Story and video: Central Vermont Medical Center opens urgent care center

BERLIN — Central Vermont Medical Center’s Express Care urgent care center began treating patients this week, giving area residents a lower cost alternative to the emergency room for non-life-threatening conditions.

Express Care will be open from noon to 8 p.m., 365 days a year. Patients don’t need an appointment and the center’s hours will allow them to get treatment for conditions such as fevers, infections, colds and minor cuts or fractures when they can’t get in to see their primary care provider.

Treatment at an urgent care center is roughly half the cost of the same procedure in an emergency department, according to CVMC officials, and the out-of-pocket costs for people with health insurance are lower as well.

Emergency departments are more expensive settings in which to be treated because laws allow them to bill differently for services in order to stay open 24/7 and treat people regardless of their ability to pay.

CVMC Express mapThe Express Care center saw 18 patients Thursday, the first day it was open. Dr. Richard Burgoyne, CVMC’s medical director, said he expects Express Care will see roughly 30 patients per day once operations are in full swing.

Urgent care centers will not only save patients money, but it is hoped they will reduce system-wide health care costs by keeping people who aren’t experiencing a medical emergency out of hospital emergency rooms.

“It fills a real need and ends this misallocation of resources where people are using the emergency room … and delivers the necessary services appropriately at physician office prices,” said Rep. Tom Koch, R-Barre Town, who attended a Friday ribbon-cutting at the center, located at 1311 Barre-Montpelier Road.

ClearChoiceMD, a New London, N.H., company, expects to open its own urgent care center less than a half-mile away, offering the same services. Concentra, a subsidiary of Humana Inc., operates an urgent care center near CVMC – though it closes at 5 p.m.

Vermont has tightly regulated the build-out of its health care system, especially since the creation of the Green Mountain Care Board in 2011, but urgent care centers aren’t subject to oversight because of an exemption for physician’s offices.

The proliferation of urgent care centers – ClearChoice plans to open five in the state this summer, and other hospitals are planning their own – raises questions about the duplication of services, which could ultimately drive up the fixed costs in Vermont’s health care system.

“Whether it’s excessive will be determined by how much people are using them,” Koch said. “If they’re not used fully and efficiently, one or more of them will probably close. That’s the way the market works, and I think people make a mistake when they say that market forces don’t apply to health care.”

That’s the view of ClearChoice executives who welcome the competition saying it will benefit consumers by forcing hospital-owned urgent care centers to offer competitive prices.

CVMC Chief Executive Judy Tartaglia said ClearChoice’s entrance into the market is troubling.

“What I worry about with out-of-state for-profits is whether they have the same sort of mission and philosophy that we do,” Tartaglia said. “We treat anybody who walks through the door regardless of their ability to pay … and I’m not sure that necessarily applies to for-profit companies.”

All 14 Vermont hospitals are nonprofit organizations, and won’t turn away patients who can’t afford their services.

ClearChoice has said its clinics will accept Medicaid and will provide a discounted fee structure for the uninsured, but if somebody doesn’t have the ability to pay for their services the company has said it will stabilize their condition and transfer the patient to another location, likely a hospital-run urgent care center or an emergency room.

The Vermont Legislature this year passed a law that will require urgent care centers, or any walk-in clinic to treat patients regardless of their insurance status.

That provision was in response to concerns that private companies operating urgent care centers might skim off the patients with private insurance, leaving the state’s hospitals to care for patients with public health coverage.

ClearChoice President Michael Porembski has said the law is discriminatory, because it singles out urgent care centers and does not apply to other private physicians offices, which aren’t required to accept Medicaid or Medicare patients.

Both programs reimburse providers at lower rates than commercial insurance, Medicare at roughly 75 percent of commercial rates and Medicaid at closer to 50 percent.

Porembski said hospitals, unlike private practices, have access to public payment models that compensate based on the proportion of uninsured and subsidized patients they serve.

But ClearChoice plans to take all patients as long as they are able to pay, so the law is unlikely to hurt their business, Porembski said.

He left open the possibility that his company may challenge the new law in court.

Correction: An earlier version of this article incorrectly stated that the Legislature passed a law requiring hospitals and private companies to go through the certificate of needs process before opening urgent care centers.

Cutting the ribbon at CVMC's new Express Care facility are (from left): CVMC President & CEO Judy Tartaglia, Express Care Medical Director Richard Burgoyne, MD, Steve Connor, Connor Construction, CVMC Facility Project Coordinator Nicole Duncan, Rep. Tom Koch and CVMC Board Chair Greg Voorheis.  Courtesy photo

Cutting the ribbon at CVMC’s new Express Care facility are (from left): CVMC President and CEO Judy Tartaglia; Express Care Medical Director Richard Burgoyne; Steve Connor, Connor Construction; CVMC Facility Project Coordinator Nicole Duncan; Rep. Tom Koch; and CVMC Board Chair Greg Voorheis. Courtesy photo

Morgan TrueMorgan True

Comments

  1. Irene Stewart :

    Our family is very excited that Clear Choice will be opening an express care office in Berlin in June. Last year our youngest of four grandsons, from out of state, was at our home for a visit. He developed a fever, and reached for his ear a couple of times. I called the CVMC Associates in Pediatrics for an appointment for this 13 month old baby. I was told they could not see him as he was not an established patient at their office. I was told that the baby would have to go to the CVMC Emergency Room. Although this was not an emergency, we took him to the ER reluctantly.
    He was seen by a PA and we were told he did have a fever and a slight ear infection, but he hesitated to prescribe any antibiotics. He said to give him Tylenol and he should be fine. Well, the fever persisted and the crying got worse. We returned to the ER two days later, and now, the 13 month old had a double ear infection, per another PA. Now, Amoxicillin was prescribed. He did not see an MD either visit.
    My daughters very excellent BC insurance was billed and they denied the nearly $1,000.00 because they do not cover ER visits for non-emergency visits. An ear infection does not qualify as an emergency.
    What should have been a $60.00 visit to the CVMC Associates in Pediatrics, turned into a $1000.00 bill. Imagine, CVMC turning a 13 month old baby away with a fever, because he is from out of state and not an established patient. Another example of a horrible CVMC policy.
    Grandparents – beware when your grandchildren come for a visit from another state. Don’t bother calling the CVMC Associates in Pediatrics for a visit, as the baby will be turned away. Great way for more revenue – send them to the very over priced Emergency Room. Yes, CVMC Practices do turn sick babies away even with great insurance.

