Hospitality Health ER ownership says it’s taking the high road despite getting mixed messages from the community it serves.
The freestanding emergency room won a prized honor from the top local business advocate, and profits have led Hospitality into a two-phase expansion that will double its original Longview location that opened less than three years ago.
However, top administrators for the city and Gregg County have asked the 2,500-plus people covered by their self-funded health plans to avoid Hospitality Health or any other health care provider not included in their plans’ network .
Starting June 1, employees on the city’s health plan will be responsible for 100 percent of their emergency room bills if their diagnosis is deemed a non-emergency. City health trustees made the move one day after Blue Cross Blue Shield issued a similar directive to its policyholders, according to the Dallas Morning News.
Public administrators say it’s simply a matter of money, and that when employees or their dependents go to Hospitality Health for emergency care, the bills to the city and county often are at least four times higher than costs for the same services at in-network providers such as local hospitals or Excel ER.
The concierge services often offered by many freestanding ERs – such as gift bags, refreshments, car washes or massages – also raise the ire of public administrators who say employees and taxpayers end up paying for those luxuries in the end.
Gregg County Judge Bill Stoudt recounted a single 24-hour period in which two county employees needed the same medical treatment. One employee went to Hospitality Health, and his bill was about 10 times higher than the bill for the other employee who went to a local hospital.
“We learned that Hospitality does things a little differently,” Stoudt said.
Urgent or emergent?
Freestanding emergency centers are state-licensed, 24-hour facilities that provide the same level of access and services as a hospital-based emergency room, with the exception of trauma care.
Urgent care centers provide walk-in or unscheduled care, though some centers have call-ahead or online appointment-making options.
In a May 1 memo to Longview employees, Administration Director Mary Ann Miller included information, graphics and charts with suggestions for which level of care is necessary for certain symptoms – as well as their out-of-pocket costs.
“Unfortunately, more than half of our plan’s emergency room costs are not for life-threatening illnesses or injuries but for minor problems that could be handled in a more cost efficient setting such as the city’s Health or Wellness Clinic, your primary care doctor or an urgent care facility,” Miller wrote in the memo.
The city of Longview health plan’s network includes both hospitals, Excel ER, HealthCARE Express, Quick Care and Taylor Medical Center.
Hospitality Health ER co-founder Jeanne Shipp said she worries that the city’s and county’s steering of employees away from certain health care providers might leave a patient with a true emergency to second-guess and diagnose themselves.
“The layperson doesn’t know when they’re having chest pain what’s really wrong with them,” Shipp said. “It may be something not so serious, but it could be something serious. ... They shouldn’t have to think if it’s (in) a network.. .. Insurance is complicated anyway, but for somebody that is anxious and having an emergency, they certainly don’t need to be worrying about these things.”
City health trustees have added Teledoc, a telemedicine service that administrators say will allow employees and dependents 24-hour online or phone access to a physician who can either diagnose and prescribe treatment or recommend the patient head to an emergency center.
Hospitality ownership – Jeanne Shipp, her daughter Jill Shipp and son Jeb Shipp – said they were “delighted and shocked” and “very grateful” that the Longview Chamber of Commerce named their facility as Small Business of the Year last month, but as a business that entered Longview’s market in December 2015, they realize they’re outsiders.
“We are not local. We were not born and raised there,” said Jill Shipp, who now lives in Longview along with other family. “So, it was not a shock that we were not included or one of the recommended (emergency care providers of the city). However, we love the city of Longview. Since we opened, we have always wanted to be transparent with them.”
Jeb Shipp, who handles billing, said Hospitality might not be a contracted provider with the city and county, but they are in-network – a claim that public administrators dispute.
“We are non-contracted,” Jeb Shipp said, “however our claims do get processed with the patient’s in-network benefits, so it is essentially the same as it is to go to a contracted provider.”
But like city of Longview administrators, Stoudt and County Human Resources Director Rita Fyffe are telling their employees that Hospitality is not in their plan’s network.
“If a person goes to a facility that has the letters ER on the end of it, by law if you have someone who goes there, you can’t deny payment to them,” Fyffe said. “What’s happened, though, is they don’t have contractual rates with ... our third-party administrator who set up the provider network. So therefore, what happens is if an employee goes there, we can’t deny paying those claims. However, we steer our employees to provider networks who have contractual rates which are going to be lower .”
While Fyffe declined to release ER billing information citing patient confidentiality, a look at policyholders’ bills to the city for emergency care reflects higher costs at Hospitality compared with other providers. Hospitality might not be city employees’ top choice for ER care, but it’s significantly ahead of the competition in charges to the city’s health plan.
‘Appropriate level of care’
Hospitality was the plan’s top biller for emergency care this past year, collecting $132,201 on 53 patient visits. It charged the city an average of $2,494 per patient, which is almost four times as much as Christus Good Shepherd Health System.
Christus surpassed Hospitality in visits with 58 ER patients. However, the average bill to Christus was $666 a patient.
Longview Regional Medical Center billed the city on average $1,169 for employees who received its emergency care this past year, and Pineywoods ER, more commonly known as Excel ER, averaged $467 a patient.
