Conor here: Any word on whether the 2024 presidential candidates think our healthcare system is “weird?”
By Phil Galewitz, a senior correspondent KFF Health News who covers Medicaid, Medicare, long-term care, hospitals, and various state health issues. He has covered health for more than three decades. Originally published at KFF Health News.
Facing an ultracompetitive market in one of the nation’s fastest-growing cities, UF Health is trying a new way to attract patients: a combination emergency room and urgent care center.
In the past year and a half, UF Health and a private equity-backed company, Intuitive Health, have opened three centers that offer both types of care 24/7 so patients don’t have to decide which facility they need.
Instead, doctors there decide whether it’s urgent or emergency care —the health system bills accordingly — and inform the patient of their decision at 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,” said Steven Wylie, associate vice president for planning and business development at UF Health Jacksonville. About 70% of patients at its facilities are billed at urgent care rates, Wylie said.
Emergency care is almost always more expensive than urgent care. For patients who might otherwise show up at the ER with an urgent care-level problem — a small cut that requires stitches or an infection treatable with antibiotics — the savings could be hundreds or thousands of dollars.
While no research has been conducted on this new hybrid model, consumer advocates worry hospitals are more likely to route patients to costlier ER-level care whenever possible.
A sign on the front door at a UF Health emergency and urgent care facility in Jacksonville, Florida, notifies patients they may be billed for emergency services. (PHIL GALEWITZ/KFF HEALTH NEWS)
For instance, some services that trigger higher-priced, ER-level care at UF Health’s facilities — such as blood work and ultrasounds — can be obtained at some urgent care centers.
“That sounds crazy, that a blood test can trigger an ER fee, which can cost thousands of dollars,” said Cynthia Fisher, founder and chair of PatientRightsAdvocate.org, a patient advocacy organization.
For UF Health, the hybrid centers can increase profits because they help attract patients. Those patient visits can lead to more revenue through diagnostic testing and referrals for specialists or inpatient care.
Offering less expensive urgent care around-the-clock, the hybrid facilities stand out in an industry known for its aggressive billing practices.
On a recent visit to one of UF Health’s facilities about 15 miles southeast of downtown, several patients said in interviews that they sought a short wait for care. None had sat in the waiting room more than five minutes.
“Sometimes urgent care sends you to the ER, so here you can get everything,” said Andrea Cruz, 24, who was pregnant and came in for shortness of breath. Cruz said she was being treated as an ER patient because she needed blood tests and monitoring.
“It’s good to have a place like this that can treat you no matter what,” said Penny Wilding, 91, who said she has no regular physician and was being evaluated for a likely urinary tract infection.
UF Health is one of about a dozen health systems in 10 states partnering with Intuitive Health to set up and run hybrid ER-urgent care facilities. More are in the works; VHC Health, a large hospital in Arlington, Virginia, plans to start building one this year.
Intuitive Health was established in 2008 by three emergency physicians. For several years the company ran independent combination ER-urgent care centers in Texas.
Then Altamont Capital Partners, a multibillion-dollar private equity firm based in Palo Alto, California, bought a majority stake in Intuitive in 2014.
Soon after, the company began partnering with hospitals to open facilities in states including Arizona, Indiana, Kentucky, and Delaware. Under their agreements, the hospitals handle medical staff and billing while Intuitive manages administrative functions — including initial efforts to collect payment, including checking insurance and taking copays — and nonclinical staff, said Thom Herrmann, CEO of Intuitive Health.
Herrmann said hospitals have become more interested in the concept as Medicare and other insurers pay for value instead of just a fee for each service. That means hospitals have an incentive to find ways to treat patients for less.
And Intuitive has a strong incentive to partner with hospitals, said Christine Monahan, an assistant research professor at the Center on Health Insurance Reforms at Georgetown University: Facilities licensed as freestanding emergency rooms — as Intuitive’s are — must be affiliated with hospitals to be covered by Medicare.
At the combo facilities, emergency room specialists make medical decisions that determine whether patients are billed for higher-priced ER care or lower-priced urgent care after patients undergo a medical screening. The health system compares the care needed against criteria for urgent- or emergency-level care and bills.
