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Under the “Live Healthy” initiative proposed by Florida lawmakers in early December, every hospital emergency department (ED) would need to create a plan for handling patients who present with non-emergent conditions and/or for those who do not have access to a primary care physician. The aim of the proposed legislation is to divert non-emergent ED visits to urgent care or primary care, thus saving ED resources and encouraging less costly preventive care. If passed, the rules would require hospitals to obtain state approval for their diversion plans in order to secure licensure, so it would not be an optional program. The ED diversion plan would require hospitals to do one of two things: either establish an urgent care adjacent to the hospital ED or create a partnership with an urgent care center within a reasonable distance; or a create a partnership with a federally qualified health center or other primary care provider.

Balanced optimism is in order: “Anything that drives more patients to urgent care vs the ED is a good thing for our industry,” says Alan Ayers, MBA, MAcc, president of Experity Consulting and Practice Management Editor of JUCM. “However, the initiative may potentially increase the risk of inappropriate patients being referred or brought directly to the urgent care, including patients who require hospital admission.” Further, he says, triage could effectively become a function of insurance status or ability to pay, and higher-acuity patients who require more time could present in urgent care, thus scrubbing away at margins. He also notes that “a strategy of cost avoidance means the urgent care itself is unprofitable, but the overall loss to the health system is less than unreimbursed ED visits.”   

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