A growing number of hospitals are offering people both hospital emergency room services and urgent care at one site, reports Philip Galewitz for KFF Health News. This model could be a financial winner for Intuitive Health, which is offering it in partnership with hospitals. Patients have little say over whether the care is billed as ER or urgent care or the cost.
The doctors at the Intuitive Health facilities decide whether patients receive ER care or urgent care. And, they have every financial incentive to choose hospital ER care. If the doctors decide the wound treatment is ER care, the cost could be thousands of dollars more than if urgent care.
There’s no bright line between what services are urgent and what services are emergency. Often care received in a hospital ER could have been gotten at an urgent care facility, such as ultrasounds and blood work. Physicians notify patients when the physicians determine the care needed is emergency care. While patients can choose not to receive ER care, the facilities can still charge them a triage fee.
The value proposition for Intuitive Health–backed by Altamont Capital Partners, a private equity firm–is even greater than being able to bill for ER care for services that need not be treated as ER care. Intuitive Health can build a large patient base that leads to more medical tests, more physician and hospital services and more revenue.
Patients using the Intuitive Health facility in Florida had short waits for care. They appear to like having access to both emergency and urgent care services at one location. Intuitive is responsible for administrative activities, such as collecting payment; their hospital partners provide the physicians and do the billing.
Medicare pays for these services because of the hospital affiliation, as do most other insurers. But, what patients pay varies considerably. If patients pay the “all-inclusive” fee out of pocket, it’s $250. With insurance, their copays could be higher than that, depending upon what the facility charges their insurers.
Patients with commercial insurance have no federal protection from surprise medical bills, since the protections do not cover urgent care facilities.
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