Avoid the ED

Trips to the hospital emergency department (ED) are expensive. While going to the ED is necessary if you are having a life-threatening emergency, there are other options for more routine issues, even if they are urgent. Here are a few ways Specialty Solutions members can help patients avoid unnecessary visits to the ED:

Walk-in Care – Spectrum Orthopaedics at Sewall Street-Portland, Auburn, and Saco offer OrthoAccess, a one-of-a-kind walk-in clinic for the immediate assessment and treatment of sprains, strains, minor fractures, dislocations, and activity- or sports-related injuries. There is no appointment necessary and care is available weekdays from 11:00 a.m. – 7:00 p.m. and on Saturdays from 9:00 a.m. – 2:00 p.m.

After Hours Care – New England Cancer Specialists and Spectrum Orthopaedics at Sewall Street - Portland (Sewall Street) and Auburn regularly offer after hours care (which includes evenings, weekends, or both) and several other member practices offer appointments outside of normal business hours on a request basis.

24-hour Call Service – All Specialty Solutions practices offer 24-hour call service for existing patients with an urgent need so that they may speak directly to a physician or advanced practice provider outside of normal business hours. In many cases, the on-call provider is able to offer advice on managinig the sitaution and help the patient avoid a costly trip to the ED.

Same-day Appointments – Several Specialty Solutions practices including all Spectrum orthopaedic sites, Coastal Women’s Healthcare, and New England Cancer Specialists reserve time in their practice schedules every day to ensure that patients can schedule same-day appointments.

Care Management – Maine Nephrology has a Care Management program that includes a full-time RN and part-time social worker. MNA care managers work with patients to establish an integrated and coordinated care plan and provide education and support to improving patient self-management skills. MNA also collaborates with MMC and MHACO with a focus on patients with end-stage renal disease. Upon discharge,these patients are automatically referred to the MNA care management program and provided with a medication list that is reviewed by the pharmacist.

Lower Fees

When you receive medical services, the bill that you (or your health plan) receives for the services will include multiple charges and commonly include both “professional fees” and “facility fees” (although often there are other categories as well). “Professional fees” are the charges that pay for the time and expertise for the doctors and other medical professionals that provide your care. “Facility Fees” cover the costs associated with using the facility or equipment. Within a single health plan, professional fees for comparable in-network providers within the same geography are usually similar regardless of where you receive care. However, there can be very wide variation in facility fees and it is typically less expensive to obtain care at a freestanding or non-hospital-owned facility.

Facility fees are charged when you are having surgery or certain types of procedures. If you go to a provider that can do the surgery or procedure in an ambulatory surgery center (ASC) or in his/her office, you will save money. Depending on the procedure and the geographic market, facility fees at a hospital can be double or triple what they might be at an independent ASC. A recent white paper from the Ambulatory Surgery Center Association (ASCA) estimates that using an ASC instead of a hospital-owned site reduces private healthcare costs in the U.S. by $38 billion per year – with potential for even greater savings if more cases were moved to an outpatient setting. (Commercial Insurance Cost Savings in Ambulatory Surgery Centers, 2016)

Similarly, if you need advanced imaging – such as a CT scan or an MRI – the savings can be quite significant if you receive the scan at an independent facility. Here are examples of the ways Specialty Solutions practices help patients save money on facility fees.

Ambulatory Surgery Centers – Eyecare Medical Group, Plastic & Hand Surgical Associates, Portland Gastroenterology Center, and Spectrum Orthopaedics at Auburn and Sewall Street-Portland all have AAAHC-certified ASCs.

Imaging – Coastal Women’s Healthcare offers digital ultrasound for OB/GYN and mammograms as well as general and vascular imaging through Coastal Imaging (Scarborough). Several SS sites also offer advanced imaging, including MRI (extremity and wide-bore scanners) at Spectrum’s Sewall Street-Portland location and MRI at its location in Auburn. A full suite of MRI and CT services is offered at Marshwood Imaging (Scarborough). New England Cancer Specialists also offers CT scanning at Scarborough.

Other Medical Services – Depending on the specialty, Specialty Solutions practices may be able to provide savings on other aspects of your care. For example, New England Cancer Specialists is the lowest-cost chemotherapy site in Maine. Maine Nephrology Associates has an on-site laboratory, performs kidney ultrasound, offers sodium classes and dietary counseling, provides kidney education classes at no cost, and provides 24-hour blood pressure monitoring for its patients.

Advocacy + Support

Allergy & Asthma Associates, Eyecare Medical Group, and New England Cancer Specialists have Patient Financial Advocates on site, who actively assist patients in reviewing their insurance coverage and identifying any unexpected cost, and help patients find financial assistance when necessary. At New England Cancer Specialists, the team of advocates help patients find financial assistance for medications, treatment costs, and even non-medical expenses, such as travel costs. They work closely with local and national foundations to find grants and have an in-house financial assistance program to help alleviate costs associated with physician visits and drug administration charges.