Inside its combo facilities, UF posts a sign listing some of the urgent care services it offers, including treatment for ear infections, sprains, and minor wounds. When its doctors determine ER-level care is necessary, UF requires patients to sign a form acknowledging they will be billed for an ER visit.
Patients who opt out of ER care at that time are charged a triage fee. UF would not disclose the amount of the fee, saying it varies.
A sign inside a UF Health emergency and urgent care facility in Jacksonville, Florida, shows services it provides under urgent care billing for a $250 fee for patients without insurance. If they do not qualify for urgent care, patients are billed for emergency services, which can cost several times as much.(PHIL GALEWITZ/KFF HEALTH NEWS)
UF officials say patients pay only for the level of care they need. Its centers accept most insurance plans, including Medicare, which covers people older than 65 and those with disabilities, and Medicaid, the program for low-income people.
But there are important caveats, said Fisher, the patient advocate.
Patients who pay cash for urgent care at UF’s hybrid centers are charged an “all-inclusive” $250 fee, whether they need an X-ray or a rapid strep test, to name two such services, or both.
But if they use insurance, patients may have higher cost sharing if their health plan is charged more than it would pay for stand-alone urgent care, she said.
Also, federal surprise billing protections that shield patients in an ER don’t extend to urgent care centers, Fisher said.
Herrmann said Intuitive’s facilities charge commercial insurers for urgent care the same as if they provided only urgent care. But Medicare may pay more.
While urgent care has long been intended for minor injuries and illnesses and ERs are supposed to be for life- or health-threatening conditions, the two models have melded in recent years. Urgent care clinics have increased the scope of injuries and conditions they can treat, while hospitals have taken to advertising ER wait times on highway billboards to attract patients.
Intuitive is credited with pioneering hybrid ER-urgent care, though its facilities are not the only ones with both “emergency” and “urgent care” on their signs. Such branding can sometimes confuse patients.
While Intuitive’s hybrid facilities offer some price transparency, providers have the upper hand on cost, said Vivian Ho, a health economist at Rice University in Texas. “Patients are at the mercy of what the hospital tells them,” she said.
But Daniel Marthey, an assistant professor of health policy and management at Texas A&M University, said the facilities can help patients find a lower-cost option for care by avoiding steep ER bills when they need only urgent-level care. “This is a potentially good thing for patients,” he said.
Marthey said hospitals may be investing in hybrid facilities to make up for lost revenue after federal surprise medical billing protections took effect in 2022 and restricted what hospitals could charge patients treated by out-of-network providers, particularly in emergencies.
“Basically, they are just competing for market share,” Marthey said.
UF Health has placed its new facilities in suburban areas near freestanding ERs owned by competitors HCA Healthcare and Ascension rather than near its downtown hospital in Jacksonville. It is also building a fourth facility, near The Villages, a large retirement community more than 100 miles south.
“This has been more of an offensive move to expand our market reach and go into suburban markets,” Wylie said.
Though the three centers are not state-approved to care for trauma patients, doctors there said they can handle almost any emergency, including heart attacks and strokes. Patients needing hospitalization are taken by ambulance to the UF hospital about 20 minutes away. If they need to follow up with a specialist, they’re referred to a UF physician.
“If you fall and sprain your leg and need an X-ray and crutches, you can come here and get charged urgent care,” said Justin Nippert, medical director of two of UF’s combo centers. “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.”
28 comments
Comments are closed.
Interesting that urgent/critical care are being merged when the UK has done the opposite. IIRC it was Blair’s government that set up “urgent care centres” (the name has changed at least once).
For once the NHS website is admirably clear about the kind of conditions for which the “urgent care centre” is where you should go (rather than try to see a GP or spend 10 hours in Emergency Department of your local hospital). If you break a bone or do something that won’t cause you to bleed out but does require sutures then an urgent care centre can be amazingly quick, efficient and good. I’ve used our city one twice with excellent experiences.
