Urgent Care Centers
Provider Type
- Participating Physician Groups (PPG)
Health Net encourages participating physician groups (PPGs) to operate urgent care centers and endorse their use by Health Net members for medical conditions that require immediate attention. Additionally, members who cannot wait hours or days for a scheduled appointment with a primary care physician (PCP) may visit an urgent care center. These centers provide immediate medical care and reduce inappropriate emergency room encounters.
Health Net requires that PPG urgent care centers follow these standards:
- Maintain written policies, procedures and evaluation techniques
- Be located by and have a contracting relationship with a hospital emergency room
- Maintain extended hours with services available seven days a week
- Have staff that includes the following qualified physicians. Certified physician assistants (PAs) and nurse practitioners (NPs) must have on-site physician supervision at all times. Unlicensed residents must be directly supervised by licensed physicians.
- Panel of available specialists
- Registered nurses
- Support staff - licensed vocational nurse (LVN), nursing assistant (NA), PA, technicians
- Minimum ancillary services, which include:
- X-ray
- Lab
- Medical records procedures (each urgent care center should have its own procedures for handling medical records information) for:
- Urgent care records
- Records of transfer to primary care
- Procedure for follow-up care
- Member access:
- Available to all clinic patients (not prepaid only)
- Procedure for managing member satisfaction and system flexibility to accommodate member needs
- Methods used to educate members on correct use of the center prior to using it, obtaining follow-up care and follow-up care procedures
- Utilization management (UM) and quality improvement (QI) procedures:
- Specific procedures for evaluating utilization
- Reporting process
- Utilization review (UR) and QI committee (QIC) activity to:
- Process and document procedures in place where the PPG's UR committee reviews utilization and quality of care provided at the urgent care center
- Document activities of UR committee and report to urgent care center staff
- Make Health Net's periodic UR available
Health Net performs utilization and quality audits by random selection or focused review, either on-site at the urgent care center, based on emergency room utilization reports, or at Health Net, with records copied and submitted by the urgent care center.