Non-physician Owned Urgent Care? All Eyes On Massachusetts

A recent article posted on the web-based Patriot Ledger announced that the State of Massachusetts was investigating the legitimacy of non-physician owned urgent care facilities within the state. Their focus is seemingly directed at the franchise group  Doctors Express  which currently operates two centers in Braintree and Springfield and has plans for seventeen others there and elsewhere in the northeast.

The bone of contention, according to State Law, is that for-profit health clinics such as Doctors Express, must be owned by a physician or group practice. This is commonly known as Corporate Practice of Medicine (CPOM) law and it prevents non-physician entities from engaging in the practice of medicine for profit. However, in the instance of franchising or as is the case in other urgent care ownership structures, the workaround is that a physician commonly owns the clinic while the non-physician group or management company is engaged to take care of all other functionality of the business. These other functions may include operations, staffing, billing and collections.

Currently, at least eight states have relatively strict CPOM guidelines and many others have language that often limits who may own or practice certain types of medical services. In fact, very few states such as Florida  have virtually open access to ownership and the practice of medicine, although recent efforts have been made to restrict the glut of pain management shops popping up on nearly every corner to limit the pill-mills that offer no medicine but simply rake in the cash.

So why are so many concerned about what impact this action by the General Counsel in Massachusetts might have on urgent care ownership and the overall industry?

The truth is that all eyes are looking to Massachusetts  perhaps even a good portion of the northeast- to see exactly how the rest of the U.S. is going to respond to ObamaCare. After all, Massachusetts is a case-study in what happens when you essentially open up access to healthcare without a game plan on how to administrate resources. In theory, making sure that all Americans have access to healthcare- both preventative and urgent/emergent is a very good thing; provided of course that you have the infrastructure to actually take care of the millions of patients showing up to your offices, clinics and emergency rooms.

Such is the case in Massachusetts. These folks basically woke up one morning after passing their new laws giving full healthcare access to EVERYONE and found out that their idyllic system of being able to see a primary care practitioner or specialist in a timely manner went the way of the dinosaur over night. These practitioners were overburdened with a flood appointments brought about by thousands of patients with insurance resources under the new healthcare laws. Hence the essential land-grab going on in the state; anyone with an ounce of entrepreneurship and an inkling of urgent care insight is realizing that a solution to the complaint of the middle-class masses over not being able to receive timely healthcare any longer is the provision of urgent care.

And so we have the current dilemma: the pressing need to meet demand accompanied by American free-enterprise butting heads with legal interpretation. (Are you scratching your head and saying didn’t this just happen in the Supreme Court a week ago?) But perhaps the real story here isn’t contained within a few short paragraphs. Just maybe one needs to look beyond the report and to the comments section to get a real feel for not only the motivation for this action but also how potential patients in the area are reacting.

Nearly every comment posted alluded to how the investigation into Doctors Express and their ownership structure must surely be due to hospital influence and the lack of profitability since urgent care might be taking the paying patients. Further, another comment suggested that insurance companies were also a likely culprit trying to stymie reimbursement or freeing up emergency rooms of non-emergent patients. One commenter even asked the obvious question of Why wasn’t the issue addressed prior to the opening of the first two centers?

Overall, each respondent seemed supportive of urgent care in general and there was a sense in their comments that they saw this move by the state as a means as one put it as More government intervention and micro management.

Whatever the outcome of this investigation, it would seem that there is still support for the continued growth of urgent care in the Massachusetts marketplace. Patients want convenience, competent care and reasonable costs for the delivery of that care. They don’t care whose name is on the ownership papers when they walk into the urgent care. Are they treated any better by the physician/owner than by an employed practitioner? After all, they know the physician they see when they’re lying in the emergency room doesn’t have any ownership stake in the hospital either.  Perhaps the true spirit of CPOM needs re-examined or at least enforced more fairly.

All eyes ARE on Massachusetts. Maybe now more than ever.