The Debate on Westchester Walk-in Medical-Care
They’re fast and convenient, but are urgent-care centers good for our healthcare system?
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“When they are covered, they will go more often. That will flood the ERs and put even more pressure on primary-care physicians.”
How bad will it be? When the Massachusetts universal-coverage law went into effect, the state experienced a 4-percent rise in ER visits, according to a 2011 study published in the Annals of Emergency Medicine.
But even with universal coverage, there are profitable patients, and then there are unprofitable ones. HVHC’s VP of Finance Mark Webster points out that people who get insurance from the controversial exchanges—a set of government-regulated healthcare plans from which people can purchase health insurance—will probably have high-deductible policies that require substantial out-of-pocket payments for much care. On top of that, the Congressional Budget Office estimates that more than a third of those receiving insurance for the first time will be covered under Medicaid, which reimburses doctors at lower rates than other forms of insurance. A 2011 study by the journal Health Affairs found nearly a third of doctors unwilling to accept new Medicaid patients.
The urgent-care facilities we talked to report that around 90 percent of customers/patients today have insurance and that the rest receive substantial discounts for out-of-pocket payment. No one mentioned the patients who have no means to pay but need care—and who represent as many as 5 percent of the ER patients at Hudson Valley and other hospitals. Several urgent-care providers state clearly on their websites that they don’t accept Medicaid. Hospitals typically don’t have that option.
“It appears that the urgent-care centers are profiteering by taking in patients who are well-insured or can pay and leaving the rest to us,” says William J. Higgins, MD, vice president and director of Medical Affairs for Hudson Valley Hospital Center.
Choolfaian agrees. “The primary people who go to urgent-care clinics are those with insurance or who are able to pay out of pocket,” he says. “The hospitals are left with those who can’t pay. They are skimming the cream from the top.”
“We are here 24 hours a day, seven days a week, 365 days a year to provide care,” says HVHC’s Webster. “For the urgent-care centers, they are there to make a dollar. Patient care is a side benefit.”
To be fair, however, that’s part of the dichotomy of medicine in a free-market economy. “If insurance companies and the government want more primary-care physicians, they have to adjust how they reimburse them,” offers Purugganan of Doctors Express. “As a business person, I feel there needs to be a balance.” What does the future hold? WESTMED’s Shuker says, “We see an expansion of services we can provide to patients on the day of their visit, but, perhaps more important, a more facile way of getting them back to their primary physicians and usual specialists who take great care of them year-round.”
For better, worse, or otherwise, the rapid growth of urgent-care clinics reflects the continual state of flux in the Westchester healthcare industry. Dr. Fusco has practiced medicine for 20 years in Port Chester, taking over from his father, who emigrated from Italy in 1959 and opened the office in 1964. As Fusco says, “The delivery of medicine is multi-faceted. You have to move along with the times.”
Dave Donelson lives in West Harrison and is the author of eight books, including the Dynamic Manager Guides and Handbooks.