Journal of Urgent Care Medicine

Vermont Will Try an ‘All-Payer’ System Starting in January

Vermont is going to try following Maryland’s lead by testing an all-payer reimbursement system for healthcare providers in 2017. Where Maryland’s long-held policy covers only hospitals, though, Vermont plans to use an accountable care organization (ACO)-type structure to cover all providers, regardless of setting (including urgent care). All-payer systems require all insurers, whether private, Medicare, or Medicaid, to pay similar rates for services. The goal is to increase the quality of care while decreasing the …

Rural Areas Suffer Most When Insurers Drop Out of Public Exchanges

A new study from the Kaiser Family Foundation shows that the dwindling number of insurers participating in public exchanges set up under the Affordable Care Act (ACA, also known as Obamacare) is much harder on people in rural communities than on city dwellers. Larger urban areas are more likely to have at least two insurers to choose from, giving those payers an incentive to offer lower rates. However, insurers often have a monopoly by default …

Is Urgent Care Prepared for Medicaid and CHIP Overhaul?

Major changes are afoot for urgent care centers that treat patients under Medicaid and the Children’s Health Insurance Program (CHIP), thanks to a new rule the Centers for Medicare and Medicaid Services (CMS) is imposing. In addition to new requirements for insurers, the rule also creates new compliance and administrative burdens that could affect revenue for medical practices (eg, requiring care coordination between different settings and institution of quality-rating systems and allowing states to encourage …

UCA Seeks Accommodations for Small Practices in Proposed CMS Payments System

A new payment system being considered by the Centers for Medicare and Medicaid Services (CMS) will have to make more accommodations for smaller practices—such as many urgent care centers—if there’s any hope of it succeeding, according to comments the Urgent Care Association (UCA) submitted to CMS. In its current form, the Merit-Based Incentive Payments System (MIPS) would require some clinicians to get an exemption from MIPS by participating in an Advanced Alternative Payment Model or …

Healthcare is Outpacing Inflation—Make Your Case on Cost Savings

Healthcare costs are growing at a slower pace than in years past, but they’re still rising faster than the overall inflation rate, according to new data from the PwC Health Research Institute. That means the pressure is still on insurers and employers (not to mention everyday people who pay out of pocket) to make sure their own costs are kept in check. Urgent care has the chance to play the hero in this scenario by …

Paying a Bigger Share of Medical Bills Could Have Patients Turning to Urgent Care

There’s a “new, critical stakeholder” with a voice in discussions about healthcare costs—and it’s someone urgent care operators know as well as anyone. A new report from InstaMed says 74% of patients had to pay a bigger share of their healthcare costs in 2015, prompting revenue cycle analysts to look at them more closely as actual “consumers” of services. “Both payers and providers will be challenged to overhaul their payment processes or face lost revenue …

Urgent Care Take Note: Insurers Are Warming to Telemedicine

Blue Cross Blue Shield of Michigan is the latest big insurer to start encouraging telemedicine for plan members with relatively minor complaints. As of July 1, BCBS will be working with American Well to offer the service to employers with fully insured and PPO policies. Plans see the new technology as a way to reduce costs—mainly by keeping patients out of the emergency room, which aligns perfectly with the urgent care approach—and to meet consumer …

New Data: Hospital Bills Don’t Discriminate Between Insured and Uninsured

New data from the National Bureau of Economic Research (NBER) indicate that while the Affordable Care Act (ACA, or “Obamacare”) has made sure more Americans have health insurance, it has done little to make care more affordable across the board. While nearly 90% of the country has coverage, NBER statistics show that more people than ever find basic healthcare unaffordable. A recent study of over 1 million patients from 2003 to 2007 illustrates just how …

Advantage, Urgent Care? Plans Are Already Passing ACA Losses Off on Members

Urgent care operators may have new leverage when negotiating reimbursements or appealing to cash-paying patients in North Carolina. Blue Cross and Blue Shield of North Carolina (BCBSNC) says it has lost $280 million by covering residents under the Affordable Care Act (ACA, or “Obamacare”)—and in response, it’s filing for a 2017 rate increase of 18.8%. BCBSNC says higher-than-expected ED visits and orthopedic treatments (the cost of which could be greatly diminished if appropriate patients visited …

With Less Competition, ACA Insurers Plan Major Price Increases

With many health insurers already scaling back—or vacating—state exchanges under the Affordable Care Act (ACA, or “Obamacare”), companies that plan on continuing to offer coverage may start charging members more for the “privilege” of being insured soon. Insurance industry projections show that many states could see jumps of 20% or so, while plan members in Pennsylvania and Georgia could see premiums go up by more than a third next year. Initially, 23 health insurance co-ops …