Sunil Budhrani, M.D., has spent about 20 years treating patients in emergency departments, so he knows that many people still go to the ED for minor injuries or illnesses.
Dr. Budhrani, now the chief medical officer of Innovation Health, is “amazed” that he continues to see patients come to the ED for such minor conditions as cuts, bruises and sore throats, he said in a recent interview with FierceHealthcare. Innovation Health is a joint venture of Aetna and Inova Health System, which serves the Washington, D.C. metro area.
A new feature of that effort is an illustrateddecision tree that help patients decide which place — ED or urgent-care center — is warranted by certain symptoms.
Innovation Health distributes this guidance information to providers as well as directly to patients.
Dr. Budhrani can communicate directly with the medical directors of a major health system such as Inova about how to instruct members about the services that Innovation Health offers. Innovation Health also uses its contractual relationships with other providers to let them know that it has one of the largest networks of urgent-care centers in its region.
Great for expanding and diversifying its customer base.
In this FierceHealthcare interview, Todd Strumwasser, M.D., Dignity Health’s senior vice president of operations for the San Francisco Bay Area, talks about the role of the system’s 12 planned joint-venture urgent-care centers in the San Francisco Bay Area in enabling better management of population health, cutting costs and sharpening focus on the sickest patients.
A study by Excellus BlueCross BlueShield says 90 percent of visits to new York State hospital emergency departments are for conditions that could be just as well treated in less expensive settings.
The annual cost of these unnecessary visits is $1.3 billion, according to the study.
“The best method of care for nearly all of these cases is for patients to see their primary-care doctors in office visits,” said Jamie Kerr, M.D., medical director of Excellus BCBS. “But when the physician isn’t available, many of these potentially preventable E.R. cases can be addressed with telemedicine visits or going to urgent-care centers at considerably greater convenience and less cost.”
Four companies running urgent-care centers in New York have agreed to disclose more fully which insurance plans they accept, following an inquiry by the state’s attorney general that found unclear or incomplete information on their websites that could result in larger-than-expected bills for consumers.
The agreements mark the first enforcement action brought under New York’s new “surprise medical bill” law, seen as one of the broadest in the nation. The law aims to reduce the number of consumers who get such bills when they unknowingly see providers who are not part of their insurance plan networks.
In July, New York Atty. Gen. Eric T. Schneiderman sent strongly worded letters to about 20 urgent-care clinics, asking for more information. Some of their Web sites, the letters noted, could be improperly listing which health plans they were part of, potentially a deceptive business practice. Similar concerns have been raised by advocates in other states, who note that urgent care centers often say they “work with” or “accept” insurance, but do not clearly say whether that they are part of particular insurers’ networks.
Such statements “may lead consumers to believe that an out-of-network urgent care center is … ‘in network’ with their health plan,” the July 2 letters said.
That’s key because consumers who go to clinics that aren’t part of their plans’ networks might owe the balance between clinic charges and what their insurers pay toward out-of-network visits, sometimes resulting in large bills.
Those bills, also known as “balance bills,” are part of the complex way that health care is paid for in the U.S. They occur because insurers form networks of physicians, hospitals and other providers who have agreed to negotiated rates, which are generally lower than their usual fees. Patients who go outside the network for care – because they want to, don’t know or are seen by an out-of-network provider while at an in-network facility – are subject to balance billing.
Although such bills have long led to consumer complaints, relatively few states have addressed balance billing except for emergency room care.
After review of responses to its July letters, the attorney general’s office decided the information from the four companies, which have more than a half a dozen facilities altogether, was unclear, incomplete, or not specific enough.
Under the agreement those owners will specifically list all the health plans they contract with as in-network providers and stop using the terms “works with” or “accepts.” They must also clearly explain that if they are “out of network,” the consumer could incur higher charges.
New York’s “surprise bill” law went into effect in March, imposing new requirements on hospitals, doctors and other medical providers. Among other things, the law requires that most health groups and facilities disclose in writing or on their websites the names of the health plans with whom they participate.
The urgent centers that signed agreements are: 181st Street Urgent Care in Manhattan; Brookdale Urgent Care, affiliated with Brookdale Hospital; New York Doctor’s Urgent Care with two locations in Manhattan, and Cure Urgent Care, with three locations in Manhattan and Long Island.
“Another issue to consider is whether an urgent care center perpetuates the fragmented nature of healthcare. Hospital and health system leaders have repeatedly said that care coordination is imperative to achieve better quality, cost, and outcomes. Will patients, who are in a hurry, especially when seeking an urgent care center, get so used to the easy access and quick service that they forgo seeing or keeping their primary care physician in the loop?”