Tuesday, November 22, 2011

Informed Patient: Hospital Systems Move Into the Walk-In Market

Health Blog

WSJ's blog on health and the business of health.

By Laura Landro

For patients with immediate medical needs, a growing number of walk-in clinics and freestanding emergency rooms offer an alternative to hours-long waits in the hospital emergency department, today’s Informed Patient column reports.

Many urgent-care clinics are independently owned by physician groups and in-store retail clinics are run by chains like Walgreen and CVS. But health systems with hospitals see the walk-in market as an important part of their business, too — and a growing number are opening their own facilities.

“Hospital systems feel they need to stop losing these walk-in patients with minor injuries and illnesses to new players,” Tom Charland, chief executive of consulting and research firm Merchant Medicine, tells the Health Blog.

With new models of care envisioned under the new health-care law including bundled payment systems that reimburse for episodes of care rather than for each service, hospitals “will be responsible for the total cost of patients, so it is in their interest to send them to the lowest-cost provider,” Charland adds.

Hospitals are also watching Wal-Mart, which is seeking partners to push into the primary-care market by expanding the quick-service clinics it already runs.

Massachusetts General Hospital runs an urgent-care clinic that medical director Jeffrey Collins says helps to relieve the burden on its emergency department, controls costs and provides an “access point” into the health care system for patients who don’t have primary-care doctors.

Collins often sees patients in their 20s and 30s who don’t have a regular doctor but see the clinic as the place to go when they are sick, and patients over 55 who may have retired or lost jobs but aren’t yet eligible for Medicare and have urgent health issues.

The urgent-care clinic also often sees patients who have been discharged from the hospital and get sick; they can be treated and stabilized there, avoiding costly hospital readmissions, Collins says.

Kevin McDonnell, chief operating officer of AtlantiCare Health Services in Egg Harbor Township, N.J., says the two-hospital system began opening urgent-care clinics several years ago. An early foray into retail health clinics staffed by nurse practitioners in a local grocery chain proved a bust due to low volume, and O’Donnell says it became clear that patients preferred to see a doctor in an urgent-care setting if they had a choice. Staff physicians embrace the concept because they can steer patients to AtlantiCare urgent clinics after hours.

Freestanding emergency rooms are also growing in popularity, as health systems find that they can help relieve the burden on primary hospital emergency rooms and draw patients who might have trouble getting to the main hospital ED.

While many of the freestanding ERs are owned by hospital systems, some are being built by independent companies that aren’t bound by some of the same regulations as hospitals — such as seeing all patients regardless of ability to pay.

Insurers also may not cover all services at independent freestanding emergency rooms. States are now wrestling with how to regulate such facilities.

Don Dillahunty, president of  Dallas urgent-care clinic chain PrimaCare Medical Centers,  says that typically the cost to be seen at a freestanding ER is comparable to being treated at a hospital emergency department — four to six times that of the cost at an urgent care clinic for a similar illness or injury. He predicts that independent freestanding ERs “will face increasing cost-containment pressures from payers, both commercial and government, and may eventually be forced to align with hospital systems.”

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