Keep up with the latest orthopedics news and insights from the industry’s trusted legal partner, Ged Lawyers. Here is an overview of what happened this month in the urgent care medicine field.
Patients with Medicaid and other insurance restrictions will now be able to receive healthcare services at the many facilities of Baptist Health South Florida. The large system of 12 hospitals, over 500 physicians, and more than 200 urgent cares, outpatient centers, and practices recently became part of AmeriHealth Caritas Next’s Health Insurance Marketplace provider network.
With plans available in 12 states and the District of Columbia, AmeriHealth Caritas offers insurance for low-income and chronically-ill individuals. Now, during annual enrollment periods, residents of Broward, Miami-Dade, and Palm Beach counties will be able to enroll in their choice of eight Bronze Plans, seven Silver Plans, and four Gold Plans. Enrollees will join the insurance network’s more than five million existing members.
“Baptist Health South Florida has served our local Medicaid members for many years and has become an important partner in our company’s efforts to build healthier, stronger communities in the region,” said AmeriHealth Caritas Next President Loretta Lenko.
Each year, the urgent care market is growing by 10 percent each year. This expansion has been driven by big companies, including MedExpress and CityMD, and now, the number of urgent care facilities in the United States far outpaces emergency rooms - 11,000 to 4,000. At the same time, the country will face a primary physician shortage of about 55,000 clinicians over the next decade.
While urgent care provides necessary immediate clinical visits, some professionals worry that patients will only seek medical help only when they are sick or injured. In turn, they may neglect developing long-standing relationships with primary care physicians.
“There’s this idea of the longitudinal relationship with your primary care doctor, where you don’t just see somebody once. You see them kind of over and over and over again, and that builds a relationship,” said ER doctor and health economist at the University of Pennsylvania.
Clinician visits are taking longer than they should be for one key reason: patients often have to re-enter their data and medical history. A recent study from Carta Healthcare found that 83 percent of patients had to provide duplicate health information each time they sought medical attention. Moreover, 42 percent of patients spent six minutes recounting their medical histories at doctors’ visits because data they provided in the past hadn’t been shared across systems.
One in five patients said that having to fill out repeat forms during doctors’ visits also made them less likely to return to a provider.
“This data reveals the direct impacts of inefficient data collection within the healthcare system on patients as doctors are spending too much time inputting duplicate data, and less time providing care,” explained Syed Hamza Sohail.
After meeting a representative from MedExpress at a conference, ER physician Chris Whelan and a partner opened the first of what would eventually be eight Health Express clinics in 2011.
In 2016, these clinics were faltering, so Whelan tried to sell them. However, with an investment banker or law firm, the deal fell through. But Whelan was now working about a hundred hours a week - 50 clinical hours and 50 management hours. So, once the volume of his clinics picked up again, he decided to attempt to sell the facilities again.
In 2018, his bid was successful; he sold all eight facilities to South Shore Health System.
What can urgent care operators learn from Whelan’s experience?
“For entrepreneurs who are trying to figure out when it's the best time to sell, Whelan says it starts by being true to your business. In his case, he says a sale helped deliver better patient care. The aim can also be to make a profit, move on in life or leverage the sale to grow and improve the business,” wrote Adam Burroughs for Smart Business Dealmakers.
Urgent care clinics that provide PIP-related care for individuals involved in auto accidents expect to receive claims reimbursement promptly. However, many clinics, including one with more than 18,734 outstanding PIP claims from 2014 to 2020, do not see timely repayment from insurance companies.
One of the reasons for unpaid or underpaid PIP claims is the skyrocketing number of fraudulent claims overall..The National Insurance Crime Bureau notes that PIP claims comprised only two percent of Florida’s collected insurance premiums but 50 percent of overall fraud claims.
So, many frustrated clinics that turn to Ged Lawyers to retrieve unpaid or underpaid PIP claims wonder how long the process will take. When we issue a demand to an insurance provider, we expect repayment within 30 days.
If they do not pay within this timeframe, we seek litigation with a less predictable timeframe. However, our digital platform lets you keep track of your outstanding PIP claims so you know where every claim recovery stands.
If you’re tired of waiting months or even years to repay your PIP claims, contact Ged Lawyers at 561-995-1966 or through our website.