Urgent care or emergency room? With a “one-stop shop,” hospitals offer both under one roof

Faced with an ultra-competitive market in one of the nation’s fastest-growing cities, UF Health is testing a new way to attract patients: a combination emergency room and urgent care center.

Over the past year and a half, UF Health and a 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 need.

Instead, physicians decide whether it is urgent or emergency care (the health system bills accordingly) and inform the patient of their decision at the time of service.

“Most of the time, you don’t know where you should go — whether to an urgent care center or an emergency room — and that triage decision you make can have dramatic economic repercussions,” said Steven Wylie, associate vice president for business planning and development at UF Health Jacksonville. About 70% of patients at his facilities receive urgent care fees, Wylie said.

Urgent care is almost always more expensive than urgent care. For patients who would otherwise go to the ER with an urgent problem (a small cut that requires stitches or an infection treatable with antibiotics), the savings could be hundreds or thousands of dollars.

While no research has been done on this new hybrid model, consumer advocates fear that hospitals will be more likely to refer patients to more expensive emergency-level care whenever possible.

For example, some services that result in more expensive emergency room care at UF Health facilities (such as blood tests and ultrasounds) can be obtained at some urgent care centers.

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

For UF Health, hybrid centers can boost profits because they help attract patients. Those patients’ visits can generate more revenue through diagnostic testing and referrals to specialists or inpatient care.

By offering less expensive urgent care 24 hours a day, hybrid centers stand out in an industry known for aggressive billing practices.

On a recent visit to one of UF Health’s facilities, about 15 miles southeast of downtown, several patients said in interviews that they were looking for a short wait for care. None had sat in the waiting room for more than five minutes.

“Sometimes urgent care sends you to the ER, so you can get everything here,” said Andrea Cruz, 24, who was pregnant and came in for shortness of breath. Cruz said she was being treated as an ER patient because she needed blood work and monitoring.

“It’s nice to have a place like this where you can be treated no matter what,” said Penny Wilding, 91, who said she doesn’t have a regular doctor and was being evaluated for a suspected urinary tract infection.

UF Health is one of about a dozen health systems in 10 states partnering with Intuitive Health to establish and operate hybrid urgent care and emergency room facilities. More are in the works; VHC Health, a large hospital in Arlington, Virginia, plans to begin building one this year.

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

Then Altamont Capital Partners, a multi-billion dollar private equity firm based in Palo Alto, California, 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 their agreements, the hospitals handle the medical staff and billing, while Intuitive handles administrative functions (including initial efforts to collect payments, including verifying insurance and accepting co-pays) and nonclinical staff, said Thom Herrmann, chief executive of Intuitive Health.

Herrmann said hospitals have become more interested in the concept as Medicare and other insurers pay for value rather than just a fee for each service. That means hospitals have an incentive to find ways to treat patients for less money.

And Intuitive has a strong incentive to partner with hospitals, said Christine Monahan, a research assistant professor at Georgetown University’s Center on Health Insurance Reform: Facilities licensed as freestanding emergency rooms, like Intuitive’s, must be affiliated with hospitals to be covered by Medicare.

At combination centers, emergency room specialists determine whether to bill for more expensive emergency room care or less expensive urgent care after patients undergo a medical evaluation. They compare the necessary care to a list of criteria that trigger emergency-level care and bills, such as whether the patient requires intravenous fluids or cardiac monitoring.

Inside its combined facilities, UF posts a sign listing some of the urgent care services it offers, including treatment for ear infections, sprains and minor wounds. When its doctors determine that emergency room-level care is necessary, UF requires patients to sign a form acknowledging that they will be charged for an emergency room visit.

Patients who choose not to receive emergency care at that time are charged a triage fee. UF did not disclose the amount of the fee, but said it varies.

UF officials say patients pay only for the level of care they need. Their facilities accept most insurance plans, including Medicare, which covers people 65 and older and people with disabilities, and Medicaid, the program for low-income people.

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

Patients who pay cash for urgent care at UF Hybrid centers are charged an “all-inclusive” fee of $250, whether they need an X-ray or a rapid strep test, to name two of those services, or both.

But if they use insurance, patients may have to share higher costs if their health plan is charged more than it would pay for stand-alone urgent care, he said.

Additionally, federal protections against surprise bills that protect patients in emergency rooms do not extend to urgent care centers, Fisher said.

Herrmann said Intuitive’s facilities charge commercial insurers the same for urgent care as if they were providing only urgent care, but Medicare could pay more.

While urgent care has long been thought of as treating minor injuries and illnesses and emergency rooms are supposed to treat life- or health-threatening conditions, the two models have merged in recent years. Urgent care clinics have expanded the scope of injuries and conditions they can treat, while hospitals have begun advertising emergency room wait times on roadside billboards to attract patients.

Intuitive is credited with pioneering the combination of emergency room and urgent care, though its facilities aren’t the only ones to have both “emergency” and “urgent care” on their signs. This type of branding can sometimes confuse patients.

While Intuitive’s hybrid facilities offer some price transparency, providers have a cost advantage, said Vivian Ho, a health economist at Rice University in Texas. “Patients are at the mercy of what the hospital tells them,” she said.

But Daniel Marthey, an assistant professor of health policy and management at Texas A&M University, said the facilities can help patients find a lower-cost care option by avoiding hefty emergency room bills when they only need urgent-level care. “This is potentially a good thing for patients,” he said.

Marthey said hospitals may be investing in hybrid facilities to make up for lost revenue after federal protections against surprise medical billing went into effect in 2022 and restricted what hospitals could charge patients treated by out-of-network providers, particularly in emergencies.

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

UF Health has located its new facilities in suburban areas near freestanding emergency rooms owned by competitors such as HCA Healthcare and Ascension, rather than near its downtown Jacksonville hospital. It is also building a fourth facility, near The Villages, a large retirement community more than 100 miles to the south.

“This has been more of an offensive move to expand our market reach and get into suburban markets,” Wylie said.

Although the three centers are not state-approved to treat trauma patients, doctors there say they can handle almost any emergency, including heart attacks and strokes. Patients who need hospitalization are taken by ambulance to the UF hospital, which is about 20 minutes away. If they need a follow-up appointment with a specialist, they are referred to a UF doctor.

“If you fall and twist your leg and need an X-ray and crutches, you can come here and get urgent care at an additional cost,” said Justin Nippert, medical director of two of UF’s combined centers. “But if you break your ankle and need it set back in place, you can get treatment here, too. It’s an all-inclusive place.”