Sadly, broader NHS cuts are starting to degrade them and I’m a lot more suspicious as to what they are allowed to do. “Pass the buck” is the name of the game across the NHS these days. However in terms of cost (to show at least some link to the theme of the article) they are cost-effective and it’s a crying shame that I sense they’re being starved.
This is the perfect Neo-liberal “slippery slope.”
Several times in the piece, the claim was made that the dual use nature of the facility would benefit the ‘customer’ by ‘allowing’ treatment at the lower cost Urgent Care Clinic rates. Have they never heard of “Gresham’s Law?” “Bad money drives out good money.” Over time, these “dual use” facilities will tend to become primarily higher priced Emergency Room “franchises.”
The tell that the fix is in here is the inclusion of a venture capitalist organization; the Altamont Capital Partners. As history shows, when you turn the running of any enterprise over to financiers, the primary goal of the enterprise soon becomes the financial enrichment of the “partners” backing the enterprise. To apply this model to the health of the nation is pure political malpractice.
The final insult added to the ‘injury’ that sends ‘customers’ to these hybrid medical outlets is the explicit use of the word “Triage” to describe the ‘fee’ charged when the ‘customer’ declines to be ‘treated’ by the franchise. “Triage” here is a direct statement of the social policy inherent in fee based medicine. The sheep will be separated from the goats, and fleeced.
Another sign of “The End of Days.”
Stay safe for as long as you can afford to!
indeed; and
Intuitive is credited with pioneering hybrid ER-urgent care
I’m so old I remember when there was no such thing as “urgent care.” As a matter of fact, I have never been to one. And now they are “pioneering” a variant? I want the vaccine.
I do realize I have been lucky because long gone are the days when docs kept a few slots for last-minute (dare I say urgent) appts. Seems to me when I left for North Carolina in 2016 that was the model but when I returned in 2021 I had to wait months for an appt…yeah, weird.
We use a local “community” clinic. Whenever something “urgent” comes up, which is not often, (knocks on wood, {top of head,}) the clinic has “suggested” that we go straight to the Emergency Room. No immediate slots being available at the clinic. This is plain old ‘profiteering’ on the part of the medical system. The one or two times I have had to “interact” with an “Urgent Care Clinic,” they have always wanted to send me to the Emergency Room due to my generally high blood pressure readings. It seems that I suffer from a fairly common ailment: White Coat Syndrome. Someone within the system has gamed this out.
The upshot of this is that I am constantly arguing with my Medica about cutting down on my meds and switching to more “natural” treatments, such as my presently ongoing ‘experiment’ with daily high doses of niacin and nattokinase. Up until the moment I die, this will be a common element in my life. I have accepted that the American Medical System is not my friend.
Phylis has not been to a doctor in over four years now. It has been five years since her cancer prompted leg amputation, and no recurrence of the cancer. At least, no obvious signs of such. In that regard, Phyllis states that: “Perhaps it is better that I not know that doom is creeping up on me from behind. It will happen sooner or later. Why live my life in fear?”
Money and Medicine do not mix well.
Stay safe.
I started taking large amounts of taurine approximately three months ago in addition to nattokinase, lumbrokinase and serrapeptase that I started three years ago. Also added powdered B3.
Currently taking 8 grams of taurine per day and BP has significantly come down. Had to have cardio version done three weeks ago and no more a-fib and both HDL and LDL are much improved. Cardiologist told me after I came to from esophageal ultrasound that my heart muscle looked great which I attribute to the taurine. Eight months ago he wasn’t quite on such a positive note. (Going on eight years of mitral valve replacement.)
Correction. Taking 16 grams of taurine,10 in morning and six in the evening.
News I can use! Thanks Buzz.
Reading some of the side effects of the meds makes me wonder just how I have made it this long. I often joke about those auctioneer speed legal disclaimers at the end of drugs commercials.
“Some sweating, palpitations, loss of financial independence, and occasional bouts of death will happen to users of this product. See our website for more information. Ask your doctor if Placebo brand is right for you.”
