Hospitals divert primary care patients to ‘look-alike’ health centers to boost finances

But unlike community health centers, they don’t get annual federal grants to cover operating costs. Nor do they receive the federal government’s financial benefits to cover their risk of malpractice.

Although they are not part of a hospital system, many hospital-based therapists have clinics on hospital grounds or within a short distance. As a result, the clinics help divert patients from the expensive emergency room without requiring urgent care.

That would help reduce losses, especially from uninsured patients using the ER for primary care. Consolidating clinics is also a strategy for hospitals with large numbers of patients in Medicaid, which generally pays hospitals less than commercial health plans, said Jeffrey Allen, a partner at consulting firm Forvis. “It’s a growing trend,” he said.

Hospitals are betting they will come out ahead by spinning off cash-strapped services and providing similar support funds to keep them solvent, he said. In the same way, hospitals expect more patients from similar clinics and those who need admission or special care to go to their hospitals. At least eight hospital systems have converted existing clinics or built new ones, he said. It received designations that range from 2019 to 2022, according to KHN’s analysis of federal data. They include:

• Parkview Health, a large hospital system in Indiana and Ohio, opened a similar facility in Fort Wayne, Indiana, called Alliance Health Centers, to be named in 2021. The best way for those who don’t care.

• Parrish Medical Center in Titusville, Florida. He helped launch the similarly named Space Coast Health Centers in 2022. He spent $1.2 million to provide primary care and mental health care, a few blocks from the hospital. . “Many of our patients have not received primary care for years and have multiple medical and behavioral needs,” Space Coast CEO Arvin Lewis said in a statement to KHN. “We are working to improve access to care.”

• Wabash General Hospital, in partnership with the local health department, established the Wabash Community Health Center, a similar clinic near the hospital in Mount Carmel, Illinois. Danielle Stevens, the hospital’s executive vice president of business development, said the hospital is already hosting some clinics in the emergency room, and the new facility will offer mental health services and physical health in one location. “The objective is to expand services that are not provided to the community at an improved cost,” she said.

• Beverly Care’s executive director, Coralie Nakamatsu, said Beverly Hospital in Montebello, Los Angeles County, provided a $3 million loan and donated its women’s clinic to start a similar BeverlyCare. Apparently, he rents office space from the hospital for an adult and pediatric clinic. That clinic helps patients who need follow-up after visiting a hospital emergency room. The clinic offers patients a low-cost alternative to using the ER.

Brian Tabor, president of the Indiana Hospital Association, said hospitals are sometimes wary of establishing a model because it means giving control to a new organization. But the change could benefit both hospitals and patients: “Hospitals are looking for different payment models to support access in rural and underserved areas, and for some, same status has proven to be a truly critical tool.

Nationally, 108 similar health centers provide services, up from 87 in 2020, according to the Federal Health Resources and Services Administration. Most of them are not started in hospitals.

Heidi De Marco-KHN

Virtual health centers are governed by a board of directors, and at least 51% of the directors must be patients – just like full community health centers. Virtual health centers treat patients on a sliding fee scale based on their income.

Organizations require a similar rating from the federal government as a prerequisite to becoming a fully federally qualified health center.

In the Allentown, Pennsylvania area, both major health systems—St. Luke University Health Network and Lehigh Valley Health Network—recently transitioned many of their primary care clinics. Neither hospital would provide a spokesperson to discuss the changes, but both responded to questions in writing.

St. Luke’s launched Star Community Health in 2018. In the year In 2020, it received the same designation. Although they did not provide any details about the expansion, they said, “STAR has been able to treat a broader group of individuals who otherwise would not have access to care.”

Lehigh Valley has consolidated several of its primary care practices under the Valley Health Partners Community Health Center. Additional funding from Medicare and Medicaid has allowed the clinics to expand services for mental health and substance abuse, as well as help from financial counselors, social workers and clinical pharmacists, spokeswoman Jamie Stover said.

Lee Health, a hospital system in Fort Myers, Florida, has converted more than two dozen of its outpatient clinics to the same level since 2014. similar. Other employees are still employed in the hospital system.

The increased Medicaid funding helped pay for four new adult family practice clinics and a children’s mental health clinic, John said. And the mobile health clinic will be sold to underserved areas in part through improved Medicaid reimbursements.

Jones said the clinic will likely receive $120 per Medicaid primary care office visit, nearly double what the clinics received when they were owned by Lee Health.

Jones credits similar clinics with reducing unnecessary ER visits at Lee Health hospitals by at least 20 percent. Many of the visits are from uninsured patients, he said.

Look-Alikes benefit from the federal 340B program, which allows them to buy drugs at deeply discounted prices to sell to patients. The patients’ insurers typically pay the centers higher, and the clinics pick up the difference. Clinics may, but are not required to, reduce out-of-pocket costs for patients, although Jones Lee Health said it will reduce drug costs for uninsured or low-income patients.

Hospital systems that qualify for the 340B program, such as Lee Health, typically can only use it for their patients, Jones said.

A similar situation allows the clinics to participate in the National Health Service Corps, agreeing to work in an area where there is a shortage of health care providers paying off student loans. “It’s a great way to keep up with suppliers,” Jones said.

Balancing care has helped Lee Health secure new funding to expand care to the medically underserved, he said.

“It’s a cool model and a very efficient way to use limited resources,” Jones said.

KN (Kaiser Health News) is a national news division that produces in-depth journalism on health issues. Along with policy analysis and polling, KHN is one of the three major work programs on the KFF (Kaiser Family Foundation). KFF is a non-profit organization that provides information to the nation on health issues.

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