Provider-Based Clinics

Frequently Asked Questions

Franciscan Alliance has chosen to convert some of its physician/practitioner offices into provider-based clinics, sometimes referred to as hospital outpatient departments. As hospital outpatient departments, the clinics will be held to hospital-level standards for care delivery which are greater than the standards required of physician offices. The change will provide a higher level of care, improved integration with health care professionals, enhanced quality, and will result in cost savings that benefit the communities we are privileged to serve. The change may impact how you are billed for services. Charges for visits to provider-based clinics are split into separate bills – one for physician services and one for hospital services. Depending on insurance coverage, patients may experience higher out-of-pocket expenses.

Below are answers to frequently asked questions about provider-based clinics.

What is a Provider-Based Clinic?

Provider-based clinics are healthcare facilities that are subject to federal and state standards for licensed and accredited hospitals. In fact, they function as departments of the hospital, which means that the hospital bears the expense of the space and equipment, and hospital employees perform staff services. These clinics may be located on a hospital’s main campus or can also be located in facilities that are located off-campus. Local and national integrated healthcare delivery systems commonly use provider-based clinics to support a continuum of care for their patients.

Why did Franciscan Alliance convert to this model for its physician office locations?

Following the Franciscan values established by our founding congregation - the Sisters of St. Francis of Perpetual Adoration - Franciscan Alliance practices Christian Stewardship which promotes the use of physical and financial resources in a manner respectful to the individual, responsive to the needs of society, and consistent with Church teachings. In keeping with these values some Franciscan hospitals serve communities populated by a disproportionate share of low-income families and individuals who often are unable to cover fully the costs of necessary healthcare. Franciscan subsidizes care to many such families and individuals. The federal government recognizes that subsidy and passed a law that enables those hospitals to purchase drugs at a reduced price; however, physician offices are not permitted to take advantage of the lower prices, even though they serve the same communities. By converting the offices to provider-based clinics, Franciscan is able to reduce its expenditures on drugs and remain a viable source of healthcare in low-income communities.

How does this clinic model affect the care and services I receive?

By converting the physicians’ practices into provider-based clinics, Franciscan Alliance integrates primary care and specialty care into the hospital system, thereby improving performance among hospitals and practitioners and enhancing overall quality of care in the following ways:

• Coordination of patient care across our care locations (e.g., clinic exams, screening/diagnostic exams, outpatient procedures, inpatient care) and with other entities (e.g., pharmacies, extended care facilities, home heath, rehab centers)
• Ease of transmitting important medical information electronically to specialists, and other providers involved in patient care
• Adherence with standards established by the Accreditation Commission for Health Care (ACHC) and verified through surveys

How will I know which clinics are provider-based?

All provider-based clinics will have signs at the entry of the clinic identifying it as outpatient department of the hospital.

What is different about billing for services in a provider-based clinic?

When you see a physician/practitioner in a provider-based clinic, professional and facility fees are billed separately. The professional fee consists of physician/practitioner charges, and the hospital or overhead charges comprise the facility fee. By contrast, charges for services provided in physician offices usually combine the professional and overhead components into a single bill.

What should I ask my insurance carrier?

Insurance benefits vary significantly by insurance company, but in general, physician services are processed under the benefit plan’s physician benefits and are subject to co-payment amounts from the patient. Hospital services are generally processed under the benefit plan’s hospital benefits and are subject to deductibles and coinsurance amounts.
We advise you to ask your insurance carrier if your benefit plan covers “clinic services” or “facility charges” in a provider-based clinic (or hospital outpatient department) and how much of the charge is covered or will be applied to your deductible.

What if I have questions about the bills I get or need assistance with payment options?

If you have questions about your bills or would like assistance from a financial counselor, please call our Central Billing Office Customer Service at 1-866-903-0436 and we will be happy to assist you. Hours are M-F 8:00 am to 6:30 pm Eastern/7:00 am to 5:30 pm Central.