What’s Behind New Combined Urgent Care-ER Facilities

It’s Saturday afternoon, and your 4-year-old is bleeding from a gash on his face after a playtime mishap.

Should you go to the emergency room or the urgent care clinic?

VHC Health in Arlington, Va., plans to soon join a small but growing number of hospitals moving to resolve this dilemma by offering both types of care at a single outpatient center. Officials at the hospital, formerly Virginia Hospital Center, say they hope to start construction this year on a facility in nearby Falls Church. They’re touting it as the first of its kind in Virginia.

“Our model aims to address this uncertainty by offering triage and directing patients to the appropriate service, ensuring they receive timely and cost-effective care,” said Adrian Stanton, a vice president at VHC.

At its combo facility, the ER will be open 24/7, with the urgent care operating extended hours that could include some evenings and weekends, he said.

Fairfax County officials are still reviewing the building plans, a process expected to last into the fall. It is estimated construction will take 18 months.

VHC would join about a dozen health systems in 10 states working with Intuitive Health to open hybrid ER-urgent care facilities. Founded by emergency physicians, Intuitive ran independent hybrid centers in Texas before Altamont Capital Partners, a multibillion-dollar private equity firm, bought a majority stake and began partnering with hospitals.

At the facilities, doctors decide whether a patient needs urgent or emergency care — the health system bills accordingly — and inform the patient of their decision before testing or treatment begins.

Emergency care is almost always more expensive than urgent care. For patients who might otherwise show up at the ER with an urgent care-level problem — a small cut that requires stitches or an infection treatable with antibiotics — the savings could be hundreds or thousands of dollars.

For instance, at UF Health’s three hybrid facilities in Jacksonville, Fla., urgent care services are offered for an “all-inclusive” $250 fee for patients who pay cash.

While no research has been conducted on this new hybrid model, consumer advocates worry that hospitals are more likely to route patients to costlier ER-level care whenever possible. For instance, some services that trigger higher-priced, ER-level care at UF Health’s facilities — such as bloodwork and ultrasounds — can be obtained at some urgent care centers.

“That sounds crazy, that a blood test can trigger an ER fee, which can cost thousands of dollars,” said Cynthia Fisher, founder and chair of PatientRightsAdvocate.org.

The centers can increase hospital profits because they help attract patients, leading to more revenue through diagnostic testing and referrals for specialists or inpatient care.

On a recent visit to one of UF Health’s facilities, several patients said in interviews that they sought a short wait for care. None had sat in the waiting room for more than five minutes.

“Sometimes urgent care sends you to the ER, so here you can get everything,” said Andrea Cruz, 24, who was pregnant and came in for shortness of breath. Cruz said she was being treated as an ER patient because she needed blood tests and monitoring.

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