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A rising variety of hospitals are outsourcing often-unprofitable outpatient companies for his or her poorest sufferers by organising unbiased, nonprofit organizations to supply major care.
Just like the practically 1,400 federally certified well being facilities—which get these extra {dollars} as effectively—a clinic designated by the federal government as a “look-alike” can also be eligible for federal applications that would assist cut back prices and recruit suppliers. They permit the clinics to acquire prescribed drugs at deep reductions and appeal to medical doctors by making them eligible for a authorities program that helps them repay their pupil debt in the event that they work in an space with a scarcity of medical suppliers.
However in contrast to the neighborhood well being facilities, the look-alikes don’t get an annual federal grant to cowl operational prices. Nor do the look-alikes get the monetary profit by which the federal authorities covers their malpractice dangers.
Though they aren’t a part of a hospital system, most of the hospital-formed look-alikes have clinics on hospital campuses or inside a brief distance. In consequence, the clinics might help divert sufferers with out pressing wants from costly emergency rooms.
That helps cut back losses, particularly from uninsured sufferers who might need been utilizing the ER for major care. Changing clinics to look-alikes can also be usually a technique for hospitals which have a excessive proportion of sufferers enrolled in Medicaid, which usually reimburses hospitals at decrease charges than business well being plans do, stated Jeffrey Allen, a accomplice with the consulting agency Forvis. “It’s a pattern that’s gaining momentum,” he stated.
Hospitals are betting that they’ll come out forward by spinning off a money-losing service and offering grant funding to the look-alike to maintain it solvent, he stated. On the identical time, hospitals anticipate many sufferers from the look-alike clinics who have to be admitted for companies or require specialised care to be routed to their hospitals, he stated.At the very least eight hospital programs have transformed present clinics or constructed new ones that obtained look-alike designation from 2019 by way of 2022, in keeping with a KHN evaluation of federal knowledge. They embody:
Indiana Hospital Affiliation President Brian Tabor stated hospitals are generally cautious of forming a look-alike as a result of it means giving management to a brand new group. However, he stated, the conversion can profit each hospitals and sufferers: “Hospitals are exploring totally different cost fashions to assist entry in rural and underserved areas, and look-alike standing has emerged for some as an actual vital software.”
Nationally, 108 look-alike well being facilities function right now, a rise from 87 in 2020, in keeping with the federal Well being Assets and Companies Administration. The bulk weren’t began by hospitals.
Heidi de Marco—KHN
Look-alike well being facilities are overseen by a board of administrators, and a minimum of 51% of the administrators are required to be sufferers—identical to full-fledged neighborhood well being facilities. Look-alike well being facilities deal with sufferers on a sliding charge scale based mostly on their earnings.
Organizations sometimes search look-alike standing from the federal authorities as a precursor to changing into a totally funded federally certified well being heart.
Within the Allentown, Pennsylvania, space, each main well being programs—St. Luke’s College Well being Community and Lehigh Valley Well being Community—not too long ago transitioned lots of their major care clinics to look-alikes. Neither hospital would supply a spokesperson to speak in regards to the adjustments, however each answered questions in writing.
St. Luke’s began Star Neighborhood Well being in 2018; it obtained its look-alike designation in 2020. “Star has been capable of deal with a broader group of people that might in any other case not have entry to care,” Star CEO Mark Roberts stated, though he supplied no particulars in regards to the enlargement.
Lehigh Valley transformed a number of of its major care practices to look-alike standing underneath the identify Valley Well being Companions Neighborhood Well being Middle. The additional funding from Medicare and Medicaid has allowed the clinics to develop companies for psychological well being and substance use, in addition to to supply help from monetary counselors, social employees, and medical pharmacists, stated spokesperson Jamie Stover.
Lee Well being, a hospital system based mostly in Fort Myers, Florida, transformed greater than two dozen of its outpatient clinics to look-alike standing beginning in 2014. Bob Johns, senior vp for Lee Neighborhood Healthcare, is the lone full-time government of the look-alike. The opposite personnel are nonetheless employed by the hospital system.
The upper Medicaid funding has helped pay for 4 new grownup household apply clinics and a pediatric psychological well being clinic, Johns stated. And a cellular well being clinic that goes to underserved areas can also be partly funded by way of the improved Medicaid reimbursements.
Johns stated the look-alike clinic will get about $120 for a Medicaid major care workplace go to, practically double the cost that the clinics obtained after they have been owned by Lee Well being.
Johns credit the look-alike clinics for decreasing pointless ER visits at Lee Well being hospitals by a minimum of 20%. Lots of these visits have been from uninsured sufferers, he stated.
Look-alikes additionally profit from the federal 340B program, which permits them to purchase medicines at deeply discounted charges to promote to sufferers. The sufferers’ insurers sometimes pay the facilities a better price, and the clinics hold the distinction. Clinics can cut back the out-of-pocket prices for sufferers however aren’t required to, though Johns stated Lee Well being does cut back the drug prices for sufferers who’re uninsured or have low incomes.
Hospital programs like Lee Well being that qualify for the 340B program sometimes can use it for less than their admitted sufferers, Johns stated.
The look-alike standing additionally permits the clinics to take part within the Nationwide Well being Service Corps, a federal program that pays the coed loans of clinicians who comply with work in an space with a scarcity of well being care suppliers, he stated. “It’s an effective way for us to hold on to suppliers,” Johns stated.
Shifting care to look-alikes has helped Lee Well being discover new funding to develop care to the medically underserved, he stated.
“It’s a cool mannequin and a really environment friendly means to make use of restricted assets,” Johns stated.
KHN (Kaiser Well being Information) is a nationwide newsroom that produces in-depth journalism about well being points. Along with Coverage Evaluation and Polling, KHN is without doubt one of the three main working applications at KFF (Kaiser Household Basis). KFF is an endowed nonprofit group offering data on well being points to the nation.
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