Ep. 219: The Level Playing Field Urgent Care Has Been Waiting For

Patient Care Marketing Pros (00:00)
Hey, what's going on? You were listening to a seasonal walk-ins welcome where I am in full cold season. Yeah, it's still cold. Not just cold. Like I feel like I have a cold. Yeah. So I've got, I've got my, my bottle of water. I'm going to try not to cough into the microphone today. I've got a couple of, of, uh, throat lozenges and I'm ready to rock. I always laugh at the word loss.

Listen, Austin, cough drop. know it's like it's a real name. Who came up with that name? I wonder if Lawson just like a brand like Kleenex. It might be or just somebody's last name. I could have said I had a halls. There you go. Everybody knows what that is. Yeah, exactly. So I'll start with a question. Favorite flavored cough drop. ⁓ Ecoli. Ecoli. No, you call it Rico. Let's go with that.

I was like, wow. Okay. like equal. want to hear it. No, I you were saying that the tune in my hand again, equalize our recall. Wow. Okay. this was what was in my medicine cabinet when I left today, but minor the, ⁓ and it's completely worthless. but it's the smoothie ones. Yeah. Yeah. All smoothies. I'm like, taste amazing. ⁓ They're doing nothing for me. I just am popping in them like pieces. like getting even to have honey. ⁓

Or lemon like that tends to be the go-to. This is honey and lemon, sir. There you go. Well, you know one thing that I try to do every year, but then work out I will go into our met Madison. Well, Madison cabinet and say what's really expired? Let me get rid of some of that. So don't get because I even yet the other day ⁓ and he had like Apparently it was a cut on her eye or something cut it touched her eye

made a lot of pain. So we gave her we didn't know we gave her Benadryl but the kids Benadryl the newest one was a year old right? It's fine. Well, so if it's sugar free, it's expired. Okay, if it's sugar, it's probably fine. That's interesting. learned this when I was at Coca Cola. So ⁓ aspartame any of that stuff that that's a sweetener type situation. One is horrendous for you. ⁓ But two, it expires way quicker than sugary stuff. So

That's why you get the like the sugar crust around the rim of the Nyquil. Not what we're here to talk about today, but this is very fascinating. So and before we hop right into the episode, just to start more, we are testing out some new camera equipment. So we have one new camera so far looks pretty good and we're going to be adding more cameras to get different angles and the switcher and all these cool things just to kind of up the ante on our video production. You'll just wait till I bring in my video glasses. Oh yeah. And you got some meta glasses.

have a POV from the podcast. trying to hack it right now because it only let me record up to five minutes of video and I thought it would do a lot longer than that. That's kind of short. Well, people are doing it. Well, what they're doing is they're just cutting five minute clips and then putting them together. they didn't mention that in any one of the videos. Anyway, but so if you are somebody that always listens, doesn't watch the video, go watch the video and like look at the difference right now. This camera running a Canon R50V just to try it out. And I think we like it. And so we're going to add more

and then add a video switcher and it's going to look really cool. We're excited for that. So go over to the YouTube channel, go ahead and subscribe because it's just going to get better and better and better and better. And video subscriptions like we've had our subscribers, we've had more subscribers recently in the past month or two than ever. like we need our little button. It's too far away. Exactly. We only know. It sounds funny. We don't know why. We just because we're putting out the content that we put out, but we've had more subscribers recently. We appreciate you guys.

Please leave reviews, please give ratings and that helps everything for us. We love you for that. Absolutely. But let's get into the episode now. So this episode is titled The Great Equalizer. I be honest, is Nick had come up with this and he said, won't you look through it? And I couldn't believe what we're about to talk about because it feels like pie in the sky for years. Here we go. Well, I spent a lot of time. ⁓

thinking about what you would be thinking about the audience, right? Like, what are the things that are keeping you up at night? What are the things that bother you? What are the concerns that you have? And so I went to work on putting together an episode based on what you care about. And that is your money, right? absolutely. Now, this is going to be either amazing news for you or you may not care at all. But we're calling it the great equalizer.

because the game is going to be changing in 2026. What's happening is ⁓ the Center for Medicare and Medicaid has changed how hospitals are going to be reimbursed based on the care that they give. It used to be that you would pay, let's just say for, and I've got numbers broken down in here that we can look at, but an x-ray, if you did an x-ray at an urgent care,

you would get one reimbursement. But if you went to a hospital and got it, you would get a much higher reimbursement. So this is the game changer. They're doing away with that for the hospitals. Now, granted, privately held urgent cares, your systems, it's not like you're getting paid more. What's happening, though, is they can no longer compete with you. Yeah, not at the same level. Right. Because they're a hospital system. They have built in brand and logo. You're paying for the logo in the room where for you, you're just paying for the doctor.

