DX / Differentials / URGENT CARE

D-01 — PATIENT ACQUISITION COST · URGENT CARE

Cost per new patient is climbing — urgent care

Cost per visit is climbing — and there is no published benchmark to check it against

DIFFERENTIAL — LIKELY CAUSES, MOST LIKELY FIRST

1. 01

   The denominator moved — you are dividing by a seasonally depressed visit count

   Cost per visit is a ratio. Hold spend constant and the ratio swings by nearly 40% across the year purely from arrival seasonality.

   On an average day in July there are 14% fewer patients than baseline; in December there are 25% more — a 39-point peak-to-trough swing. Experity's live series shows the same thing at a point in time: 27 average daily visits per clinic on 6 May 2026, against a UCA annual average of 33.96 for 2025 and peaks in the mid-to-high 30s in early 2026.

   Practice Velocity study of more than 20,000,000 patient visits over five years, via JUCM Developing Data, 14 Dec 2016; Experity urgent care visit data page (updated 6 May 2026); Urgent Care Association urgent-care-data page

   NOT THIS IF — You are already comparing same-month year over year, or against a trailing twelve months, and the cost per visit still rises.

2. 02

   Net revenue per visit fell while spend held — the economics worsened, not the acquisition

   Reimbursement per visit is set locally and moves without warning. The marketing ratio deteriorates even when the marketing did not change.

   National median commercial net revenue per visit is $163.91. States in the bottom quartile averaged $130.30 per visit; the top quartile averaged $221.72 — a 70% spread, with a state range of $112.90 to $299.38 and a standard deviation of about 22%. The authors conclude there is "no single national market rate for urgent care, but more than 50 local microeconomies."

   Experity EMR — 17,410,492 commercially insured visits, 1 Nov 2024 to 31 Oct 2025 — via JUCM Developing Data, "Commercial Reimbursement In Urgent Care" (Ayers), 30 Dec 2025. Experity customers, commercially insured visits only; excludes Medicare, Medicaid, workers' comp and self-pay

   NOT THIS IF — Your contracted rates, payer mix and acuity distribution are all unchanged over the period the ratio moved.

3. 03

   Acuity mix drifted down, or global-rate exposure grew

   Under a level-based E/M schedule, revenue per visit is set by the code distribution. Under a global rate it is fixed regardless of complexity, so acuity stops being a lever at all and volume becomes the only one.

   Median allowed amounts at urgent care centers in 2023: 99202 $112 · 99203 $145 · 99204 $179 · 99205 $213. In 2023 CPT 99213 held first position, 99214 rose from third to second, and S9083 (the urgent care global fee) fell from second to third. The global fee itself varies by region: average allowed $110 Midwest · $152 South · $159 West · $167 Northeast. UCA reports that since 2019 more centers are being reimbursed on a global S9083 or fixed amount per visit regardless of complexity.

   FAIR Health, FH Healthcare Indicators & FH Medical Price Index 2025 white paper (figures 15 and 17) and 2024 edition (table 3); UCA 2023 Finance Benchmarking Report via UCA 2023 Industry White Paper, p.9

   NOT THIS IF — A majority of your visits are already paid at a global rate. Then acuity is irrelevant to revenue and the problem is contracted rate or volume.

4. 04

   You are paying to acquire visits you already had

   In a 5-mile catchment saturated with alternatives, paid media captures a large share of people who were coming anyway — brand searchers and returning patients — and the ratio inflates without any new demand.

   52% of centers define their target market as 0–5 miles and 38% as 6–10 miles. 89.4% of the US population is already within a 20-minute drive of an urgent care center and 78.6% within 10 minutes. Return-visit behaviour is real but modest: the closest thing the vertical has to a lifetime-value numerator is an unattributed industry figure of 1.7–2.0 visits per patient per year, which we flag as having no named primary.

   UCA 2022 Operations Benchmarking Report, p.7 (n=1,035); DX Marketing via UCA Spring 2021 Benchmarking Report p.9, UCA Fast Facts 2022 and the UCA data page. The 1.7–2.0 figure appears in JUCM, 31 May 2022, with no named primary — treat as directional only

   NOT THIS IF — Your paid volume is already majority non-brand and majority first-visit patients in the record.

