Navigating Around Legislative Obstacles and Proving Value in 2017

Urgent care in a shifting healthcare delivery environment brings to mind Shel Silverstein’s children’s classic, The Missing Piece Meets the Big O. In that tale, the missing piece stands alone, waiting for someone to come along and take it somewhere. Various shapes come by, but none are quite right. Some could not roll. Some had too many missing pieces. Finally, a shape comes along that fits just right and they roll along until the missing …

Read More
Data: Option to Visit Urgent Care Lowers Visits to EDs

Data: Option to Visit Urgent Care Lowers Visits to EDs

Markets where there are higher concentrations of urgent care centers have lower emergency room visit rates, according to a new survey from the Deloitte Center for Health Solutions. Not unexpectedly, the inverse relationship was also shown; areas where urgent care centers are less concentrated tend to have higher ED visit rates, as well as larger uninsured and Medicaid populations. Industry watchers are eager to see how the numbers trend, as urgent care continues to emerge …

Read More
Medicaid ‘Experiment’ Fails to Reduce Use of ED

Medicaid ‘Experiment’ Fails to Reduce Use of ED

A new study of the Oregon Health Insurance Experiment shows the program has fallen short on one of the key benefits promised—namely, that emergency room traffic would be reduced if state Medicaid rolls were opened up to low-income adults through a lottery system. Nearly 90,000 residents signed up for the lottery, but EDs are as crowded as ever. It’s beyond question that urgent care could reduce the congestion, but most Medicaid programs don’t offer urgent …

Read More
Going My Way? Helping Patients Who Need a Ride Can Help Your Business

Going My Way? Helping Patients Who Need a Ride Can Help Your Business

Patients have options for getting to many care settings even if they’re unable to drive themselves or get a ride from a loved one. Some Medicaid patients arrive in the emergency room in an ambulance—even if they’re complaints don’t warrant such urgency. A couple of major health plans in Miami send vans around to collect Medicare members who need to see their primary care, and employers often provide transportation to workers who need to see …

Read More
Your Nondiscrimination Statements Have to Be Posted by October 17

Your Nondiscrimination Statements Have to Be Posted by October 17

Urgent care operators—and all healthcare providers who receive federal funds (eg, reimbursement under government programs like Medicaid or plans that take part in the Affordable Care Act)—are required by federal law to post nondiscrimination notices in public view by October 17. The U.S. Department of Health and Human Services (HHS) Office of Civil Rights says physicians must take “appropriate initial and continuing steps” to notify patients of certain information/services related to nondiscrimination. HHS has posted …

Read More
Proper Billing Operations Are the Best Defense Against Fraud Charges

Proper Billing Operations Are the Best Defense Against Fraud Charges

The case of a Canton, MI urgent care provider charged with 22 counts of medical fraud should serve as a cautionary tale and a reminder that unethical (or even just plain sloppy) billing practices can land operators, office staff, and physicians in hot water—or even jail. The physician in the Michigan case stands accused of billing Medicaid and Blue Cross Blue Shield for services he didn’t provide, resulting in nine counts of Medicaid fraud, 12 …

Read More
Colorado to Vote on Single-Payer Health System

Colorado to Vote on Single-Payer Health System

Payers, politicians, and practitioners don’t often line up on the same side of issues, but in Colorado they’re united in their distaste for a proposed single-payer system that would increase health coverage in the state—at the cost of a $25 billion tax increase that could drive employers out, some fear. Proponents counter that “ColoradoCare” would end up saving more than $6 billion annually by 2019. Under the program, residents would choose among private health insurance …

Read More
Is Urgent Care Prepared for Medicaid and CHIP Overhaul?

Is Urgent Care Prepared for Medicaid and CHIP Overhaul?

Major changes are afoot for urgent care centers that treat patients under Medicaid and the Children’s Health Insurance Program (CHIP), thanks to a new rule the Centers for Medicare and Medicaid Services (CMS) is imposing. In addition to new requirements for insurers, the rule also creates new compliance and administrative burdens that could affect revenue for medical practices (eg, requiring care coordination between different settings and institution of quality-rating systems and allowing states to encourage …

Read More
DOJ Sweep Underscores Need for Toeing the Line in Medicare Practices

DOJ Sweep Underscores Need for Toeing the Line in Medicare Practices

Physicians and nurses were charged along with business owners after the Department of Justice moved in on scores of clinics that were allegedly involved in fraudulently collecting fees from Medicare and Medicaid. The DOJ says more than 300 people were charged in healthcare fraud schemes involving $900 million in false billings. Sixty suspects were allegedly linked to schemes involving Medicare Part D, which is the fastest-growing component of Medicare, overall. According to court documents, the …

Read More
Medicaid Holdouts Continue to Confound ACA Proponents

Medicaid Holdouts Continue to Confound ACA Proponents

Those who herald the Affordable Care Act (ACA, or “Obamacare”) as a success continue to be vexed by the six million or so citizens who are eligible for Medicaid but simply don’t sign up for it. Perhaps that should not be surprising, however, given that most people eligible for Medicaid are exempt from having to pay a penalty for being uninsured—one of the ACA’s prime incentives for individuals to get insured—and those eligible can sign …

Read More