Yeah. Well, and so now, and you said it's Medicare, Medicaid related, which that means that system will start promoting, don't go to the hospital. you now go to an urgent, it's all equalized. so there's some good possibilities here where the hospital will not be gaining as much revenue per visit as they used to. Well, they're losing their advantage completely. Yeah. Yeah. Like there. And so

Now it's a little bit more even playing playing fields. So even from like a marketing standpoint, you know, you may have hospital systems that are dumping millions of dollars into what they do. Well, now they won't have as much money to play with as they once did, or they can't get the newest and latest and greatest equipment because now it's taking a little more effort to get to that point. And now they got to up their game per se, which that's a new challenge, right? If the hospitals are just like cash like cash cowing things and then now they can't as much that

makes a difference. Well, you know, this was the second highest and no, I didn't memorize the other five searches. This was the second highest search in the past 90 days by what clinic owners are searching for. So clearly it's a buzzword. Everyone is Googling site neutrality right now. And I think one of the important things to know is it's not a political thing. It's a financial thing. Well, it reminds me of really just the phrase neutrality. If you remember net neutrality. I do.

So I think every industry goes through a neutrality state standing point where there are some bullies in the industry. And sometimes you have people step in like, let's level the playing field a little bit here because this is becoming unfair. And sometimes it was never intended that way. It just kind of gets to that point by accident, like most things. And then somebody has to step in like, let's crack it a little bit and kind of smooth it out. Well, what's really cool about this is that CMS is starting to pay the exact same rate no matter

if it's a hospital independent. the pay is now for the service being provided, not for where you're having that service done. Yeah. And that, that, that little bitty shift in ink. Yeah. Right. Paperwork. A comma. That is the leveling of the playing field. Literally. Right. Because that, that now allows everybody to play. Now we're all playing the same game. They were playing chess and you were playing checkers. Y'all are all playing the same game. Yeah.

Kind of reminds me of, mean, this is NASCAR reference, when you're like in NASCAR, you all have the same mechanical limitations. It's all about the driver at that point where you don't have a huge mechanical advantage over the next one because there's limits placed to make it more even. That's right. Honestly, make it more fun. And also that goes into now an urgent care really has to figure out their experience part. Right. I mean, because

If it's now equal playing field on that side at least now it's like, okay, well I want to go to the better place that has a better experience because I don't have another reason to go to the hospital. I've lost a reason to make a change, right? So it's fascinating to me and ⁓ I'm really curious honestly to see how hospitals react to this. Well, so let me throw some numbers at you real quick. This is just three different things that I was doing the research. I'll even give you the code.

I even have the code in here. So for a standard visit, like an urgent care visit, right, or just a standard visit code 99214. For an independent, it would be $135. But for a hospital, they would get reimbursed $215. That's an $80 difference. Right? That's that's a patient. Yeah, right. That's that's the difference in having to see two patients versus one patient, right? A chest X-ray 71046 for those coders out there. $18.

is the reimbursement. That's $72 for a hospital, right? That's four times more, four times more, right? IV hydration for those of you who offer IV hydration code number 96360 $65 for an independent and then $160 for a hospital that's $95 more. Again, this is the difference between having to see 40 patients per day versus 30 patients per day or whatever it is, right? And it's not it's not

that the medicine or the care is better. It's just simply this facility fee. Yeah. Right. It reminds me of I've been recently looking at cars. It's the dealership fee. Yeah, exactly. It's the same car. If I bought a Tesla, I could go directly to Tesla. can bypass all of those fees. I don't care how you feel about Tesla. That's just making a point, right? Direct to consumer. It's direct to consumer versus I have to go to a car lot and they have a docking fee, a ⁓ markup fee. There's all

there's the price of the car and 30 other fees attached to it. That's all the hospitals do. There's the exact same car. Yeah. Well, I mean, and I really think and hospitals will agree they really an ER or whatever they really don't head colds, like basic upper respiratory like the like non life threatening thing. They don't want to like you can talk to any ER like we really don't want these to come in because it clogs up the line for the people that have a real emergency that need to be saved. ⁓

