JACKSONVILLE, Fla. — Going through an ultracompetitive market in one of many nation’s fastest-growing cities, UF Well being is making an attempt a brand new option to appeal to sufferers: a mixture emergency room and pressing care heart.
Previously 12 months and a half, UF Well being and a personal equity-backed firm, Intuitive Well being, have opened three facilities that supply each forms of care 24/7 so sufferers don’t need to resolve which facility they want.
As an alternative, docs 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,” mentioned Steven Wylie, affiliate vp for planning and enterprise growth at UF Well being Jacksonville. About 70% of sufferers at its services are billed at pressing care charges, Wylie mentioned.
Emergency care is nearly at all times dearer than pressing care. For sufferers who would possibly 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 could possibly be lots of or 1000’s of {dollars}.
Whereas no analysis has been carried out on this new hybrid mannequin, client advocates fear hospitals usually tend to route sufferers to costlier ER-level care each time potential.
As an example, some providers that set off higher-priced, ER-level care at UF Well being’s services — similar to blood work and ultrasounds — could 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,” mentioned Cynthia Fisher, founder and chair of PatientRightsAdvocate.org, a affected person advocacy group.
For UF Well being, the hybrid facilities can enhance income as a result of they assist appeal to sufferers. These affected person visits can result in extra income via diagnostic testing and referrals for specialists or inpatient care.
Providing inexpensive pressing care around-the-clock, the hybrid services stand out in an trade recognized for its aggressive billing practices.
On a current go to to considered one of UF Well being’s services about 15 miles southeast of downtown, a number of sufferers mentioned 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,” mentioned Andrea Cruz, 24, who was pregnant and got here in for shortness of breath. Cruz mentioned she was being handled as an ER affected person as a result of she wanted blood exams and monitoring.
“It’s good to have a place like this that can treat you no matter what,” mentioned Penny Wilding, 91, who mentioned she has no common doctor and was being evaluated for a possible urinary tract an infection.
UF Well being is considered one of a couple of dozen well being methods in 10 states partnering with Intuitive Well being to arrange and run hybrid ER-urgent care services. Extra are within the works; VHC Well being, a big hospital in Arlington, Virginia, plans to begin constructing one this 12 months.
Intuitive Well being 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 Companions, a multibillion-dollar personal fairness agency based mostly in Palo Alto, California, purchased a majority stake in Intuitive in 2014.
Quickly after, the corporate started partnering with hospitals to open services in states together with Arizona, Indiana, Kentucky, and Delaware. Underneath their agreements, the hospitals deal with medical employees and billing whereas Intuitive manages administrative capabilities — together with preliminary efforts to gather fee, together with checking insurance coverage and taking copays — and nonclinical employees, mentioned Thom Herrmann, CEO of Intuitive Well being.
Herrmann mentioned hospitals have develop into extra within the idea as Medicare and different insurers pay for worth as a substitute of only a charge for every service. Meaning hospitals have an incentive to seek out methods to deal with sufferers for much less.
And Intuitive has a powerful incentive to companion with hospitals, mentioned Christine Monahan, an assistant analysis professor on the Heart on Well being Insurance coverage Reforms at Georgetown College: Services licensed as freestanding emergency rooms — as Intuitive’s are — should be affiliated with hospitals to be coated by Medicare.
On the combo services, emergency room specialists decide whether or not to invoice for higher-priced ER or lower-priced pressing care after sufferers bear a medical screening. They evaluate the care wanted towards a listing of standards that set off emergency-level care and payments, such because the affected person requiring IV fluids or cardiac monitoring.
Inside its combo services, UF posts an indication itemizing among the pressing care providers it gives, together with therapy for ear infections, sprains, and minor wounds. When its docs decide ER-level care is important, UF requires sufferers to signal a type acknowledging they are going to be billed for an ER go to.
Sufferers who choose out of ER care at the moment are charged a triage charge. UF wouldn’t disclose the quantity of the charge, saying it varies.
UF officers say sufferers pay just for the extent of care they want. Its facilities settle for most insurance policy, together with Medicare, which covers folks older than 65 and people with disabilities, and Medicaid, this system for low-income folks.
However there are essential caveats, mentioned Fisher, the affected person advocate.
Sufferers who pay money for pressing care at UF’s hybrid facilities are charged an “all-inclusive” $250 charge, whether or not they want an X-ray or a fast strep take a look at, to call two such providers, or each.
But when they use insurance coverage, sufferers might have greater price sharing if their well being plan is charged greater than it might pay for stand-alone pressing care, she mentioned.
Additionally, federal shock billing protections that protect sufferers in an ER don’t lengthen to pressing care facilities, Fisher mentioned.
Herrmann mentioned Intuitive’s services cost industrial insurers for pressing care the identical as in the event that they offered solely pressing care. However Medicare might pay extra.
Whereas pressing care has lengthy been meant for minor accidents and sicknesses and ERs are presupposed to be for life- or health-threatening situations, the 2 fashions have melded in recent times. Pressing care clinics have elevated the scope of accidents and situations they’ll 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 will not be the one ones with each “emergency” and “urgent care” on their indicators. Such branding can typically confuse sufferers.
Whereas Intuitive’s hybrid services supply some value transparency, suppliers have the higher hand on price, mentioned Vivian Ho, a well being economist at Rice College in Texas. “Patients are at the mercy of what the hospital tells them,” she mentioned.
However Daniel Marthey, an assistant professor of well being coverage and administration at Texas A&M College, mentioned the services will help sufferers discover a lower-cost possibility for care by avoiding steep ER payments after they want solely urgent-level care. “This is a potentially good thing for patients,” he mentioned.
Marthey mentioned hospitals could also be investing in hybrid services to make up for misplaced income after federal shock 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 mentioned.
UF Well being has positioned its new services in suburban areas close to freestanding ERs owned by rivals HCA Healthcare and Ascension quite than close to its downtown hospital in Jacksonville. It’s also 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 mentioned.
Although the three facilities will not be state-approved to take care of trauma sufferers, docs there mentioned they’ll deal with virtually any emergency, together with coronary heart assaults and strokes. Sufferers needing hospitalization are taken by ambulance to the UF hospital about 20 minutes away. If they should comply with 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,” mentioned 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.”
