HHS Ambulance Program Would Cut Costs and Push More Patients to Urgent Care

HHS Ambulance Program Would Cut Costs and Push More Patients to Urgent Care

The United States Department of Health and Human Services is working on a pilot program that would give ambulance operators the option—aided by incentives—to take patients with nonemergent complaints to lower-cost setting like urgent care instead of the emergency room. While the aim is to reduce Medicare and Medicaid costs, patients would benefit from getting in and out of a healthcare facility in less time, with less exposure to whatever brought other patients to the …

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What the Proposed Prior Authorization Bill Could Mean for Urgent Care

What the Proposed Prior Authorization Bill Could Mean for Urgent Care

A bipartisan collective of legislators wants to put forth a bill in Congress to streamline the prior authorization process in order to facilitate faster, lower-cost care. Since those are the same key attributes that continue to fuel the growth of urgent care, on the surface it might sound like the bill could boost our industry. Not so fast. According to congressional staff working behind the scenes, as quoted in an article published by MedPage Today, …

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Annual Wellness Exam vs Annual Physical: The Difference Matters—a Lot

Annual Wellness Exam vs Annual Physical: The Difference Matters—a Lot

The terms annual wellness exam and annual physical may cover some of the same territory, but thinking they’re one and the same could be a costly mistake for your patient (which, of course, would be a second-hand costly mistake for you if that irate patient chooses to stop visiting your facility when they need same-day care or starts badmouthing you to their friends and family). This may be an especially complicated issue in urgent care. …

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More Ambulances May Be Rolling Up to Urgent Care, Thanks to the Department of Health

More Ambulances May Be Rolling Up to Urgent Care, Thanks to the Department of Health

Picture a Medicare patient who needs to see a provider today. It’s not an emergency, but they can’t wait until next Monday, when their primary care doc can squeeze them in. The solution is easy: urgent care, right? The only wrinkle is, they don’t drive anymore. So, they call an ambulance whose only option is to deliver them to the ED even thought their complaint is nonemergent. They wait for hours as the cost mounts. …

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New VA Regs Would Allow Millions of Vets to Choose Urgent Care

New VA Regs Would Allow Millions of Vets to Choose Urgent Care

As many as 2.1 million United States veterans will be able drop into any approved urgent care center that’s convenient to them whenever they need to, without prior authorization, under new regulations proposed by the Department of Veterans Affairs this week. The option to see private physicians, including urgent care providers, would apply to any vets who would have to wait more than 20 days or who would have to drive 30 minutes or more …

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Update: CMS Wraps Up New Medicare Card Program Ahead of Schedule

Update: CMS Wraps Up New Medicare Card Program Ahead of Schedule

The Centers for Medicare and Medicaid Services has completed mailing new cards to the 61 million people covered by Medicare in the U.S., each with their own unique, randomly assigned Medicare Beneficiary Identifier (MBI). The old cards were based on each person’s Social Security number, the widespread access to which left individuals open to identity theft. When the plan was rolled out to the public last April, CMS said it would take a year for …

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Hospitals Slam North Carolina Proposal, but Could it Benefit Urgent Care?

Hospitals Slam North Carolina Proposal, but Could it Benefit Urgent Care?

North Carolina’s state treasurer would like to see his state become the second in the country to align healthcare reimbursements with Medicare rates. The proposal is already being slammed by hospital systems and the North Carolina Healthcare Association on the grounds that any savings realized by the health plan and its members will come at the expense of overall quality of care across the state. However, Dale Folwell claims the plan he’d like to implement …

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Watch Out: Employer Health System Networks Are Getting Tighter

Watch Out: Employer Health System Networks Are Getting Tighter

The pressure to demonstrate the value you provide to employers, compared with telemedicine, on-site clinics, and other venues for on-demand primary care, is increasing as employer health system networks continue to become more exclusive. An article posted recently by HealthLeaders suggests that employers and insurers believe tightening their provider selections will raise quality and cut costs. Regardless of whether that logic proves fruitful in the end, the result today is that provider networks are smaller. …

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Why Are North Carolinians Going to the ED Instead of Urgent Care—at a Cost of $75 Million?

Why Are North Carolinians Going to the ED Instead of Urgent Care—at a Cost of $75 Million?

North Carolina’s Medicaid program has spent at least $75 million for patients to have nonemergency complaints addressed in the emergency room over the past couple of years. According to a new report released by the state, patients have to gone to the ED with primary complaints as mundane as bad breath, sunburn, bunions, and common warts. The report goes on to specify that those concerns—and many more—could be handled much less expensively and just as …

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Anthem Policy Should Direct More Patients to Urgent Cares—if You Seize the Opportunity

Anthem Policy Should Direct More Patients to Urgent Cares—if You Seize the Opportunity

One out of every six patients who visit an emergency room could see denied claims—and a whopping hospital bill—if a retrospective review policy imposed by Anthem not long ago were adopted by other insurers. A study just published in JAMA Network found that 15.7% of ED visits by commercially insured adults could result in denial of the claim on the grounds that presenting symptoms were found to be nonemergent after the fact. The researchers considered …

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