Now you could, I'm sure the owners of hospitals will argue differently, but I do think it's one of those like, let's clear out the ER and make the urgent care more, this will make it more prevalent over time too. Cause you know, from a hospital standpoint, they're not going to, they're going to push harder to say, don't come in for an x-ray. That $18 ain't worth it. No. And so I'm super curious if we'll see a shift in hospital advertising saying why an ER

versus an urgent care and said the urgent care doing all the advertising why ER versus urgent care. That'll be real fast. for just one minute that a hospital actually cared that you were there. Yeah. Well, I mean, honestly, I'm not trying to beat up on hospitals. Okay. They're a very reactionary situation. know, ER is emergency. There's a difference between ⁓ emergency and urgent. Yeah. And that's, and that's something that a lot of people don't understand that urgent is

need to figure it out. It would make me feel better. Emergencies like I might die. Yeah, two completely different like and y'all put it on on like every phone tree that you have. For emergencies, please hang up until 9-1-1. If your chest is hurting, if you're bleeding out, if you're dying, don't don't come here, right? No, don't come into our lobby. I like the fact that hospitals are going to have to finally know their role, just as urgent care has had to know their role. I was like this is because the cool part with this.

hospitals have bigger budgets. And so now they're going to shift their budget to like, don't. Because if they're really going to get paid 18 bucks for a chest x-ray versus setting two is just the example you gave. They are losing every time a patient comes in that's not an emergency. Unless they can convert them into a surgery or a specialist. At this point you'd rather have the urgent care send for the specialist or a surgery.

I'm really fascinated. I wonder how many independent urgent cares are going to have relationships now with hospitals to get those people to come into the urgent care first and let them become a referral source. You know, it would be a good day when we could get urgent care clinics and hospitals to work cohesively together and on the same page. But not actually be owned by the hospital either. Right. Because we just do that, right? Like we have urgent care.

Urgent care is our own by hospitals. So let's talk about that for a second. And I think this is a point I wanted to make, but I actually left it out on my notes. You should stop seeing hospital systems acquiring urgent care clinics because it's not an easy win for them anymore. They can't just go in, acquire it. And because it's St. Vincent or

UAB or you name the hospital and they get the higher pay and they get the higher payout that's disappearing. So there's no incentive for them to go acquire urgent cares anymore. Well, you know, I do wonder because we saw that here. So Birmingham is kind of the I don't say birthplace of pretty much the birthplace of urgent care. And three or four years ago, we saw a chain was about five years ago. We saw hospitals putting out like here's an urgent care by St. Vincent's, UAB, whatever. And then two to three years ago, they got rid of them.

And I wonder if it's because of this thing where they saw it coming and they're like, we're just going to lose dollars. I'll tell you what, we had to go to the ER not too long ago and it was a standalone ER. We went out of our way to go to a standalone ER. Yeah, freestanding. But I will tell you that the experience, it was still an ER. It was still an ER visit. And there's still ER patients there. Exactly. But I will say that they are starting to understand, they are starting to grasp, they're starting to make the switch that we have to actually care about the people that are coming in here.

And they're making that switch in the personnel that they hire. They're making the switch in the cleanliness of the place. I know you think hospitals you think inherently clean, but they're actually quite nasty. And there are good people in ERs, but there's also chaos. My wife's been in the ER more than once, and it's amazing how long they'll leave somebody alone in a room and in pain. Just leave them alone. I'm come on now.

Well, I mean, honestly, they did that to Heather too. it's just kind of wild. And then of course, with Courtney, with her heart stuff, ERs actually say we can't help you. Just after you sit there the whole time. Yeah, like we actually can't do a single thing for you. But we're gonna charge you $800. Well, again, we're in the early throes of 2026. But I think the advantage that you're going to have is that being a lean

operation is better than being a large operation. yeah. Well, that doesn't mean that large operations can't run lean. I just make that delineation. Yeah. Well, I mean, ⁓ urgent cares and you guys know like it's you have to run lean or you're not going to run at all. every patient matters. Margins are tighter, all the things. But hopefully with this change here, you're going to see an increase in patients because hospitals just going to push back and say, please don't come here.

