I’m Connor. I’m a 2024 presidential candidate who believes our health care system is “strange?”
Phil Galewicz is a senior correspondent for KFF Health News covering Medicaid, Medicare, long-term care, hospitals and various state health issues. He has covered health issues for more than 30 years. Originally published in KFF Health News.
Facing a highly competitive market in one of the nation’s fastest-growing cities, UF Health is trying a new way to attract patients: combining an emergency room with an urgent care center.
In the past year and a half, UF Health and the 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 want.
Instead, doctors there will determine whether a care is urgent or emergency, and the health system will bill accordingly and communicate that decision to patients at the time the service is provided.
“Most of the time, they don’t know where to go – emergency room or urgent care – and that triage decision can have a dramatic impact on the economy,” said Steven Wiley, vice president of planning and business development at UF Health Jacksonville, where about 70 percent of patients are billed at the emergency care rate, Wiley said.
Urgent care is almost always more expensive than urgent care, which can save hundreds or even thousands of dollars for patients who would otherwise visit the emergency department for an emergency-level problem, like a small cut that requires stitches or an infection that can be treated with antibiotics.
Studies have yet to be done on this new hybrid model, but consumer advocacy groups worry that hospitals will be more likely to refer patients to more expensive emergency-level care when possible.
A sign is posted at the front entrance of the UF Health Urgent Care and Emergency Care facility in Jacksonville, Fla., informing patients that they may be charged a fee for emergency services. (Phil Galewicz/KFF Health News)
For example, services such as blood tests and ultrasounds that would require costly ER-level care at UF Health facilities are available at some urgent care centers.
“It’s ridiculous that a blood test should result in an emergency room visit that can cost thousands of dollars,” said Cynthia Fisher, founder and president of the patient advocacy group PatientRightsAdvocate.org.
For UF Health, the hybrid center can increase profits by helping attract patients, whose visits can lead to additional revenue through diagnostic testing and referrals to specialists and inpatient care.
Hybrid facilities, which offer cheaper emergency care around the clock, stand out in an industry known for aggressive billing practices.
During a recent visit to the UF Health facility about 15 miles southeast of downtown, several patients in interviews said they wished the wait time for care was shorter — no one sat in the waiting room for more than five minutes.
“We get everything here because sometimes urgent care sends you to the emergency room,” said Andrea Cruz, 24, who is pregnant and came to the hospital for shortness of breath. Cruz said she was treated as an emergency room patient because she needed blood tests and follow-up care.
“It’s good to have a place like this that will treat whatever the situation is,” said Penny Wilding, 91, who said she was being treated for a suspected urinary tract infection because she doesn’t have a regular doctor.
UF Health is one of about a dozen health systems in 10 states that have partnered with Intuitive Health to set up and operate hybrid ER urgent care facilities. More are planned, with VHC Health, a large hospital in Arlington, Virginia, expected to begin construction on one this year.
Intuitive Health was founded by three emergency physicians in 2008. For several years, the company operated a freestanding combined ER and urgent care center in Texas.
Altamont Capital Partners, a multibillion-dollar private equity firm based in Palo Alto, California, then 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 the arrangement, hospitals handle medical staffing and billing, while Intuitive manages administrative functions (including early-stage payment collection efforts such as verifying insurance and collecting copayments) and nonclinical staff, said Tom Herman, CEO of Intuitive Health.
Hellman said hospitals have become more interested in the concept because Medicare and other insurers now pay for value rather than fee-for-service, meaning hospitals have an incentive to find ways to treat patients more cheaply.
Christine Monahan, a research assistant professor at Georgetown University’s Center on Health Insurance Reform, said Intuitive has a strong incentive to partner with hospitals, and facilities like Intuitive that are licensed as freestanding emergency rooms must be affiliated with a hospital to qualify for Medicare coverage.
In a complex, after a patient undergoes a medical examination, emergency room specialists make a medical judgment call and decide whether to charge the patient a high emergency care fee or a low emergency care fee. The health system compares the care needed with the criteria for urgent or emergency level care and billing.
UF posts signs throughout the complex listing the urgent care services it offers, such as treatment for ear infections, sprains and minor injuries. If a doctor determines ER-level care is needed, UF asks patients to sign a form acknowledging that they will be charged for the ER visit.
Patients who decline emergency care at that point are charged a triage fee, which UF declined to disclose the amount of the fee and said the fee varies.
A sign inside a UF Health Urgent Care and Emergency Care facility in Jacksonville, Fla., displays a service that offers urgent care to uninsured patients for a fee of $250. If patients don’t qualify for urgent care, they are billed for emergency services, which can cost several times as much. (Phil Galewicz/KFF Health News)
UF officials say patients pay only for the level of care they need, and the center accepts most insurance plans, including Medicare, which covers people 65 and older and those with disabilities, and Medicaid, a program for low-income people.
But there are important caveats, says patient advocate Fisher.
Patients who pay cash for urgent care at UF’s hybrid center are charged an “all-inclusive” $250 fee, regardless of whether they need services like X-rays or rapid strep tests or both.
But when using insurance, patients could end up paying more out of pocket if their health plan charges more than what it would pay for a standalone emergency treatment, she said.
And federal surprise billing protections that protect emergency room patients don’t apply to urgent care centers, Fisher said.
Herman said Intuitive facilities charge private insurers the same amount as they would if they were providing only emergency care, but Medicare may pay more.
Urgent care has long been for minor injuries and illnesses, while ERs were for life- or health-threatening conditions, but in recent years the two models have merged: Urgent care has expanded the range of injuries and conditions it can treat, and hospitals have begun advertising ER wait times on highway billboards to attract patients.
While Intuitive is known for pioneering hybrid ER and urgent care, its facilities are not the only ones to have both “urgent” and “urgent care” on their signs. It can be confusing to patients.
Vivian Ho, a health economist at Rice University in Texas, said Intuitive’s hybrid facilities offer some price transparency, but give providers the upper hand when it comes to costs. “Patients are at the mercy of what the hospital tells them to do,” she said.
But Daniel Marcy, an assistant professor of health policy and management at Texas A&M University, said such facilities could help patients who only need emergency-level care avoid high emergency-care bills and find lower-cost options for care. “That could be a good thing for patients,” he said.
Murthy said hospitals may invest in hybrid facilities to make up for lost revenue. Federal Surprise Medical Billing Protection It took effect in 2022 and limited the amount hospitals can charge patients who receive treatment at out-of-network providers, especially in emergencies.
“Basically, they’re just competing for market share,” Murthy said.
UF Health located the new facility not near a hospital in downtown Jacksonville but in the suburbs, near free-standing urgent care centers owned by rivals HCA Healthcare and Ascension. The company is also building a fourth facility near The Villages, a large retirement community more than 100 miles to the south.
“This is a more aggressive move to expand our market reach and get into the suburban market,” Wiley said.
The three centers aren’t state-certified to treat trauma patients, but doctors say they can handle just about any emergency, including heart attacks and strokes. Patients who need to be hospitalized are taken by ambulance to UF Hospital, about 20 minutes away. If they need follow-up with a specialist, they’re referred to a UF doctor.
“If you fall and sprain your ankle and need an X-ray and crutches, you can come in here and get emergency care for a fee,” said Justin Nippert, medical director of the University of Florida Hospital’s two intercenters, “but if you break your ankle and need to get it put back in place, you can also get care here. It’s a one-stop shop.”