“Freestanding ERs are still a relatively new presence in the health care landscape, especially in East Texas,” said city spokesman Shawn Hara. “So in that sense, they have increased from zero to current usage.”
For at least two years, city health trustees have asked Longview municipal employees to choose in-network providers for medical and dental care, Hara said. Emails were sent that communicated the state of standalone ERs at least six times between January 2016 and March 2017, and it was “explicitly mentioned during mandatory open-enrollment meetings” in October and November 2016 as well as August 2017, he said.
More than two dozen meetings were held across multiple city departments and buildings for employees in each of the last two open-enrollment periods, city records show.
The city contracts with Longview Regional Medical Center to offer a wellness clinic for employees.
Hara called the clinic ”a great resource” and said it isn’t intended to function in the same 24-hour-a-day, seven-day-a-week manner as ERs or urgent care centers. It provides care for minor non-emergencies, X-rays, annual bloodwork, school physicals, blood pressure checks, diabetes management and referrals to specialists.
Use of the employee clinic on Fourth Street has remained steady during the past two-plus years, averaging between 292 and 303 patient visits a month, based on yearly totals from the city.
“There are times that employees need care beyond that provided by the clinic or outside of clinic hours,” Hara said, “and they have options for choosing that care. The key is that they choose the appropriate level of care for the situation.”
Hospitality Health’s 9,000-square-foot facility on McCann Road is in the midst of Phase 1 expansion, Jeanne Shipp said. By August, weather permitting, contractors will have added about 6,000 more square feet to the center.
“We will have about 15,000 square feet,” she said, “and then we will be starting on our Phase 2 pretty quickly, and that’s still a bit of a work in progress, and I’m not sure yet of that square footage.”
Jill Shipp said there was a lot of communication with the facility’s partners to make sure they need the expanded space, though she noted every available office at Hospitality is being used for patient or family care.
“We’re trying to create a facility that is in the best interest of the patient and their family,” Jill Shipp said, “and that’s part of the reason we have no offices in our buildings right now, because we need every piece of square footage to be able to accommodate patients and their families.”
As for comments about their concierge services, Jill Shipp said the family doesn’t offer gift bags and other amenities when they first open their freestanding ERs but that “patients gravitate towards our facility,” adding, “I don’t think anyone would come to us if we did not offer efficient, high-quality emergency care with answers and solutions.”
‘Drop the ball’
Hospitality had the chance to join the county’s network of providers, Stoudt said, when he invited out-of-network providers to submit their proposals including costs for service to the plan’s third-party administrator.
Stoudt and Fyffe say Excel ER provided the information and followed through, but Hospitality didn’t, so Excel is in-network, and Hospitality is out.
“We gave them the same information that we gave to Excel,” Fyffe said. “Excel chose to go through the network. They got credentialed, and then once they were credentialed, then we were able to put it out to the employees that the employees to use them.”
Jeb Shipp said the county’s account of what happened “is incorrect.”
“At that time, they were doing what was called a bidding process, and they said they were going to get all of the information from the freestanding ERs in Gregg County and then they would determine which one they would allow to go in network,” Jeb Shipp said, “and so we were waiting to hear a response from them as far as what information they needed exactly, and by the time we actually heard back from them, they had already chosen Excel to go in network. So, we wanted to work with them, and that is inaccurate that we were unwilling to disclose our charges.”
Jeanne Shipp, who attended meetings with the county, said she believes Stoudt’s “intentions were pure,” but that the problem lied elsewhere.
“I think he has staff that he depends on to implement things, and I think perhaps the ball may have been dropped,” she said. “It may have just been in an innocent way, but the bottom line is we weren’t notified, and I think his intention was that we should have been notified.”
In response, Fyffe said, “We told (Hospitality) exactly what the process is for them to get into the network. We didn’t drop the ball with anything. I don’t know why they would say that.”
Kilgore City Manager Josh Selleck hasn’t had anyone come to City Hall inquiring about building a freestanding ER. He attributes that lack of interest to the city’s relationship with Christus Good Shepherd Health System, which leases and operates an ER at Laird Memorial Hospital in the city.
His opposition to the growth of freestanding ERs extends beyond the bills to Kilgore’s municipal health plan. Selleck calls the state’s licensing system for emergency centers “a scheme that allows these freestanding ERs to cherry-pick the individuals that have the ability to pay and forces our real hospitals to handle all of the indigent care.
“So it’s hard for me to tell an employee who has a 3-year-old with a fever that you have to sit in the ER at Good Shepherd and Regional and wait for four hours as Good Shepherd or Regional deals with all of the indigent (patients) when they can go to a legislatively sanctioned essentially freestanding urgent care – that’s what they can provide services to – which gives you back rubs, car washes, free water, illegally offers to waive your co-pay or deductible, and you can get in to see someone for your kid’s fever in 10 minutes,” he said.
Hospitality ownership says it realizes it’s not the top choice of most city and county administrators, but it will continue serving the community.
“We’ve been transparent with the community ,” Jill Shipp said. “So, we’re not recommended entities, but we try to do the right thing by the community and the right thing by the city and hope that speaks for itself.”