Does the Usage of Urgent Care Centers Decrease the Total Cost of Care?

By | April 22, 2021

We continue to evaluate the value of various care sites, and part of this is considering whether or not the Emergency Department (ED) is overutilized for non-emergent services. Since Urgent Care Centers can provide services at a lower price point, the intuitive solution is to shift care to those facilities. Thus, there is a conundrum of whether it is beneficial to encourage patients to select Urgent Care sites as a substitution for ED visits. Moreover, there is growing concern that Urgent Care sites, because of their convenience, actually can increase the cost of care because the ease of using them causes a decrease in visits to PCP’s and other sources such as telehealth or even self-care.

A recent study in Health Affairs by Wang et al., Urgent Care Centers Deter Some Emergency Department Visits, But On Net, Increase Spending, evaluated the data from a national managed care plan at the zip code level. The study found that although urgent care visits deterred Lower-acuity ED visits, the impact was negligible. Furthermore, they estimated that 37 additional urgent care visits were associated with the avoidance of one ED visit. This finding translated into a savings of $1,646 in ED costs for every $6,327 increase in urgent center costs. Hence, urgent care costs are significantly cheaper than an ED visit; however, this price difference is considerably offset by increased utilization of urgent care sites for other services.

One advantage of how the authors reviewed this information was the idea of “substitution ratio,” which, in this case, was the number of urgent care visits needed to offset one ED visit. Their findings argue that using urgent care centers in isolation to reduce ED visits is ineffective from an overall cost perspective. So, as we begin to think about improving this “substitution ratio,” it’s essential to focus on both the numerator and denominator.

The numerator, which is the number of urgent care visits, may be impacted by better self-management, use of PCP services, or digital medicine. How we guide consumers to the appropriate level of care is paramount. We must think about needed services in a triage mentality, helping people decide what is most suitable for their needs. Furthermore, it behooves us to not just rely on the consumer since they cannot distinguish their needs without some level of consultation from the subject matter experts. Additionally, just incenting them to use one level of service over another is ineffectual without the needed input from the healthcare ecosystem.

Focusing on such a model will also enhance the denominator, which is the frequency of avoided ED visits because there are situations where consumers do not know they may receive treatment for a condition at a different level of service. Also, there currently exist barriers that require further evaluations, such as transportation needs, PCP access, and health literacy. Health plans and accountable care organizations are well-positioned to invest in such areas with funding of such consumer-facing information services, increased payment for PCP extended hours, and other modalities such as nursing lines and telehealth. Let us remember, using urgent care as an extension of primary care hours can be quite costly for all.

As we continue to focus on affordability for those we serve, let us continue to consider what are the appropriate sites of care needed to support all patients and those that care for them.