The New Model of Urgent and Not-So-Urgent Care
Charlotte, N.C.-based Carolinas HealthCare System, for example, operates 32 hospital emergency departments, four freestanding ERs with five more planned, and 19 urgent-care centers. It is considering starting retail clinics in grocery or drugstores. “We can integrate care across a broad spectrum of settings and we have an electronic medical record that links all our patients no matter where they go,” says president and chief operating officer Joseph Piemont.
Full article on urgent care clinics.
This is a good model. I like it.
I’m sure the federal government will find a way to mess this up.
@Brian Williams: The federal (and state) governments have already found a way to mess this up.
The reporter does not discuss this, because it’s not in the usual press releases, but a health-care lawyer told me that “stand-alone” ERs are profitable because they are not subject to EMTALA like ERs in hospitals are. So, they can pick and choose their patients and send the profitable ones to the hospital that owns them. (I’m not saying this is bad or good, or even that I fully understand the law: I’m just reporting!)
I also get frustrated with people who blame patients for using ERs for care that is not truly emergent. If you are in pain with a severe sprain, for example, it is not reasonable for you to wait until the next morning, when your primary-care doc resumes his “banker’s hours”.
Then again, why can’t the urgent-care clinic be located right beside the ER in the hospital? Then it could be open 24/7 as well. (I’ve never seen one open past 10 p.m.) Perhaps a health-care lawyer could weigh in on that one: It makes too much sense. EMTALA probably working its wondrous ways again!
It would be nice if a physician group would establish retail clinics and walk-in clinics as part of their practice. I can envision my doctor offering me the option of receiving follow up care on the phone or being advised to swing by a retail clinic he or she is affiliated with for a blood draw.
A few observations: hospitals love the free-standing ERs because, depending on licensing/regulatory conditions, the ER will charge a facility fee (usually rev code 450) plus codes for services delivered, i.e. lab, imaging etc., so they bring in lots of revenue. The ER physician will charge a separate fee usually based on CPT codes 99281-285, is usually not a hospital employee but a contracted doc, and most of the time is not in the patient’s managed care network so contract pricing does not apply ($400-600 as opposed to $100-125 in-network). The Urgent Care centers are a better deal if in-network and offering extended hours as they don’t charge a separate and additional facility fee.
John Graham and JS Walker: thanks for those clarifying comments.
We’ve had various hospital networks operating urgent care centers and freestanding ERs for quite a while in my area. Most would be in-network for non-HMO health plans.
One hospital was so rapacious that people who went to its urgent care centers expecting to get the usual urgent care center prices ended up being charged ER department rates. Patients were outraged and so were their physicians. It was so bad that a group of physicians banded together and started up their own after hours practice.
Needless to say, that hospital still preens itself on what a fine public service it is.
From a patient perspective, the stand alone ERs are useful, especially in a rapidly growing urban area where hospitals have yet to catch up with housing and drive times, especially in rush hour, can be daunting. A couple of Kaiser-Permanente members of my acquaintance who had broken bones will expound about this, at length and at high volume, to anyone who listens.
The stand alone ERs have the facilities to diagnose, treat, and stabilize and can airlift to higher level ERs if necessary.