JACKSONVILLE, Fla. — Facing an ultracompetitive market in one of many nation’s fastest-growing cities, UF Health is attempting a brand new option to appeal to sufferers: a mixture emergency room and pressing care middle.
In the previous yr and a half, UF Health and a personal equity-backed firm, Intuitive Health, have opened three facilities that supply each sorts of care 24/7 so sufferers don’t must resolve which facility they want.
Instead, medical doctors there resolve whether or not it’s pressing or emergency care —the well being system payments accordingly — and inform the affected person of their choice on the time of the service.
“Most of the time you do not realize where you should go — to an urgent care or an ER — and that triage decision you make can have dramatic economic repercussions,” stated Steven Wylie, affiliate vp for planning and enterprise improvement at UF Health Jacksonville. About 70% of sufferers at its services are billed at pressing care charges, Wylie stated.
Emergency care is sort of at all times dearer than pressing care. For sufferers who may in any other case present up on the ER with an pressing care-level drawback — a small minimize that requires stitches or an an infection treatable with antibiotics — the financial savings may very well be tons of or 1000’s of {dollars}.
While no analysis has been performed on this new hybrid mannequin, shopper advocates fear hospitals usually tend to route sufferers to costlier ER-level care every time attainable.
The entrance door to a UF Health emergency and pressing care facility in Jacksonville, Florida. (Phil Galewitz/KFF Health News)
An indication on the entrance door at a UF Health emergency and pressing care facility in Jacksonville, Florida, notifies sufferers they could be billed for emergency companies. (Phil Galewitz/KFF Health News)
For occasion, some companies that set off higher-priced, ER-level care at UF Health’s services — corresponding to blood work and ultrasounds — will be obtained at some pressing care facilities.
“That sounds crazy, that a blood test can trigger an ER fee, which can cost thousands of dollars,” stated Cynthia Fisher, founder and chair of PatientRightsAdvocate.org, a affected person advocacy group.
For UF Health, the hybrid facilities can enhance earnings as a result of they assist appeal to sufferers. Those affected person visits can result in extra income by means of diagnostic testing and referrals for specialists or inpatient care.
Offering inexpensive pressing care around-the-clock, the hybrid services stand out in an business recognized for its aggressive billing practices.
On a latest go to to one in every of UF Health’s services about 15 miles southeast of downtown, a number of sufferers stated in interviews that they sought a brief look forward to care. None had sat within the ready room greater than 5 minutes.
“Sometimes urgent care sends you to the ER, so here you can get everything,” stated Andrea Cruz, 24, who was pregnant and got here in for shortness of breath. Cruz stated she was being handled as an ER affected person as a result of she wanted blood checks and monitoring.
Echo Klitz, a nurse supervisor at a UF Health emergency and pressing care middle in Jacksonville, Florida, checks on Andrea Cruz, who got here in for shortness of breath and was being handled as an ER affected person. (Phil Galewitz/KFF Health News)
“It’s good to have a place like this that can treat you no matter what,” stated Penny Wilding, 91, who stated she has no common doctor and was being evaluated for a possible urinary tract an infection.
UF Health is one in every of a few dozen well being programs in 10 states partnering with Intuitive Health to arrange and run hybrid ER-urgent care services. More are within the works; VHC Health, a big hospital in Arlington, Virginia, plans to start out constructing one this yr.
Intuitive Health was established in 2008 by three emergency physicians. For a number of years the corporate ran impartial mixture ER-urgent care facilities in Texas.
Then Altamont Capital Partners, a multibillion-dollar non-public fairness agency based mostly in Palo Alto, California, purchased a majority stake in Intuitive in 2014.
Soon after, the corporate started partnering with hospitals to open services in states together with Arizona, Indiana, Kentucky, and Delaware. Under their agreements, the hospitals deal with medical workers and billing whereas Intuitive manages administrative features — together with preliminary efforts to gather fee, together with checking insurance coverage and taking copays — and nonclinical workers, stated Thom Herrmann, CEO of Intuitive Health.
Herrmann stated hospitals have turn out to be extra within the idea as Medicare and different insurers pay for worth as an alternative of only a price for every service. That means hospitals have an incentive to search out methods to deal with sufferers for much less.
And Intuitive has a robust incentive to associate with hospitals, stated Christine Monahan, an assistant analysis professor on the Center on Health Insurance Reforms at Georgetown University: Facilities licensed as freestanding emergency rooms — as Intuitive’s are — have to be affiliated with hospitals to be lined by Medicare.
