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News: Urgent Care Centers Offer Access—at a Cost : Emergency Medicine News - LWW Journals

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urgent care, ED visits, medical care costs

Proponents of urgent care centers boast that these facilities are significantly cheaper for low-acuity visits than emergency departments, but a recent study found they also attract patients who might have waited before seeking care or used other means to solve their health problems, increasing use and significantly raising costs.

In fact, the authors of the study estimated that 37 additional urgent care visits were associated with only one less low-acuity ED visit. Even though the low-acuity ED visit cost $1646, the cost of the 37 urgent care visits totaled $6327. (Health Aff [Millwood]. 2021;40[4]:587.)

“What we tried to do was show the impact of an additional urgent care visit or the opening of an additional urgent care clinic on emergency department visits,” said Ari B. Friedman, MD, PhD, an assistant professor of emergency medicine at the University of Pennsylvania. Dr. Friedman, along with Ateev Mehrotra, MD, MPH, and Bill Wang, both from the department of health care policy at Harvard Medical School, analyzed insurance claims from 2008 to 2019 and enrollment data from a national managed care plan to evaluate the effect on rates of urgent care visits and lower-acuity visits to the ED.

Profit-Driven Medicine

Prior studies, including one by Dr. Friedman, showed that opening urgent care centers was associated with fewer lower-acuity ED visits. “On one hand, the fact that urgent cares pull any visits away from emergency departments is notable,” he said. “On the other hand, it seems it takes an awful lot of urgent care visits ... before you see a single decline in emergency department visits.”

Dr. Friedman said urgent care centers are heterogeneous, with some having a few rooms with basic laboratory and x-ray capabilities and others like that at Beth Israel that views them as a way to decompress the emergency department. “They literally have everything except for acute treatment of significant disease or injury on their site,” he said.

Dr. Friedman and his colleagues examined claims from about 20 million patients per year who were covered by a national managed care plan from Jan. 1, 2008, to Dec. 31, 2019. They merged the ZIP code population characteristics from the 2010 Census with county-level characteristics from the 2019 Area Health Resources Files. Using the Centers for Medicare and Medicaid Services' place-of-service codes, the health plan's location variables, and other national data, they identified urgent care and low-acuity ED visits, including conditions such as rash, muscle strain, and urinary tract infection, all identified by ICD codes.

They winnowed the data down to determine how many urgent care visits were associated with reducing one low-acuity ED visit, and concluded that urgent care centers were associated with increased overall costs for lower-acuity visits, reflecting “a substantial increase in access to unscheduled care” and posing risks for health insurers and patients who must pay these increased costs.

“It's not the worst thing, but people have better access to unscheduled care, assuming that unscheduled care doesn't lead to unnecessary prescriptions and things like that,” said Dr. Friedman. “At the same time, this is a very expensive way to do that.”

Is It Worth It?

Cedric Dark, MD, MPH, an assistant professor of emergency medicine at Baylor College of Medicine in Houston, said he was not surprised by the Friedman study, noting that it's the same trend seen for other disruptive innovations in health care. “Even if the prices are lower at some of these places, they drive more volume and kind of create their own market,” he said. “It's interesting to quantify it because the common wisdom is that if you can divert someone from an emergency department to an urgent care center for what would otherwise be a low-acuity visit, then we save money.”

Dr. Dark said that is the case when looking at an individual visit, but that ignores supplier-induced demand. “As an emergency physician, I know there are many things that don't need to roll into the emergency room,” he said. “These patients could go to the primary care doctor the next day or could have been treated in a minute clinic or an urgent care center. But because these things are ultimately profit-driven medicine, we find that as a society we spend more money on care than that which would otherwise have not occurred.”

These innovations meet the call for on-demand medicine, but they are also going to increase the cost of health care and national expenditures on health, Dr. Dark said. “As a society, is that convenience worthwhile?”

Insurance companies worry about the big dollars and try disincentives like high co-pays to keep patients out of the emergency department, he said, noting that this analysis shows that going to the ED is not such a horrible thing. Patients are just going to go more often and spend more money than they would have otherwise, Dr. Dark said.

Vivian Ho, PhD, a professor of economics at Rice University and Baylor College of Medicine, agreed, saying she had used urgent centers when she knew she could not get an appointment, particularly for her son, and always on a weekend when the doctor's office was closed. But her son was once misdiagnosed, and she paid for a useless prescription.

Innovations such as urgent care centers are not going away, Dr. Dark said. “We need to separate the concept of what's most expensive for the patient versus what's right for the patient at a point in time.”

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Ms. SoRelle has been a medical and science writer for more than 40 years, previously at the University of Texas MD Anderson Cancer Center, The Houston Chronicle, and Baylor College of Medicine. She has received more than 60 awards, including the Texas Human Rights Foundation Award. She has been a contributor to EMN for more than 20 years.

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