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More urgent care clinics to charge fees at time of service

When Elliot Hospital announced this month that it will require at least some payment up-front from patients at its urgent-care facilities in Manchester and Londonderry if they do not have insurance, the hospital joined a growing national trend.

Thousands of hospitals across the country are similarly increasing their efforts to collect payment at the time of service in their emergency departments if patients’ complaints aren’t deemed emergencies. No local hospitals said they plan to ask for payment in their emergency departments instead of sending home bills, but in the growing urgent-care industry, where the most common patient complaint is a sore throat or cough, Elliot is not alone in looking to secure payment before rendering service.

The change is a symptom of the changing role of insurance in patients’ lives, said Henry Lipman, senior vice president for finances and external relations at Lakes Region General Hospital, which opened an urgent-care clinic earlier this month.

In years past when most patients had insurance that paid a large portion of their medical bills, hospitals were almost guaranteed payment if they processed bills after treating the patient.

“As more and more people moved to high-deductible health plans, revenue isn’t as collectable as it once was,” he said. “When you get to the people who don’t have insurance at all, the statistics (of unpaid bills) are amazing. Collecting up-front from those people who can afford it can help us continue to provide care for people who can’t.

“Health care is not like a car. If you don’t pay your car payment, they can repossess the car. You can’t repossess health care.”

The broadest definition of urgent care, as defined by the Urgent Care Association of America, is health care provided on a walk-in, no-appointment basis for acute illness or injury that is not life- or limb-threatening, and is either beyond the scope or availability of the typical primary care practice or retail clinic. As of September 2011, there were approximately 9,000 facilities in the United States that meet this definition.

The business plan for the Lakes Region center always intended to collect insurance co-payments or a $150 fee from patients without insurance or who use Medicaid at the time of service, Lipman said.

If patients can’t afford that payment or can’t pay for another reason, they will be referred to the hospital’s emergency department just down the hall if they need immediate care, or told to see their primary-care physician.

ConvenientMD, a for-profit urgent-care company with a location in Windham and one under construction on Loudon Road in Concord, plans to require $100 from uninsured patients or an insurance co-pay up-front, said Gareth Dickens, the company president.

So far, between 5 and 10 percent of the clinic’s patients in Windham have not had insurance, he said.

The fee will cover seeing the clinic physician and any medicine the doctor dispenses. X-rays would be an additional $50, with another $50 required for any lab work, he said.

“It happens at the time of service, if a patient can pay then. We accept credit cards, debit cards, checks, cash – we make it easy. If they can’t pay then, we’ll send them a statement for that amount,” Dickens said. “We’re not holding people up before they can walk in the door.”

Concord Hospital has no plans to require payment at the time of service for care, but it does ask and has made steps over the past few years to make up-front payment easier if patients are able to pay then, said CEO Mike Green.

As many as 18 percent of the 20,000 annual visitors to the clinic lack insurance, he said.

“We used to just ask for their insurance information and bill the insurance or ask them their home address and send them a bill. That doesn’t work very well anymore,” he said.

“We’ve put in place practices that allow us to ask people to use their credit card before they check out or pay in cash before they check out, rather than simply sending them a bill. The likelihood of collection is better at the time of service.”

Still, he said, the mission of the hospital, including the Horseshoe Pond clinic, is to provide care to residents of the region as they need it.

“It’s very hard for me to conceive a scenario where we would require someone at any of our current facilities to pay before we’d give them care. I’m concerned about ConvenientMD across the river. . . . I worry they will skim off the paying patients and leave us in an unsustainable situation trying to support patients who can’t pay for care.”

If ConvenientMD has a noticeable effect on the hospital, officials might restructure so the clinic operates under a license separate from the hospital’s, Green said, which would be similar to the new clinic in Laconia.

New London Hospital doesn’t have the urgent-care demand to operate a walk-in clinic separate from its emergency room, but Chief Financial Officer Donald Griffin said he’s worried about the future implications of hospitals around his requiring up-front payment.

“We fear that at some point, the bigger hospitals that surround us may be forced in a matter of economic preservation to slow down the spigot on free care and when that happens, we would inevitably be a spot where people might go,” he said.

(Sarah Palermo can be reached at 369-3322 or spalermo@cmonitor.com or on Twitter @SPalermoNews.)

Legacy Comments1

I cannot wait until Michael Green is gone. I would love to believe that he would be replaced by someone more competent, but given the elitest Board, that will never happen. He has done more to ruin health care then any regional administrator. His $800,000.00 salary is outrageous. His tenure should have been investigated by the IRS. Green is part of system completely broken. Asking people to take on more debt, if they even have a credit card, only exacerbates the situation. Where is an estimate for care? Publish the secretive billing/coding Chargemaster used to determine charges.

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