Like many health systems, Englewood, Colo.-based Centura Health is turning to retail-oriented healthcare to provide more convenient, accessible care options to its customers. Its newest offering, a free-standing hybrid urgent-care/emergency department, may help resolve the uncertainty and cost concerns patients face when deciding whether to go to an ED or to seek urgent care.
Over the next eight months, the 16-hospital system will open four freestanding centers that offer both emergency care and urgent care 24 hours a day, with an emphasis on providing the latter, lower-cost option when possible. Centura serves patients across Colorado and western Kansas, and is jointly sponsored by Englewood-based Catholic Health Initiatives and Adventist Health System, based in Altamonte Springs, Fla.
Centura is developing the centers in a joint venture with The Larkin Group, a freestanding ED operator based in Texas that will manage the centers. This is the first non-hospital-based project to emerge from the joint venture, which was formed in June.
The first two hybrid centers will open in the Denver suburbs of Arvada and Golden. The model aims to ensure that patients won't use a high-cost ED for non-emergent needs, but also that they won't seek urgent care for injuries that are too serious for those physicians to handle.
“If you pick the wrong (care) choice, you could have (adverse) outcomes in either direction,” said Dr. Kelly Larkin, CEO of The Larkin Group. “We love that we can take that decision away from the consumer and they can come in with the knowledge they'll be in the right place, and professionals will be in the right place to make that (decision) for them.”
A majority of patients will be classified as needing urgent care, Larkin said, but emergency services, including X-ray machines, CT scanners, ultrasound, EKG and laboratory tests will be available for more serious needs. Clinical decision trees will help physicians decide whether a patient should be treated with emergency or urgent care.
For now, the centers will be staffed by emergency medicine physicians from the same group that staffs Centura's hospital-based EDs, although Larkin said emergency nurse practitioners or physician assistants could be added in the future if the centers experience high volumes. Many U.S. urgent-care centers are staffed by family physicians, with some employing emergency doctors as well.
Centura's integrated model also makes billing easier for patients in an industry that has been historically charged with duping patients. Urgent-care centers and freestanding EDs have been accused by patients of being unclear about which insurers they accept and the cost of their services. The new Centura centers should be able to avoid those issues because their services fall under the same insurance contracts that patients use throughout the rest of the Centura system, said Pam Nicholson, Centura's senior vice president for strategy.
Centura said the centers will charge emergency care patients for the controversial facility fees that are often tacked on to patient bills in hospital-based and even freestanding EDs, but at a lower cost than a hospital-based ED. As a non-hospital-based facility, the centers won't assess a facility fee to the CMS.
Health systems across the U.S. have looked to retail clinics and freestanding ambulatory facilities as ways to introduce their other services. Unlike independent facilities, the Centura hybrid model can connect patients to primary-care physicians or specialists within the Centura network, Nicholson said.
That is precisely the goal of such system-affiliated freestanding EDs and urgent-care centers, said Alan Ayers, vice president of strategic development at Practice Velocity an urgent-care software and billing company. Health systems' motivation is not to gain market share or to close access gaps with such centers, but rather, to capture those patients who can provide downstream revenue in other services, like primary care or specialist referrals, he said.
“What we've found by and large … is that they're not really needing (these facilities),” Ayers, a board member at the Urgent Care Association of America, said. “They're going into affluent suburban communities where hospitals are and they're not going into rural areas.”
