Faced with an extremely competitive market in one of the fastest-growing cities in the country, UF Health is trying to attract patients in a new way: with a combination emergency department and urgent care center.

Over the past year and a half, UF Health and Intuitive Health, a private equity-backed company, have opened three centers that offer both types of care 24 hours a day, so patients don’t have to choose which facility they need.

Instead, the doctors there decide whether the care is urgent or emergency – the health system bills accordingly – and inform the patient of their decision at the time of the service.

“Most of the time, you don’t know where to go — the emergency room or the urgent care — and the triage decision you make can have a dramatic economic impact,” said Steven Wylie, assistant vice president for planning and business development at UF Health Jacksonville. About 70% of patients at his facilities are billed at urgent care rates, Wylie said.

Emergency care is almost always more expensive than urgent care. For patients who would otherwise come to the emergency room with an urgent problem—a small cut that needs stitches or an infection that can be treated with antibiotics—the savings could be hundreds or thousands of dollars.

Although there are no studies yet on this new hybrid model, consumer advocates fear that it will cause hospitals to be more likely to refer patients to the more expensive emergency room if possible.

For example, some services that require more expensive emergency room-level care at UF Health facilities – such as blood tests and ultrasounds – can be obtained at some urgent care centers.

“It sounds crazy that a blood test can result in an emergency room charge that can be thousands of dollars,” said Cynthia Fisher, founder and president of PatientRightsAdvocate.org, a patient rights organization.

For UF Health, the hybrid centers can increase profits by helping to attract patients. These patient visits can lead to increased revenue through diagnostic testing and referrals to specialists or inpatient treatment.

The hybrid facilities provide low-cost emergency care around the clock, standing out in an industry known for its aggressive billing practices.

During a recent visit to one of UF Health’s facilities, about 15 miles southeast of downtown, several patients said in interviews that they would have preferred a short wait time for treatment. None had sat in the waiting room for more than five minutes.

“Sometimes the emergency room sends you to the emergency room, you can get everything here,” said Andrea Cruz, 24, who was pregnant and came in because of shortness of breath. Cruz said she was being treated like an emergency room patient because she needed blood tests and monitoring.

“It’s good to have a place like this where you can get treatment in any case,” said 91-year-old Penny Wilding, who does not have a family doctor and is being examined for a probable urinary tract infection.

UF Health is one of about a dozen health systems in 10 states working with Intuitive Health to establish and operate hybrid emergency department and urgent care facilities. More are in the pipeline; VHC Health, a major hospital in Arlington, Virginia, plans to begin construction on one later this year.

Intuitive Health was founded in 2008 by three emergency physicians. For several years, the company operated independent combined emergency department and urgent care centers in Texas.

Then in 2014, Altamont Capital Partners, a multi-billion dollar private equity firm based in Palo Alto, California, bought a majority stake in Intuitive.

Soon after, the company began partnering with hospitals to open facilities in states such as Arizona, Indiana, Kentucky and Delaware. Under their agreements, the hospitals handle medical staff and billing, while Intuitive handles administrative functions — including initial efforts to collect payments, including verifying insurance and collecting copayments — and nonclinical staff, said Thom Herrmann, CEO of Intuitive Health.

Herrmann said hospitals have become increasingly interested in the concept because Medicare and other insurers pay for value rather than just a fee for each individual service. That means hospitals have an incentive to look for ways to treat patients more cost-effectively.

And Intuitive has a strong incentive to partner with hospitals, says Christine Monahan, an assistant professor at Georgetown University’s Center on Health Insurance Reforms: Facilities licensed as stand-alone emergency departments – like Intuitive’s – must be affiliated with hospitals to be covered by Medicare.

At the combined facilities, emergency room specialists determine whether to bill for the more expensive emergency care or the less expensive urgent care after patients go through a medical evaluation. They compare the care needed against a list of criteria that trigger emergency care and billing, such as whether the patient needs intravenous fluids or cardiac monitoring.

At its combination facilities, UF posts a sign listing some of the emergency care services it offers, including treatment for ear infections, sprains and minor wounds. If doctors decide emergency room treatment is necessary, UF requires patients to sign a form acknowledging that they will be billed for an emergency room visit.

Patients who choose not to seek emergency room treatment at this time will be charged a triage fee. UF declined to disclose the amount of the fee because it can vary.

UF officials say patients pay only for the level of care they need. The centers accept most health insurance plans, including Medicare, which covers people over 65 and the disabled, and Medicaid, the program for low-income people.

However, there are important caveats, said Fisher, the patient advocate.

Patients who pay cash for emergency care at UF’s hybrid centers are charged an “all-inclusive” fee of $250, regardless of whether they need an X-ray or a rapid strep test (to name just two such services), or both.

However, when using insurance, patients may have to pay a higher share of the cost if their health insurance company bills them more than they would pay for emergency care on their own, she said.

In addition, the federal surprise bill protections that protect emergency room patients do not apply to urgent care centers, Fisher said.

Herrmann said Intuitive’s facilities charge private insurers the same for emergency care as if they provided only emergency care. But Medicare may pay more.

While urgent care has long been for minor injuries and illnesses and the emergency room for life-threatening or health-threatening conditions, the two models have merged in recent years. Urgent care clinics have expanded the range of injuries and conditions they can treat, while hospitals have taken to advertising emergency room wait times on highway billboards to attract patients.

Intuitive is considered a pioneer of hybrid emergency room-urgent care, although its facilities aren’t the only ones with signs that say both “emergency” and “urgent care.” Such branding can sometimes confuse patients.

While Intuitive’s hybrid facilities offer some price transparency, providers have the upper hand when it comes to costs, says Vivian Ho, a health economist at Rice University in Texas. “Patients are at the mercy of what the hospital tells them,” she says.

But Daniel Marthey, assistant professor of health policy and management at Texas A&M University, said the facilities could help patients find a more cost-effective treatment option by avoiding high emergency room bills when they only need urgent care. “That may be a good thing for patients,” he said.

Marthey said hospitals may invest in hybrid facilities to offset revenue losses after a federal surprise medical bill protection goes into effect in 2022, limiting the fees hospitals could charge patients treated by providers outside their network, especially in emergency situations.

“Basically, they are just competing for market share,” Marthey said.

UF Health has located its new facilities in suburban areas near freestanding emergency rooms operated by rivals HCA Healthcare and Ascension, rather than near its downtown Jacksonville hospital. It is also building a fourth facility near The Villages, a large senior living community more than 100 miles south.

“This was more of an aggressive move to expand our market reach and get into the suburban markets,” Wylie said.

Although the three centers are not state-certified to treat trauma patients, doctors there say they can treat almost any emergency, including heart attacks and strokes. Patients who require hospitalization are taken by ambulance to UF Hospital, about 20 minutes away. If they need a specialist, they are 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 emergency care for a fee,” said Justin Nippert, medical director of two of UF’s combination centers. “But if you break your ankle and need to get it put back in place, you can get that treated here, too. It’s a one-stop shop.”

KFF Health News 2024. Distributed by Tribune Content Agency, LLC.