5. 05

   Collections leakage is masquerading as acquisition cost

   The visit happened and the money did not arrive, or arrived late. Spend per collected dollar rises while spend per visit is unchanged. This is the vertical's own self-reported number-one revenue problem.

   More than 55% of respondents ranked registration errors preventing clean claims as the single largest revenue-cycle challenge. Meanwhile only 17% of patients complete registration paperwork online before the visit — 42% complete it with staff and 41% on a tablet onsite. With a credit card on file, 80% of patient responsibility on CPT 99204 is paid in the first month versus 60% without; 90% of the balance collects in 2 months versus 5; and 12-month bad-debt write-offs are 1% versus 4%.

   UCA 2023 Finance Benchmarking Report (via Solv provider blog, 29 Jan 2024); UCA 2022 Operations Benchmarking Report p.21 (n=1,055); Experity analysis of 392,699 comparable Blue Cross Blue Shield urgent care visits, 2024, via JUCM Developing Data, 27 Sep 2025

   NOT THIS IF — First-pass claim resolution is already high, days to bill is short, and patient balances collect inside two months.

HOW TO TELL THEM APART

How to tell these apart in your own numbers

Each of these is a measurement you can run yourself, without us.

WHAT RESOLVES EACH

What resolves this, and how you will know it resolved

The denominator moved — you are dividing by a seasonally depressed visit count	Rx 04 · marketing attribution →	Cheapest fix in the document. Build the seasonal index once from your own history and every subsequent cost-per-visit reading becomes interpretable. Nothing to buy and no campaign to change.
Net revenue per visit fell while spend held — the economics worsened, not the acquisition	Rx 04 · marketing attribution →	This is payer contracting, not marketing, and we say so. A 70% spread between top- and bottom-quartile states is structural — no campaign closes it. What reporting does is stop you spending against a ratio you have misdiagnosed.
Acuity mix drifted down, or global-rate exposure grew	Rx 04 · marketing attribution →	Documentation and coding sit with your clinical and RCM teams, not with an agency. Our job is to surface the drift in the same readout as the spend, so the two are never argued separately. Under a majority-global-rate contract, stop optimising acuity and optimise volume and mix instead.
You are paying to acquire visits you already had	Rx 01 · patient acquisition →	Brand-search reclamation and non-brand demand mapping inside the real 5-mile catchment. What does not work: buying wider radii to raise volume — 52% of the industry's catchment is under 5 miles and 89.4% of the country is already within a 20-minute drive of somebody's urgent care.
Collections leakage is masquerading as acquisition cost	Rx 03 · patient conversion →	Pre-arrival registration and card-on-file are the two documented levers, and both are intake work. The association's own members rank registration errors as their number-one revenue-cycle problem while 83% of intake still happens in the lobby. That is an operations gap, not a demand gap.

HOW THIS DIFFERS BY SCALE

How this differs by scale

Single site	One center, one payer contract set, one seasonal curve. Cost per visit is dominated by the seasonal denominator and by a handful of contracts; a single bad contract renegotiation can move NRV more than a year of media work. Measure same-month or do not measure.
Group	Several centers, usually one or two states. The NRV comparison becomes internal and diagnostic: if two sites under identical contracts show different NRV, the difference is acuity documentation or collections, not the market. That is the fastest read available at this scale.
Platform	Multi-state. The 70% NRV spread between top- and bottom-quartile states means a blended network cost-per-visit ratio is close to uninterpretable. Every site must be scored against its own state's reimbursement band, or you will defund the sites doing the best operational work in the worst-paying markets.

OTHER PRESENTATIONS — URGENT CARE

• Flat VCPD in a catchment that added centers faster than it added visits
• The lobby fills and empties — and the employer book is close to zero
• Same brand, same EMR, same hours — one center runs 48 visits a day and another runs 26
• Making the visit growth read as a system rather than a good flu season