A rising variety of hospitals are outsourcing often-unprofitable outpatient companies for his or her poorest sufferers by organising unbiased, nonprofit organizations to offer major care.
Just like the almost 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 might assist scale back prices and recruit suppliers. They permit the clinics to acquire pharmaceuticals at deep reductions and entice docs by making them eligible for a authorities program that helps them repay their scholar debt in the event that they work in an space with a scarcity of medical suppliers.
However not like the group 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 during which the federal authorities covers their malpractice dangers.
Despite the fact that they don’t seem to be a part of a hospital system, lots of the hospital-formed look-alikes have clinics on hospital campuses or inside a brief distance. Consequently, the clinics might help divert sufferers with out pressing wants from costly emergency rooms.
That helps scale back losses, particularly from uninsured sufferers who may need been utilizing the ER for major care. Changing clinics to look-alikes can also be typically a method for hospitals which have a excessive proportion of sufferers enrolled in Medicaid, which typically reimburses hospitals at decrease charges than business well being plans do, mentioned Jeffrey Allen, a associate with the consulting agency Forvis. “It’s a pattern that’s gaining momentum,” he mentioned.
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 mentioned. On the similar time, hospitals anticipate many sufferers from the look-alike clinics who should be admitted for companies or require specialised care to be routed to their hospitals, he mentioned.A minimum of eight hospital methods have transformed current clinics or constructed new ones that acquired look-alike designation from 2019 by way of 2022, in line with a KHN evaluation of federal information. They embody:
Parkview Well being, a big hospital system in Indiana and Ohio, which opened a look-alike referred to as Alliance Well being Facilities in Fort Wayne, Indiana, that was designated in 2021. Tami Brigle, a hospital spokesperson, mentioned look-alike standing supplied the system a greater approach to offer care to underserved individuals.Parrish Medical Heart in Titusville, Florida, which helped open House Coast Well being Facilities, designated as a look-alike in 2022. Parrish spent $1.2 million to arrange the clinic, which offers major care and psychological well being care, a number of blocks from the hospital. “A lot of our sufferers haven’t had major take care of years and have a number of medical and behavioral wants,” House Coast CEO Arvin Lewis mentioned in a press release to KHN. “We’re working to enhance entry to care.”Wabash Basic Hospital, which partnered with a neighborhood well being division to kind Wabash Neighborhood Well being Heart, a look-alike clinic close to the hospital in Mount Carmel, Illinois. Danielle Stevens, the hospital’s government vp of enterprise growth, mentioned that the hospital was treating some clinic sufferers in its emergency room and that the brand new facility offered psychological well being companies and bodily well being in a single location. “The intent is to develop companies which might be at present not supplied to the group with the improved reimbursement,” she mentioned.Beverly Hospital in Montebello, a metropolis in Los Angeles County, which offered a $3 million mortgage and donated its girls’s clinic to get the look-alike BeverlyCare began, in line with BeverlyCare Government Director Corali Nakamatsu. The look-alike leases workplace area from the hospital for its grownup and pediatrics clinic. That clinic helps sufferers who want follow-up care after visiting the hospital emergency room. The clinic additionally offers sufferers a lower-cost possibility than utilizing the ER.
Indiana Hospital Affiliation President Brian Tabor mentioned hospitals are typically cautious of forming a look-alike as a result of it means giving management to a brand new group. However, he mentioned, 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 essential software.”
Nationally, 108 look-alike well being facilities function immediately, a rise from 87 in 2020, in line 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 at the least 51% of the administrators are required to be sufferers—identical to full-fledged group well being facilities. Look-alike well being facilities deal with sufferers on a sliding payment scale based mostly on their revenue.
Organizations sometimes search look-alike standing from the federal authorities as a precursor to changing into a completely funded federally certified well being heart.
Within the Allentown, Pennsylvania, space, each main well being methods—St. Luke’s College Well being Community and Lehigh Valley Well being Community—lately transitioned a lot of their major care clinics to look-alikes. Neither hospital would supply a spokesperson to speak in regards to the modifications, however each answered questions in writing.
St. Luke’s began Star Neighborhood Well being in 2018; it acquired its look-alike designation in 2020. “Star has been capable of deal with a broader group of people that will in any other case not have entry to care,” Star CEO Mark Roberts mentioned, though he offered no particulars in regards to the growth.
Lehigh Valley transformed a number of of its major care practices to look-alike standing beneath the identify Valley Well being Companions Neighborhood Well being Heart. 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 staff, and scientific pharmacists, mentioned 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 mentioned. And a cellular well being clinic that goes to underserved areas can also be partly funded by way of the improved Medicaid reimbursements.
Johns mentioned the look-alike clinic will get about $120 for a Medicaid major care workplace go to, almost double the cost that the clinics acquired once they have been owned by Lee Well being.
Johns credit the look-alike clinics for lowering pointless ER visits at Lee Well being hospitals by at the least 20%. A lot of these visits have been from uninsured sufferers, he mentioned.
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 the next price, and the clinics preserve the distinction. Clinics can scale back the out-of-pocket prices for sufferers however aren’t required to, though Johns mentioned Lee Well being does scale back the drug prices for sufferers who’re uninsured or have low incomes.
Hospital methods like Lee Well being that qualify for the 340B program sometimes can use it for less than their admitted sufferers, Johns mentioned.
The look-alike standing additionally permits the clinics to take part within the Nationwide Well being Service Corps, a federal program that pays the scholar loans of clinicians who comply with work in an space with a scarcity of well being care suppliers, he mentioned. “It’s a good way for us to hold on to suppliers,” Johns mentioned.
Shifting care to look-alikes has helped Lee Well being discover new funding to develop care to the medically underserved, he mentioned.
“It’s a cool mannequin and a really environment friendly approach to make use of restricted assets,” Johns mentioned.
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 among 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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