The Idiocracy healthcare system is sounding better and better with every story like this-
https://www.youtube.com/watch?v=hcYbYhjdUb4 (3:22 mins)
If yesterday somebody had asked me the difference between an emergency room and an urgent care center, I would have figured that they would have been one and the same. So how are sick or injured people suppose to know the difference when they front up to one of these places?
I really regret not watching that film. I’m gonna track down a DVD/Blu-ray to purchase (preferably not via Amazon or ebay).
Re urgent or emergency: as I’ve mentioned in the thread, the NHS website actually isn’t too bad. I totally get that there are HUGE grey areas in which the patient should go to emergency dept in order to be sure.
Whilst my career means I’m not the “typically informed person”, my visits to the emergency department in the last 5 years always made me look at the people around me and conclude “half of you should definitely know you should be at the urgent care centre, not here”. Plus my visit in May saw heavily armed police (which we don’t see often in UK) swarming the hospital. Which meant an emergency dept patient had been armed and was definitely dangerous. I bet that little episode won’t make it to the current season of the documentary detailing life in the Emergency Dept of the QMC Nottingham! It’s all lovely! /s
But Idiocracy is rapidly becoming the world we live in.
When I handled a bat without gloves and was bitten (duh, I know), a local urgent care facility was my choice for administration of the rabies vaccine. And living in central Florida, it was at a nearby, newly built Advent Health owned facility in an upscale part of town.
And while there are 1400 beds in the entire network (I looked it up), this particular one is two stories high, and has perhaps 50-100 beds (couldn’t find this particular detail). Anyway, you’d never know it wasn’t an actual hospital-hospital other than it was smaller. Service was very quick.
What’s more, it’s already been expanded from when initially built maybe three years back so the whole thing has that brand new feeling. This is a feeder system such that more serious care is transported to the main hospital downtown.
And FWIW, since this ‘is’ NakedCapitalism, AdventHealth is a Seventh-day Adventist owned non-profit health care system headquartered in Altamonte Springs, Florida. They operate facilities in 9 states. Further to this, these break down as a total of 97 facilities such as hospitals, urgent care (like I used), emergency care (do they split the hospitals into units?), plus practices, imaging centers, and laboratories.
As a business owner, I immediately recognize whats is clearly a high growth business. For my part, I congratulate them for a) identifying a business area of need, and b) moving quickly to provide the service in a superb manner.
Bottom line? They may be owned by a religious group and operate under the moniker of non-profit, but as anybody with a passing familiarity with how things are in the real world, these folks are clearly making money hand over fist.
The scuttlebutt on Advent health was for those that work there, if you want to progress into the management side, you best be an Adventist. Maybe true maybe not. Just what I heard during the time I was getting my Health Informatics Masters at UCF.
Conor: presidential candidates can call US health care “weird” if they want. I will continue to call it what it is: criminal.
I call it deadly.
Afghanistan may be where Empires go to die; in America, individuals go to hospitals….
Eschew, and espit out.
How about “your money, or your life?” It’s straight up extortion. I would rather deal with the old-school Mafia, they were more honest. The US economy is largely based on parasitical and extortionate activity, rather than productive activity. Education, student loan rackets, housing, energy…all the basic necessities are hoarded and monopolized so that the extortion racket can be more profitable. The only “solution” is to invest in these activities, there is no alternative. Collective Stockholm Syndrome is rampant
Baystate in Western Mass. has a virtual monopoly on health care delivery in the area.
A year ago, they closed down most of their ‘urgent care’ clinics claiming workforce shortages. For over a year now, Baystate has not been accepting new patients into their system citing ‘shortages’.
This is what happens. These big hospitals start up these clinics, drive out the firms which are actually in the urgent care business. Then suddenly they go ‘appointment only’ or short hours, they close weekends, forget evenings, then they close. Because it costs money to actually be there for people when they need them, and driving everyone to a 10K siege at the emergency room is much more profitable.