They may, I wonder if it has enough impact where they'll even say, they'll deny patient care and say you need to go down the block type of thing. Cause they know they're losing dollars every time it happens. So. Well, mean, technically speaking, have to, they have to take them. I believe hospitals have to take you. Yeah. And they have to take them and they tend to have to care before they make you pay. But I'm just wondering if like their signage, their everything.

even like their pamphlets all stuff. Do you have this, this and this? And hurt you care maybe a better spot, you know, fix for you. It's funny that you say that when when we went to the ER, it's been about, I don't know, two or three weeks ago now. They have to care before they pay. I just now made that connection in that I thought it was weird that I signed in for Heather and they didn't ask me for anything. No, that's later. They didn't ask me for anything. They're going to they're going to fix you as much as they can.

without going referring. Yeah, they don't ask for hardly anything to leave and then you get a bill later. But fascinating. I've never thought of it that way. Yeah, there's and they have built in. What do you call it? Not wellness models, but basically you call that where you anyway. But they have like charities, all these different things because we experienced that when we had Adi in the NICU. And so they have programs built in where when you drop a baby off, it will be completely taken care of. You will not ever see a bill.

Nobody will and it will just be washed away. And that's part of the reason why I think costs are so high because there is that usage of that type of situation so often where my $80,000 bill for eight days in NICU, which ended up being like four grand or whatever, was zero dollars for the NICU baby that had no parents. So there's a balance. But it's interesting. It's cost get passed on for sure. Somebody's going to pay for it. Well, hospitals.

They're not stronger, they're heavier, they're bigger. And, you know, I've probably made this boat analogy before, but it's easier to turn a wave runner than it is a pontoon. And it's easier to turn a pontoon than it is a cruise ship. know what I mean? So your ability, your nimbleness to adjust to what's coming down the pipeline in this neutrality is going to be a lot easier for you, the independent urgent care, than the hospital system trying to recover from what they're about to have to deal with.

Okay, I'm not trying to beat up on hospitals. I have no problem with hospitals. I'm just saying that we serve the urgent care niche and I want to make sure that you're winning. You know what mean? Well, I think if you ⁓ if you don't have some type of relationship with your local hospital, you might want to think about considering it. Yeah, at this point, because it could benefit you. It's almost like a B2B relationship of hey, keep us in your mind. What can we put some of our stuff in your hospital as options for people? So anyway.

Well, I think one of the things that you can start thinking about now and I'm moving on to point five here, Michael, is just is how can you weaponize when I say weaponize advertise? It'd be a good way to say it. How can you leverage the transparency that's coming down the pipe as well? Because here's another thing that begins in April is hospitals now have to post their pricing. Oh, yeah. They have to post their pricing. Technically, they've always had to, but they bury it. Yeah, but now they have to. It has to be prominent.

⁓ I can't go a single episode without talking about being a pilot, can I? So we almost got so close, so close, but it makes sense. So I'm actually going somewhere with this. I have to have visibly the aircraft airworthiness certificate and registration visible to everybody in the plane to get into the plane. It has to be visible, right? That's kind of funny. Yeah, but

that that's something that it used to be. You could hide it, throw it in the glove, you know, whatever. So where do you stick it? It's under it's right. So it's right back here. But it's visible. It's in a little plastic sheet and it's visible where everybody can get access to it if they need it. Right. The commercial airplanes that they have the same. They do. I don't know where they keep it. They keep it buried. Everybody, everybody has has to do this if you're on a plane. Right. there has to be transparency. Now, I have no idea why they required the.

airworthiness certificate unless a bunch of people were getting into the planes that were not airworthy and they were crashing them. That's the only thing I can really think of. mean, to me, it's the concept of it's not technically law, but almost all elevators, I guess it's some type of law. Almost all elevators have their little elevator worthiness where it's been inspected by the state and it's safe still. And it gets real entertaining when see one that's like five years out of date. Or the one here that says 03. Yeah, that's terrifying.

