Questions for Dr. Stern
About Your Urgent Care Center
5. I am part owner of a free standing urgent care center. Our community is dominated by medicare and managed care plans. We have only been able to negotiate flat rate payment from most of our managed care payors as we have little bargaining power. 2 local hospitals have been in contact with us as of late for a possible "merger". They would, of course, benefit from our outpatient lab and radiology referrals (which currently go primarily to free standing outpatient centers). We have been told, though cannot confirm, that urgent care centers affiliated with hospitals are able to bill at higher rates. It has been inferred that hospitals can usually negotiate higher rates from managed care payors on the rationale that it is still much cheaper to see patients at an urgent care vs their Emergency Department. Is there any truth to this claim? Is there any other benefit of being hospital owned or affiliated?.
Yes, many times hospital affiliations can be quite beneficial. Many centers simply assume contracts that are already negotiated for primary care providers affiliated with the hospital. In other cases, hospitals will actually specifically mention urgent care in MCO contract negotiations. I have seen large hospital groups with multiple site urgent care centers get urgent care rates at 20% above primary care rates or half-way between ED and primary care reimbursement. In some cases, UCCs can get fee-for-service contracts when only flat-rate contracts are offered to local privately-owned UCCs. Of course, every situation depends on your specific situation and specific locality, so be careful not to make false assumptions of what will happen in your specific situation if a merger goes through. Hospitals are often very unfocused partners, and your business can be hampered or even seriously harmed by the constraints (such as requiring EMTALA, ED nurses, ED docs, JCAHO, etc). Good luck. Feel free to contact us again.
