The AAOA Foundation (AAOAF) invites applications for research grants from residents and medical students. Selected proposals may receive up to a $10,000 research grant award. Aligning with the Foundation's mission, proposals must have a primary allergy endpoint or be of…
Expanding Access through the ENT PA Model, Same-Day Appointments and Walk-In Urgent Care
By Gavin Setzen, MD, FACS, FAAOA, FARS, and Drew Franklin, MBA, FACMPE
The healthcare landscape is evolving rapidly, with a pressing need to expand patient access while maintaining high standards of care. Recent projections by the Association of American Medical Colleges (AAMC) estimate a shortage of more than 60,000 physicians by 2025. This shortfall is particularly acute in surgical subspecialties, with an expected deficit of 24,330 providers in the coming years. In response to these challenges, the ENT Physician Assistant (PA) model for walk-in urgent care has emerged as a vital solution, ensuring timely care and enhancing patient access while supporting practice growth and profitability.
Our data look at the combination of same day visits in the clinic as well as walk in Urgent Care. Approximately 19% of our appointments are scheduled online on our website using our real-time scheduling app, and the practices leverages technology to optimize patient access.
This article serves as an informative piece for AAO-HNS and AAOA members alike, highlighting the benefits, challenges, and potential strategies for adopting the ENT PA model in their practices, based on real world insights.
Addressing a Growing Need for Access
At Albany ENT & Allergy Services, we have implemented a walk-in urgent care model that integrates highly trained ENT PAs into our team. This approach allows us to provide same-day and next-day care, addressing the urgent needs of our community. During the pandemic, the demand for immediate access to ENT services increased dramatically, a trend that has continued into 2024. Our data shows that patient volumes have grown significantly, with projections of over 18,000 same-day / urgent care visits in 2024 alone. This model not only meets patient needs but also alleviates the strain on ENT surgeons, allowing them to focus on more complex and/or differentiated cases.
Enhancing Practice Growth and Patient Retention
A key advantage of the ENT PA model in walk-in urgent care is its capacity for sustainable growth. Each new patient represents an opportunity for ongoing care, making both patient acquisition and retention vital to our practice’s long-term success. Some visits may involve a one-time consultation, but many lead to broader treatment plans, including allergy testing, hearing aid evaluations, or surgical interventions. The importance of offering patients continuity of care through a well-structured urgent care model cannot be overstated.
In our practice, PAs manage 17-21 patient appointments per day, significantly enhancing patient access and supporting the overall efficiency of the clinic. With 10 new PAs hired since 2022 and our 20th expected in Q4, we are well-positioned to continue expanding patient care opportunities, with projections for continued growth into 2025. This highlights the importance of a flexible and scalable model that meets patient demand while ensuring smooth care delivery.
Variety of Urgent Care Diagnoses
One of the key features of our walk-in urgent care model is the variety of diagnoses that we encounter. According to recent data, allergic rhinitis is the top diagnosis among urgent care patients, reflecting the high prevalence of this condition in the general population. However, our urgent care services extend well beyond allergies, addressing a wide range of acute issues.
Same-day walk-ins and urgent care visits often involve conditions such as sinusitis, ear infections, and respiratory tract infections. These acute presentations require prompt attention and management, which is precisely what our urgent care model is designed to provide. By offering immediate access to care, we can address these conditions quickly, helping to prevent complications and reduce the burden on emergency departments. This approach ensures that patients receive the specialized care they need without the delays that often come with traditional referral processes.
Importantly, by seeing an increasing number of allergic rhinitis patients thru the PA / urgent care model, we are able to migrate these patients along care pathways that include our robust otolaryngic allergy program, where we have 17 dedicated nurses and nearly 4,000 active patients on immunotherapy (both SCIT and SLIT).
Reimbursement Strategies for PA Services
One of the critical considerations in deploying an ENT PA model is understanding reimbursement mechanisms. Medicare, Medicaid, TRICARE, and most private payers cover services provided by PAs, with Medicare reimbursing at 85% of the physician fee schedule. While practices may be able to leverage “incident-to” billing in the office setting (with supervision requirements), our practice has opted to bill under the PA NPI, while negotiating with the payors to be reimbursed at 100%. Recently, we were able to negotiate with our largest payor to be reimbursed at 100% for PA rendered services. This approach maximizes revenue potential while ensuring compliance with payer guidelines.
A Blueprint for the Future of ENT Care
As discussed, at Albany ENT & Allergy Services, we have developed a robust business model that not only addresses the growing demand for ENT services but also ensures access, growth, and profitability.
The ENT PA model is not just a short-term solution to a workforce shortage; it represents a sustainable path forward in the evolving landscape of otolaryngology. Success in this model requires adaptability, financial oversight, and a commitment to high-quality care. Practices that embrace the flexibility of urgent care, supported by a strong PA team, can better navigate changes in healthcare payment reform, expand their reach in the community, and continue to provide timely, specialized care to their patients.
As we move forward, our focus remains on optimizing this model for both patient and provider satisfaction, ensuring that our practice is well-positioned to thrive amid the ongoing challenges in healthcare. We believe that the ENT PA model in walk-in urgent care is a vital tool for expanding access, managing growth, and ensuring a sustainable future for otolaryngology practices across the country.
The ENT PA model in walk-in urgent care settings offers a viable solution to the challenges faced by otolaryngology practices today. By focusing on access, growth, and profitability, we can ensure that our patients receive the best possible care while maintaining the sustainability of our practice. For more information or to discuss this model further, please contact us at gsetzen@albanyent.com