isn't it? But anyway, hospitals now have to have to put their pricing out there, which means if their pricing is out there, you can do a price comparison on your website. Literally, we're telling you to do local comparisons. So if your local hospital is Baptist Hospital, for example, you can go look at their posted pricing and on your website for content when somebody says how much your x-rays, for example, you can put your price for an x-ray and then you can say

here's Baptist price and you have a side by side comparison or leading hospital in area or if you want to not do the Baptist part, Whatever you want to do. Yeah. I'm just saying like your local hospital, right? You can do that side by side comparison. You can post your pricing and it will make total sense for you to do that. And people can actually pay for the healthcare they're receiving. Shock and awe. I tell one time I was like, I was curious. It's been probably 10 years ago. I was looking at UAVs ⁓

cash price for everything. they had a, I'm sure there's a new one out there now. It was a standard spreadsheet. You downloaded it and it was amazing how much they priced things. So what do you think the most expensive thing a UAB hospital would do? MRI. Open heart transplant. okay. So a heart transplant, how much you think it, no, this is years ago. It's probably a lot more now, but 10 years ago, how much you think a heart transplant was? Cash price.

I think it was $900,000. So basically unachievable without insurance, essentially for most people. sure insurance will find every way they can. And the insurance price is going to be a lot cheaper or whatever. But it was like 900 grand to do a heart transplant, which is just comical to me. And I was like, what about like delivery of a baby? $30,000 was the cash price. So like it was was as comical to read all this stuff, but it's it's what they put out there. we had somebody we interviewed recently, you know, in their

they talk about like their software helps find those things and compare and shop it for you type of thing. So you can have like real data for you, especially when you're going to insurance and saying I want to renegotiate contracts, I can see what's out there. anyway, no, the idea that pricing is now like part of the game. We always incur like we have all of our urgent cares that we work with. They always asked you why put cash pricing on my site? Right? Yeah.

because not everybody has insurance and they want to know what's the best deal. If it is, they don't want to be surprised either. So if you have cash pricing like readily available and you're confident in your cash price, please put it on there. I know we would consider ourselves middle class, upper middle class, whatever you want to call it. We would consider ourselves middle class people. the reason I bring that up is Heather looked at me the other day and she goes,

What would it look like if we just had major medical insurance and then we cash paid our own medical expenses and maybe even opened up an HSA or something like that? We're not the only people who are thinking this way. Yeah. Right. Which means what are we going to start shopping on? We're going to be start shopping based on what we're going to be paying for the health care that we're to get. Yeah. And then that concierge model starts becoming an option, direct primary care. Yeah. All that stuff. Exactly. Which is a great business model.

Yeah, and then it can cap very, very quickly, but people are willing to pay a monthly subscription to healthcare. But the reason I think people are looking at this more and more is just simply like insurance companies are finding ways to not pay your claims. They actively, they have a whole department that is just there to find ways and loopholes not to pay your claim. ⁓ my most frustrating loophole, which I will get a bill from soon, ⁓ is investigative.

So investigative procedures is by default through Blue Cross not covered. And which blows my mind because we had a situation with my wife where she asked, there's a known problem she has and all they do once a year or once every two years is measure the size of the problem. And the doctor always submits as investigative and we tell them you are costing us $1,200 every time you do that. Why can't you just put it as normal?

They're like, it's investigators like, no, it's not to you. It's not to me. Like to you. It's like you already know what's going on. You're just verify you're not investigating what the problem is. You know what the problem is. It's just you could dispute that. I tried. You still had to pay it. Yeah, they don't care. They came to the same conclusion. It's not that don't get me started on how I get Because I went to the doctor first and they're like, we're not changing it. I like but.

you understand we have you're going to get paid no matter what but can you not come from us and then Blue Cross like they marked the investigate we can't touch it like well blank. I know right. Well that's OK. Good luck getting your money. I'll pay you five dollars a month for the rest of my life and they can never turn you into collections.

That's another story for another time. Here's the deal. want you to some personal beef right now. I'm good. I'm just saying like we are actually actively thinking how can we do our health care in such a way that we have more control by self paying, self insuring, however you want to do it. Looking at ⁓ HSAs to be able to pay and guess what we're going to be looking for on websites whenever we go to do this stuff. We're going to be looking for the pricing. So what is the biggest takeaway?