I live alone and, last year, I cut a finger really badly. I called 911 for an ambulance (and therefore ER) because I was afraid I would pass out. It’s difficult to make cost decisions at a time like that
Indeed. Like it or not, healthcare is no longer a service per se, but rather another societal profit center. As a customer (not a patient), it’s incumbent upon all of us to shop in advance of needing care. Sucks, but it’s true.
This is a pointless distinction driven by capitalist extraction; it’s the same physical facility. The goal is simply to maximize profits. Any benefits to the patient is purely accidental. I mean, look at COVID; Hospitals are straight up infecting, disabling, and killing people seeking care. Saving lives and providing care is an accidental byproduct of American capitalist health care.
Here in Outer Pentagonia, urgent care centers are mostly closed after 8pm and on Sundays. For this reason alone, ERs should operate urgent care centers. How they bill is the problem and single-payer is the answer.
At first glance I thought it was “Outer Patagonia” then I looked again. Good one! LOL
My elderly father had a disagreement with a power saw and put a deep and ragged gash in his thumb. He got the bleeding stopped and called me and after looking at it, I took him to urgent care. He has Medicare Advantage thru Kaiser Permanente and Kaiser has a local urgent care clinic that is open on Saturdays. After waiting for 1/2 hour, the doctors at the clinic examined him and cleaned up the wound, but said it was “too much” for them and sent us to our local ER where Kaiser has contracted for services. The ER was notified that we were coming and my Dad was seen right away. He got xrays and once they declared the bone ininjured and the wound clean, a Physicians’s assistant stitched him up and sent him home. He went to his regular doctor to get the stitches out a couple of weeks later. It all worked out, but it cost my Dad an extra $250 and I was kind of shocked the urgent care couldn’t handle it.
A few years ago, I was cutting a limb off a tree in the back yard with a pole saw. The blade got pinched in the cut and wouldn’t move. So being the smart guy I am, I found the end of the limb and pulled it down to open the cut. Worked perfectly! Unfortunately as the saw dislodged and accelerated toward the ground, the bridge of my nose was the first object that stopped its movement. So with a very bloody face and ugly, open wound, my wife raced me to the emergency room, less I end up even less attractive. $3500 later, they washed out the wound with saline solution, took an x-ray, super-glued the skin back together and tightened the bond with little strips of duck tape. A month later, I had an annual physical with my PCP and told him the story. He said the doctors in the emergency room did the exact right thing, and if I had called him instead, he would have done it for $100. There’s a related lesson in their somewhere. I can imagine a facility that you could walk into, they would triage the problem and send you to the most appropriate care mechanism within the facility. Maybe they could call it a “hospital” or something.
My rural little hospital in Northern California was all booked up in its clinic that functions as our urgent care shop, so Reception told me to go to the ER instead for a snapped-off deep twig in my foot. They saw me pretty quickly and did me good. I’m on Medicare and the subject of money never came up, so I’ll never know how I was billed. But I did learn that our clinic is overloaded because the hospitals in our county seat 60 miles away are so clogged and understaffed that people drive down to us for what they can get. An all-American wrinkle is that our hospital is supported by a local tax district created by voters to keep it alive–so it can be overwhelmed by victims of hospital maladministration elsewhere, whom we subsidize. The problem is, there’s no solution.
I also live in a small community (Mendocino County)
Of course there is a solution, it’s just not profitable for the status-quo. Other countries spend far less on health care per capita and have much better health outcome indicators. The solution has been staring us in the face for decades. Even Richard Nixon had a plan for a comprehensive, modern health system for the USA, but Corrupt Congress Critters shot it down
As I remember it was Teddy Kennedy who held out for a better deal. Kennedy later expressed his regret that he did not go for Nixon’s deal.
When it comes to medical treatment, all I can say is I’m glad I don’t live in the US, and I regret my return to the UK and the loss of my right to standard medical care in France. The Starmer government plans to drive us further down the road towards the US system and that will be a further pressure point adding to the horrors of life for the poor and the debt-ridden which will end in massive disruptive change from the bottom, and the recent riots will look like a food throwing argument at a children’s tea party. Dick the Butcher will be rubbing his hands in gleeful anticipation.