Journal of Urgent Care Medicine

‘There’s Profitability in Affordability’ for Urgent Care

The path to ongoing growth in the urgent care industry is paved with the dollars it saves payers and patients, according to MedExpress Chief Medical Officer Thomas Pangburn, MD. While insurers would likely disagree, Pangburn says that includes the advent of the Affordable Care Act (ACA, or “Obamacare”). Here’s some of the rationale he shared with the Pittsburgh Tribune Review : “With the Affordable Care Act and changes in the healthcare system, more and more …

New Data Show ACA Is Especially Hard on Emergency Rooms

The Affordable Care Act (ACA, or “Obamacare”) is driving higher volume in the emergency room at the same time it creates conditions resulting in lower availability of providers, according to a pair of new studies published in the Annals of Emergency Medicine. The end result: longer waits that frustrate patients and a patient load that clinicians may be hard pressed to keep pace with. While the studies were focused on Illinois and Massachusetts, the results …

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 …

Oops! ACA Architect Says Small Practices Make ‘Better’ Improvements Than ACOs

Industry insiders have watched accountable care organizations (ACOs) thrive at the expense of smaller practices—including more than a few urgent care centers. Now one of the architects of the Affordable Care Act (ACA, also known as “Obamacare”), which laid the foundation for the ACOs, is having second thoughts. Bob Kocher, MD, who as a special assistant to President Obama helped shape the ACA, writes in a Wall Street Journal op-ed piece that in spite of …

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 …

Urgent Care Surges in Southeast Michigan

Southeast Michigan is seeing a surge of urgent care growth this spring—and industry watchers are saying operators can thank President Obama, in a roundabout way. Regional growth started to pick up speed after the Affordable Care Act (ACA, or “Obamacare”) was passed in 2010, fueled by an influx of newly insured patients who need care immediately, but who may have been steered into urgent care by employers hoping to stem rising emergency room bills. With …

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 …

ACA: A Bust for Insurers, a Boon for Big Hospital Systems

Where the Affordable Care Act (ACA, or “Obamacare”) is proving to be a major financial challenge for insurers, some large hospital systems are experiencing a windfall since it launched. Tenet and HCA Holdings each say that ACA member admissions were up significantly over the previous fiscal year’s results. Tenet reports a 28% increase in inpatient admissions for that segment, with overall patient revenue going up 6%; HCA’s ACA inpatient hospitalizations were up 27%. The companies have …

Is America’s Uninsured Problem Being Replaced by America’s Underinsured Problem?

URGENT MESSAGE: Although the Affordable Care Act has made some progress in reducing the number of Americans without any health insurance, many of the newly insured are still unable to afford routine healthcare due to plan designs that include high deductibles, copays and coinsurance. Alan A. Ayers, MBA, MAcc is Practice Management Editor of JUCM—The Journal of Urgent Care Medicine, a former member of the Board of Directors of the Urgent Care Association of America, …