At the combo services, emergency room specialists make medical selections that decide whether or not sufferers are billed for higher-priced ER care or lower-priced pressing care after sufferers bear a medical screening. The well being system compares the care wanted in opposition to standards for urgent- or emergency-level care and payments.
Inside its combo services, UF posts an indication itemizing among the pressing care companies it affords, together with remedy for ear infections, sprains, and minor wounds. When its medical doctors decide ER-level care is critical, UF requires sufferers to signal a kind acknowledging they are going to be billed for an ER go to.
Patients who decide out of ER care at the moment are charged a triage price. UF wouldn’t disclose the quantity of the price, saying it varies.
An indication inside a UF Health emergency and pressing care facility in Jacksonville, Florida, reveals companies it offers below pressing care billing for a $250 price for sufferers with out insurance coverage. If they don’t qualify for pressing care, sufferers are billed for emergency companies, which might price a number of instances as a lot.(Phil Galewitz/KFF Health News)
UF officers say sufferers pay just for the extent of care they want. Its facilities settle for most insurance coverage, together with Medicare, which covers folks older than 65 and people with disabilities, and Medicaid, this system for low-income folks.
But there are necessary caveats, stated Fisher, the affected person advocate.
Patients who pay money for pressing care at UF’s hybrid facilities are charged an “all-inclusive” $250 price, whether or not they want an X-ray or a speedy strep check, to call two such companies, or each.
But in the event that they use insurance coverage, sufferers could have greater price sharing if their well being plan is charged greater than it might pay for stand-alone pressing care, she stated.
Also, federal shock billing protections that protect sufferers in an ER don’t lengthen to pressing care facilities, Fisher stated.
Herrmann stated Intuitive’s services cost industrial insurers for pressing care the identical as in the event that they supplied solely pressing care. But Medicare could pay extra.
While pressing care has lengthy been supposed for minor accidents and diseases and ERs are imagined to be for life- or health-threatening situations, the 2 fashions have melded lately. Urgent care clinics have elevated the scope of accidents and situations they will deal with, whereas hospitals have taken to promoting ER wait instances on freeway billboards to draw sufferers.
Intuitive is credited with pioneering hybrid ER-urgent care, although its services should not the one ones with each “emergency” and “urgent care” on their indicators. Such branding can sometimes confuse patients.
While Intuitive’s hybrid services provide some value transparency, suppliers have the higher hand on price, stated Vivian Ho, a well being economist at Rice University in Texas. “Patients are at the mercy of what the hospital tells them,” she stated.
But Daniel Marthey, an assistant professor of well being coverage and administration at Texas A&M University, stated the services can assist sufferers discover a lower-cost choice for care by avoiding steep ER payments after they want solely urgent-level care. “This is a potentially good thing for patients,” he stated.
Marthey stated hospitals could also be investing in hybrid services to make up for misplaced income after federal surprise medical billing protections took impact in 2022 and restricted what hospitals may cost sufferers handled by out-of-network suppliers, notably in emergencies.
“Basically, they are just competing for market share,” Marthey stated.
Justin Nippert, an emergency doctor at UF Health emergency and pressing care services in Jacksonville, Florida.(Phil Galewitz/KFF Health News)
UF Health has positioned its new services in suburban areas close to freestanding ERs owned by rivals HCA Healthcare and Ascension slightly than close to its downtown hospital in Jacksonville. It can be constructing a fourth facility, close to The Villages, a big retirement group greater than 100 miles south.
“This has been more of an offensive move to expand our market reach and go into suburban markets,” Wylie stated.
Though the three facilities should not state-approved to look after trauma sufferers, medical doctors there stated they will deal with nearly any emergency, together with coronary heart assaults and strokes. Patients needing hospitalization are taken by ambulance to the UF hospital about 20 minutes away. If they should observe up with a specialist, they’re referred to a UF doctor.
“If you fall and sprain your leg and need an X-ray and crutches, you can come here and get charged urgent care,” stated Justin Nippert, medical director of two of UF’s combo facilities. “But if you break your ankle and need it put back in place it can get treated here, too. It’s a one-stop shop.”
[Clarification: This article was updated at 5:20 p.m. ET on Aug. 2, 2024, to clarify the role of doctors in making medical decisions that affect billing at a series of hybrid urgent care-ER facilities.]
Phil Galewitz:
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@philgalewitz
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