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Customers Sick Over Bills for Urgent Care; Covenant Says Facility Offers Higher-Level Health Services

Posted on: Sunday, 11 December 2005, 15:00 CST

By GUY BOULTON

Barbara and R. Jay Gruenwald thought they were being prudent this fall when they went to the urgent care center at the St. Joseph Outpatient Center on Mayfair Road.

They knew that the minor cut on R. Jay Gruenwald's hand didn't warrant a trip to a hospital emergency room. The couple, who doesn't have health insurance, also knew an emergency room would be costly.

R. Jay Gruenwald got three stitches that day at the St. Joseph urgent care center. They also got a bill for $800.

The Gruenwalds didn't know that the urgent care center, more than seven miles from St. Joseph Regional Medical Center, is considered an extension of the hospital's emergency department and charges similar rates.

"Why would they call it urgent care if it's really an emergency room?" asked Barbara Gruenwald. "That's false advertising, isn't it?"

The Gruenwalds aren't the only patients to discover that the urgent care center, part of Covenant Healthcare, charges rates essentially the same as a hospital emergency department.

Covenant contends that there isn't a clear-cut definition of urgent care. But its practice of charging rates similar to an emergency department at its urgent care center, 201 N. Mayfair Road, differs from that of other health care systems in the Milwaukee area.

Other urgent care centers, which typically offer extended hours, are designed to provide care for patients who don't need the intensive services of a hospital emergency department. They also charge rates much lower than hospital emergency departments.

"The goal is to provide a more convenient and less expensive alternative," said Charles Dreher, the chief financial officer of Columbia St. Mary's, which runs several urgent care clinics.

The St. Joseph urgent care center isn't licensed as an emergency department, and it doesn't provide the services of one. Ambulances, for example, do not bring patients to the center. If a patient is having a heart attack or requires the care found at a hospital emergency department, he or she is transported to the nearby Wisconsin Heart Hospital, which is partly owned by Covenant, or to St. Joseph hospital.

But Covenant contends that the St. Joseph urgent care center, staffed by doctors trained in emergency medicine, provides a higher level of service than other urgent care centers.

Those services include a 24-hour lab, cardiac monitoring equipment and the ability to administer medication intravenously. The center, which sees about 25,000 patients a year, also is open 24 hours a day, seven days a week.

"We staff at a level that is way beyond what other people in the community refer to as urgent care," said Mark Mitchell, the emergency physician who oversees the center's medical staff.

By the center's admissions desk is a roughly 1-square-foot sign designed to help patients understand how they will be billed.

The sign states: "This building is part of St. Joseph Regional Medical Center. Services provided in the 24 hour urgent care facility will be billed as a hospital service. Hospital emergency room co-payments, co-insurance and deductibles will apply."

How many patients understand the sign?

"We would hope all of them would," said Ron Groepper, president of the service area of St. Joseph Regional Medical Center. He added, "I am sure that there are some that do and some that don't."

Groepper acknowledged that there was confusion about the urgent care center's billing when it opened in June 2003. But the complaints have since fallen to a very small number.

"The urgent center at this point in time is not that big of an issue for us," Groepper said.

It is for Marge Tomansky.

When her 4-year-old son woke up in the middle of the night with a high fever and in pain from an ear infection, she looked in the phone book under urgent care and called the St. Joseph center.

Tomansky, a nurse who teaches at Waukesha County Technical College, didn't think of taking her son to a hospital emergency department.

"An ear infection is not an appropriate use of an emergency room," she said.

Tomansky, who lives in Pewaukee, bypassed two closer hospitals to go to the urgent care center, where a doctor saw her son and called in a prescription for an antibiotic.

The bill came to $508.

"I've been to urgent care before," she said, "and I never expected a bill like that."

Tomansky did not notice the sign by the admissions desk, and no one told her the center charges rates similar to an emergency room.

She felt misled. Tim Tomansky, her husband, is more blunt.

"I thought we were cheated," he said. "You wonder why your insurance rates are so high, and this is part of it."

When they complained about the bill to Covenant, he contended, the answer was, "Well, your insurance company pays for it."

A patient brochure at the center states: "Charges are generally higher than typical physician office urgent care centers, and in most cases, the amount billed is more similar to emergency room charges, and emergency co-pays may apply."

But the brochure which also tells them how to apply for discounts under Covenant's charitable care policy isn't given to patients at admissions.

Covenant contends that federal law bars it from telling patients about its rates at the admission desk. The law which requires that patients first be assessed is designed to prevent hospitals from "dumping" emergency room patients who don't have insurance.

Telling patients how they will be billed, Covenant contends, could violate the law by discouraging them from seeking care.

The catch is that people may not learn that they are being charged higher rates until they already have been treated.

"There was no mention of the cost until I was leaving," said Rose Ann Hansen.

Hansen, who went to the urgent care clinic for a dog bite, was asked to put $200 on her credit card as a deposit before leaving since she doesn't have insurance.

She subsequently got two bills that brought the total cost to more than $600.

"I've never had to pay such outrageous prices," she said.

Groepper and Mitchell stressed that the higher level of services at the urgent care center justifies the higher rates.

How many of the center's patients need those services, though, apparently is unknown. Both men said they did not know how many patients required the skills and training of emergency physicians.

But late last month, Covenant said a survey of the emergency departments of St. Michael Hospital and St. Joseph hospital found that 78% to 83% of the patients could have been treated by a primary care physician.

That was at hospital emergency rooms. Presumably, the percentages would be higher at an urgent care center.

Groepper said the two health care systems where he previously worked had urgent care centers similar to the St. Joseph center and billed at rates close to an emergency department.

Further, health plans apparently haven't balked at paying the higher charges: Covenant said the urgent care center's rates haven't been an issue in recent contract negotiations with managed care companies.

Yet the reactions of some patients indicate that some people aren't aware of the urgent care billing policy at St. Joseph.

"They should have a sign that says emergency room," Gruenwald said.

The urgent care center at the St. Joseph Outpatient Center isn't an emergency room. At the same time, it differs from other urgent care centers.

Covenant has been considering changing the urgent care center's name, Groepper said.

"We are not in any way or shape or form trying to confuse the public," he said. "We don't think we are doing that. But if in fact there is some issue with that, we would want to look at that to make sure our integrity is top-notch."

$800

The bill the Gruenwalds received to treat a minor cut that needed three stitches.

$508

The bill Marge Tomansky got for a doctor's visit and antibiotics to treat her son's ear infection.

$600

Bills Rose Ann Hansen got to treat a dog bite.

Copyright 2005, Journal Sentinel Inc. All rights reserved. (Note: This notice does not apply to those news items already copyrighted and received through wire services or other media.)

Source: Milwaukee Journal Sentinel

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