue, garnering support from patients and community members who rely on Urgent Care services.
The concerted efforts of SERUCA and its members culminated in a resounding victory. Blue Cross NC announced the rescindment of the 50% reduction policy for E&M services performed on the same day as minor procedures, effective immediately across all lines of business. This decision marks a significant win for Urgent Care, ensuring centers receive fair compensation for the comprehensive care they deliver.
This victory not only benefits Urgent Care centers but also sets a precedent for other healthcare Advocacy efforts. It underscores the power of Grassroots mobilization and the importance of engaging directly with policymakers and insurance companies to effect change.
For Urgent Care centers, this decision means they can continue to offer seamless, high-quality care without the financial constraints imposed by the previous policy. Patients, too, stand to benefit, as they can receive necessary evaluations and procedures in a single visit, without worrying about the implications of fragmented care.