One, research the area around you and within the area that you serve. So a five to seven mile radius. If you're out rural 15, 20 plus, if you're on a block in New York, like point five. Right. But the point is, is look at what the emergency rooms and the hospitals and all that look at their pricing menu, see what is comparable to yours and then start putting it on your website and start putting in your buildings. Because I think people more and more 26 and beyond. mean, not everybody

with insurances going around asking how much it costs. Right. They're asking what the copay is. But I think that'll change eventually. I think it could anyway. I could just I could just be dreaming. don't know. I know we're thinking about it and that couldn't be a coincidence. I think lots of people think that way. Well, it's always interesting to me is ⁓ insurance for the individual keeps going up every year. Every year. That's another reason. And and there's no end in sight. Right. Like there's no

disrupt, there's no obvious disruptor to the industry that we can see right now. And so we're, we're just going to naturally just pay more and more. You know, as a company here, we were able to reduce our overall costs and insurance this year for health insurance, because we were creative with GAP and all the things and basically kind of shifted the model, but it still costs a lot of money. It's almost, it's one of the things I wish, you know,

Like I wish Courtney was a teacher because I can take advantage of her health insurance. Right. Because it's like a hundred dollar deductible for the year. You know, it's amazing stuff. Teachers do have the best insurance. They do have best least in this state. I don't know about other states. State of Alabama, if you're a teacher, you have remarkable insurance. They're basically free for what it is. So and they just take care of you, which is amazing. But anyway, enough of that.

But no, so it's cool. So you said April of this year is when it's supposed to all go down. That's the research that I was able to find on it. Again, mine was based off of what are people searching for. Yeah. The very clear cut thing that I could find with April was was going to be that they have to start listing their pricing. Yeah. When are they going to start coding differently? I think it'll probably roll into markets. A lot of that was just it's going to be in 2026. And it was from

It was called ⁓ CMA, which is the Center for Medicare and Medicaid. They're the ones who are putting this out there. So I can also expect that that's probably going to start with government level insurance. And then eventually, as with anything, Blue Cross is going to adopt it. to, you name it, going to, what is the one that everybody loves to hate?

united. United like they're they're all going to adopt a way to do. I mean, if the insurance is confined a way to pay hospitals less money, they're going to adopt it. Yeah. And the government has essentially saying we're going to do it. So he gives you permission to do the same. Yeah. Yeah. So there you go. That's the episode for today. I wanted to encourage you that this year could be the best year in your urgent care. Yes, you have to you have to get more patients. Yes, reimbursements are don't seem to be changing at all. ⁓

Yes, overhead is getting more expensive. at the end of the tunnel here, you don't have to fight a hospital. No. Right? That's the biggest win. And I hope that hospitals will join arms with urgent care and say, you guys are solving a problem that we don't want to solve anymore and not be a competition type of thing. Now, I know there are plenty of urgent care, like ER physicians, like they don't fight urgent care. like, we even have a...

a client that is an ER physician and they recognize the need for an urgent care and all this and the cost savings that could be passed along and all this stuff. So like it's a real thing. I think that they all see it. Maybe this will force a little bit of a shift in a positive light. I'd love to hear feedback. So for those who are like dive deep into this and have like real like buy in and have conversations with hospitals.

Send us an email. Hello, patientcaremarketpros.com and let us know what you're seeing on your end. What do you think is going to happen as well? Because all we're, you know, we're looking at with the research that we have, but for people that are on the ground with this on regular basis, what, what decisions behind these doors are happening because of this that's coming up? love to hear that. Love it. Hey, with that, I got to say our mastermind is coming up and it's happening. You can't come. I'm sorry to tell you, I love you, but you can't come. You're going to have to wait for the next one because we filled it up.

Yes. And I'm super pumped to have these clinics that are going to be coming in to Alabama and hanging out with us. And we're going to do a, I've been planning it. I've been pouring over it. I'm so excited for the topics. I'm so excited for the breakthroughs that are going to be happening with these clinics. I hope that you hear that and you go, ⁓ maybe the next one that comes up, I'll be able to attend. I don't ever want you to do anything out of pressure, but I'm telling you, we're going to have a good time and it's going to

it's going to be awesome. I'm excited about it. I hope you are too. Also, yeah. And it's just for us yesterday was the day that it's like, oh, we just hit capacity. Yep. Shut it off. Shut it off. It's done. So. All right. listen, thank you for listening. As always, we want to help you get more patients deliver better care, get repeat visits and scale your clinics. Come back next week. We'll show you how to do it again. Talk to you then. See you.