Urgent Care a Bargain?

One of the arguments for urgent care centers is that they help people avoid time-consuming, costly trips to hospital emergency departments for relatively minor injuries and illnesses. But findings reported in the April issue of Health Affairs suggest that decreases in emergency department visits may be offset by large increases in the use of urgent care centers.

One less emergency department visit for a low-acuity problems was associated with 37 additional urgent care center visits, according to a research team that included Ateev Mehrotra, M.D., M.P.H., an associate professor at Harvard Medical School and a member of the MHE Managed Healthcare Executive® editorial advisory board. Emergency department visits cost 10 times more than urgent care visits, but because of the increase in urgent care centers, Mehrotra and his colleagues found that each $1,646 in savings from an emergency department visit not occurring was associated with a $6,327 increase in urgent care center costs.

Other studies have found that less expensive care, if it is more convenient, can lead to greater utilization, thereby blunting expectations that the less expensive care is going to translate into cost savings. Mehrotra and his colleagues say their findings argue for a comprehensive approach and not just simply depending on urgent care center centers to reduce emergency department visits for care that could occur elsewhere. They mention triage lines staffed by nurses, augmented by machine learning, as way to direct patients to the appropriate care setting.

The study did not encompass primary care visits. As Mehrotra and his co-researchers acknowledge, urgent care visits may replace primary care visits, not just trips to the emergency department, and that substitution, which could result in some cost savings, was beyond the scope of their research.

Mehrotra and his colleagues used a database of healthcare claims from a large national healthcare insurer to conduct their study. They looked at the relationship between the number of lower-acuity (rashes, muscle strains) emergency department visits per enrollee to the number of urgent care visits. The association between increasing urgent care visits with decreasing emergency department visits was strongest in urban and high-income ZIP codes and in those with higher baseline use of emergency department visits.