Humana is one managed care organization (MCO) that seems to “get it” when it comes to urgent care. On their website, Humana has a page devoted to guiding their members toward urgent care centers when appropriate.
Humana lists the advantages of urgent care as:
- Urgent care centers usually have extended and weekend hours.
- No appointment is needed.
- Generally wait times are short.
- Urgent care physicians can deal with a wide range of conditions.
- Members can be responsible for “most of the charges,” if they use an ED “innapropriately.”
- “Best of all… you’ll probably just pay a set copayment.”
Humana, also, regards hospital-based urgent care centers as overusing resources. They state:
Don’t let the urgent care sign fool you!
All centers are not created equal, and the difference can affect your wallet. To reduce your costs, choose a free-standing urgent care center, one that isn’t located in a hospital. These facilities are well equipped to provide medical care for minor illnesses or injuries. The only difference is the location. Your copayment and other costs could be a lot higher if you choose an urgent care center in a hospital.
We have not previously seen payors steering patients away from hospital-based urgent care centers. This directive seems to be an attempt by Humana to avoid paying the facility fees or ED codes that are sometimes charged in urgent care centers that are based on the hospital campus or centers that are fast track segments of the emergency department. If many payors put this type of pressure on patients to avoid hospital-based urgent care centers, financial pressures on hospitals to move urgent care centers off campus may not be far behind.