  2. Robbie Harold :

    This is a great development, but many of these urgent care situations arise during off hours, e.g. during the night–do any of these centers operate around the clock? If not, the ER is still going to be the only alternative.

  3. Kathy Callaghan :

    I was surprised to learn that CVMC’s urgent care center is only open from noon to 8:00 p.m.

    Many people need care first thing in the morning if they became ill the night before, which is fairly common.

    I hope that ClearChoice MD will have morning hours.

  4. Irene Stewart :

    Robbie, yes, you are correct. Many situations arise during the night. But the situation I wrote about happened on a weekday, and I called CVMC’s Associates in Pediatrics around 10 AM. Don’t forget…ClearChoiceMD made its presence known last winter, long before CVMC even thought of doing an express care operation. It was “Reactive”, not “Proactive” for the residents of Central Vermont. They just do not want competition of any kind.
    Emergency Rooms are for critically ill patients as the cost is almost prohibitive. I do hope that DHMC’s ER Doctor will have great hours. At $50.00 a visit, it will certainly be so much less than anything CVMC charges at their express care. An X-ray for $50.00 at ClearChoice? Yes! An X-Ray at CVMC? Start at $300.00 plus! The choice is clear!

  5. Al Giordano :

    Some people, unfortunately, require care in off hours for urgent conditions but we are NEVER told before hand what the true costs will be.

    I took an opportunity to call CVMC Express Care and ask what a Medicare co-pay would be. I was assured that they were billing like a doctor’s office without a “facility fee”. Hooray!

    Upon further questioning, the poorly trained clerk informed me that an ankle x-ray would cost $400!!! Further, the reading would be another $400!!!! Even if a person has Medicare, they would have a Part B deductible and a co-pay, AND a Part A deductible and co-pay! Several hundred dollars out of pocket even w governmental insurance!! Heaven forbid I need a $93 ace bandage.

    How long will we allow this to go on? Working people should realize they are currently paying a Medicare tax on payroll to support this gluttony. In addition, every time a hospital bills $800 for x-rays, we are all paying. Open the market and stop the BS subsidies from and to hospitals. Mr governor, I hope you are listening. We can no longer allow this larceny to occur.

    I would love to hear your reply.

    • Karen McCauliffe :

      Al,

      I think you got incorrect information from Central Vermont Medical Center (CVMC) in regards to the facility fee.

      First off, doctors’ visits if the doctor is employed by a hospital charge an additional facility fee. These facility fees also apply to hospital owned urgent care centers.

      ClearChoice MD is not owned by a hospital so an additional facility fee does not apply, whereas CVMC would charge an additional facility fee.

      “After Vermont hospitals started buying up the medical practices of local physicians, state Sen. Kevin Mullin of Rutland, began hearing complaints that prices some patients were paying for routine medical care had soared.

      One family accustomed to paying about $120 in out-of-pocket costs for doctor visits and other medical services was outraged when they ended up forking over more than $1,000 for similar visits, Mullin said, mostly for seeing doctors whose practices had been bought out by a local hospital.

      “The only thing that was different was the office was [now] hospital-owned,” said Mullin, a Republican. “All of a sudden everything was charged differently.”

      The root of these increases are controversial charges known as “facility fees,” and they are routinely tacked on to patients’ bills not just for services actually provided in hospitals, but also by outpatient care centers and doctors’ offices simply because they’ve been purchased by hospital-based health care systems….

      … Like Linda Romaniello, of Davie, Fla. After her 8-year-old daughter was nipped by a dog, she took her to a local urgent care center and left with a bill for more than $500. The child was treated with antibiotic gel and a simple bandage during her 15-minute visit, according to the South Florida Sun Sentinel, which reported on the incident last year.

      Because the center was owned by Baptist Health South Florida, the hospital-based system slapped a $275 facility fee on top of the $233 doctor’s bill. The woman’s insurance refused to pay half the fee and Romaniello argued she would have gone elsewhere had she known about the extra fees beforehand. Florida has since passed a law requiring urgent care centers to post prices and all its clinics do so, a Baptist spokesperson said.

      Dr. Marc Salzberg, president of the Urgent Care Association of America, said these fees “should be transparent to the consumer” and that people should know about them “before they get care.” Salzberg says his group believes there are between 6,000 and 9,000 of these centers nationwide, 30 percent to 40 percent of them hospital-owned…”

      http://www.publicintegrity.org/2012/12/20/11978/hospital-facility-fees-boosting-medical-bills-and-not-just-hospital-care

  6. Dave Bellini :

    I hope VT Digger will write another story comparing ClearChoice to Express Care.

    Who does the patient see? PA’s, Dr.’s etc.

    What is the cost for common treatments and procedures like x-rays, office visits, stiches, etc. ? It would be good to see a side by side comparison.

  7. This is great news for this VT community. It replaces long waits for appointments and annoying visits to Emergency Rooms. Having those things available is very nice, but if you need allergy medicine or antibiotics, it is nice to have quick treatment. If you live closer or in New York, visit City MD to find the closest location.

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