Some urgent care centers charge an additional facility fee

23rd April 2019   ·   0 Comments

By Susan Buchanan
Contributing Writer

You sprained your wrist on a Sunday, and you’re headed to an urgent care center instead of a hospital ER because it’s less expensive and faster. Before arriving at the center, however, you may want to call and ask if it charges facility fees, in addition to the cost of medical care. These facility-fee surprises can run from $25 to $200 or more per visit.

Urgent care centers have sprouted locally, and they reached 8,774 nationally late last year, according to the Urgent Care Association in Illinois. That was up from 6,400 four years before. Owners include hospitals and groups of doctors or investors.

The UCA defines an urgent care center as a medical clinic with expanded hours that can treat non-life- or limb-threatening illnesses and injuries in a place distinct from a freestanding or hospital-based emergency department. Urgent care centers accept walk-in patients. Care is supported by on-site radiology and lab services.

“If an urgent care is stand alone, they just bill the professional fee,” University of New Orleans associate economics professor Walter Lane, with a research interest in health care, said last week. “But if an urgent care is hospital based, they can bill a professional or physician fee and a technical or hospital fee.”

“For all doctors, if they’re located in a hospital-owned facility that meets requirements, they can also charge the facility fee,” Lane said. “The idea was originally intended for hospital-based doctors, including surgeons and anesthesiologists, who had to work in the more-expensive hospital environment. But it was extended to primary care as well.”

Urgent care facilities must meet several criteria to be considered hospital-based. “It isn’t enough to just be affiliated with a hospital,” Lane said. “And because of this, the vast majority of urgent care clinics aren’t allowed to charge facility fees.”

If you’ve had a major illness or health mishap in the past, you’ve probably waded into the weeds of medical coding. A center’s coding can determine whether you’ll be charged a facility fee.

“Only hospital-owned urgent care centers have had the option of charging a facility fee, though most do not,” Laurel Stoimenoff, CEO of the Urgent Care Association, said last week. Changes in federal policy have affected the industry. “If a hospital historically billed facility fees at an urgent care center, they’re no longer able to do so to Centers for Medicare & Medicaid Services for any acquisitions or new urgent care centers,” she said. “CMS eliminated that capability several years ago. But those urgent centers that had facility fees in place when the policy changed in 2017 were grandfathered in and were permitted to continue” charging facility fees.

The number of Medicare and Medicaid patients at urgent care centers has grown and accounted for nearly 27 percent of visits nationwide last year, according to the UCA.

Many hospital-owned urgent care centers bill the same way that others typically do, and that’s as a CMS-designated Place of Service 20 or Urgent Care Facility, where no facility fee is allowed, Stoimenoff said. Only urgent care centers that billed as a CMS Place of Service 19 or 22 were able to charge a facility fee before 2017. “And as I explained, if they did before 2017, they were grandfathered in and could continue billing that way,” she said. But some centers that are permitted to charge facility fees no longer do because they’re trying to compete with privately owned urgent care centers in their business arena, she said.

“The vast majority of urgent care centers were billing as a Place of Service 20,” she said. “The removal of facility fees from POS codes 19 and 22, effective in 2017, had no impact on them.” A POS 19 is defined by CMS as an off-campus, hospital-provider based department, which services sick or injured individuals who don’t require hospitalization. A POS 22 is an on-campus outpatient hospital, or part of a hospital’s main campus, providing services to those who don’t need hospitalization.

A decade ago, more than half the nation’s urgent care centers were physician owned. But since then, doctor ownership has declined and hospital ownership has grown, according to the UCA.

Stoimenoff said that when facility fees can be charged, urgent centers must disclose to patients that they’ll be billed separately for the facility and the physician.

“Our Ochsner-owned urgent care locations don’t charge separate facility fees for visits,” Michael Hulefeld, Ochsner Health System’s executive vice president and chief operating officer, said last week. OHS runs urgent care centers on Canal St. in Mid-City, Hancock Whitney Center on Poydras St., Decatur St. in the French Quarter, Magazine St. in the Warehouse District, Magazine St. Uptown, River Ridge, Lakeview, Veterans Blvd., Barataria Blvd., Williams Blvd., Covington, Mandeville, Luling, Houma and Thibodaux.

“We strongly believe in investing, informing and educating our patients in real time and in answering questions effectively, so that we maintain their trust,” Hulefeld said. OHS operates Ochsner Medical Center on Jefferson Highway and a dozen other hospitals in south Louisiana. Patients who have questions about OHS’s pricing can call 504-703-2773 or 855-241-9351.

For its part, “LCMC Health doesn’t charge a provider-based facility fee for a visit to one of our urgent care centers,” said medical doctor John Heaton, LCMC Health’s president of clinical and system operations. In a joint venture with Louisiana operator Premier Health, LCMC Health Urgent Care runs centers in Lakeview, Algiers, at Clearview Parkway in Metairie and in Gretna, Marrero and Covington.

The group plans to add to its urgent care sites to provide convenient, cost-effective service, Heaton said. According to LCMC’s website, the cost of visiting an urgent care center is lower than at an emergency room, and co-payments for insured patients are smaller.

LCMC Health is a New Orleans based, non-profit system operating University Medical Center New Orleans, Children’s Hospital, Touro Infirmary, New Orleans East Hospital and West Jefferson Medical Center.

Among the states, California, New York, Texas and Florida have the most urgent care centers. A Texas-based study, released in “Annals of Emergency Medicine” in December 2017, found that a visit to an urgent care center averaged $168 in 2015, versus more than $2,000 to a hospital-based emergency room.

While ERs treat patients with serious conditions first, urgent care centers serve patients with mostly routine conditions, and it’s usually on a first-come basis.

This article originally published in the April 22, 2019 print edition of The Louisiana Weekly newspaper.