Urgent care centers draw some ER visits but associated with higher spending overall

Dive Brief:

  • While urgent care centers do keep some lower-acuity patients from visiting costly emergency departments, their presence is not associated with a drop in total healthcare costs, according to a report in Health Affairs.
  • Using commercial claims and enrollment data from 2008 to 2019, researchers found an increase of 1,000 lower-acuity urgent care visits resulted in 27 fewer lower-acuity ER visits. The entry of a high-volume urgent care center into a ZIP code was associated with a 31% drop in emergency visits.
  • However, while ER trips were far more costly ($1,716 vs. $178), each $1,646 ER visit was offset by $6,327 more in urgent care costs because the number of urgent care visits per enrollee required to reduce one ER visit was 37.

Dive Insight:

Emergency departments represent high overhead costs for hospitals, partly because of the large amount of uncompensated care. Centers that can provide less acute care can therefore charge less, potentially saving money for insurers and patients. 

This report calculates, though, that because of the high number of urgent care visits, the overall cost burden is actually higher. “This reflects a substantial increase in access to unscheduled care, but it poses risks for health insurers and patients who must pay these increased costs,” the authors wrote.

The findings could indicate that patients are going to urgent care centers instead of more appropriate and lower-cost settings like a primary care office or virtual visit.

The report authors note some methods for steering patients to the best location for them, including AI-powered triage phone lines and chat bots that ask people about their symptoms. Also, primary care centers could stay open later and payers could further fund non-emergency medical transportation to improve care access.

Insurers have made efforts to curtail unneeded emergency care, but it has caught severe backlash from providers. 

Anthem in 2017 instituted a policy in half a dozen states saying it would deny ER claims it later found were medically unnecessary. After provider complaints and some lawsuits, the payer made a number of exceptions, including for patients younger than 15.