Thirty plus years ago urgent care centers emerged as an alternative to emergency room care and “regular” physician office visits (I was there).  The main “USPs” – Unique Selling Propositions that paved the way for the urgent boom we’ve experienced in recent years are:

  • Easy access on a walk-in basis without an appointment
  • Extended hours – usually 12 hours per day during the week and 9-5 or so on weekends and most holidays
  • Better equipped than a physician’s office to offer lab, xray, other diagnostics and treatments
  • LESS EXPENSIVE THAN HOSPITAL EDs – often touted as one-fifth the cost of a similar condition/treatment
  • The “patient experience” was better – we had that retail, customer service mindset from the get-go

What are hospitals doing in urgent care?

Now we’ve entered this phase where hospitals are clamoring to get back into the urgent care space, and with good reason.  The hospital or health system wants to embrace those core reasons patients love about urgent care, with the added objectives of expanding their catchment area, competition with other hospitals/systems, offloading busy EDs, and providing respite to overburdened primaries within the system, to name a few.

But I can’t help but notice the increasing number of complaints in the press about “bill shock” when patients get their EOBs and find a $200+ “facility fee” has hit their deductible.

I get the concept of the facility fee for hospitals to cover “unreimbursed services”.  And all the regulatory, quality, etc, etc that hospitals have that private practices don’t.  But remember?  This is why the urgent care alternative WAS LESS EXPENSIVE!  Not bringing all those costs into a community environment to provide less-than-ED-level care.  Now you are only half as much (or more) as the ED instead of one-fifth.

Hospitals – you have to compete with that!  There’s an urgent care center around every corner.  Patients AND PAYERS are going to catch on to this billing anomaly soon.  Particularly in this era of value based care.  In fact CMS has now disallowed the ability to charge facility fees for most off campus outpatient services, including urgent care.  You simply cannot build those costs into your urgent care centers budget and tack on what I believe are unsustainable facility fees.  You may soon be left with just an expensive billboard.

What Are Payers Going to Do?

I just don’t see why payers are going to continue paying a facility fee (and many don’t already) for Urgent Care A vs Urgent Care B just because the hospital’s name is on it.  In a value based model you’ll be looking to provide those services at less cost, not more revenue.  I have worked with and owned many urgent care centers that turned a nice profit at an average net per visit of $150 or less.  Expecting $400 per visit in urgent care going forward is just ludicrous in my opinion.

Run the Urgent Care like a Business, not a Hospital

The best way to do this is to work with an urgent care group/provider that understands these differences and can manage the urgent care center from more of a “private” cost structure.  Need help with that? Fill out this form and we’ll get back to you to discuss how we can help.

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What do you think about facility fees?