As we all know, emergency departments in U.S. hospitals see many, many patients who aren't terribly ill, but don't have insurance and need somewhere to go. Often, though these patients are run through the gantlet of expensive tests -- required by protocol -- the likelihood is that they could just as safely be seen in a less-acute setting.
It's not that hospitals aren't aware of this, but there's not a lot they can do about it -- or at least that's what conventional wisdom holds. In desperation, some 50% of acute-care hospitals have begun charging a fee in the $100-$150 range if a patient deemed safe to be seen in a less acute setting remains determined to stay in the ED. This includes hospitals with urgent care centers on-site.
But what if we took a slightly different approach to assisting the uninsured who come to the hospital's ED doors? What if an attractive, well-staffed urgent care center was available on-site to care for the uninsured who don't need EDs? More radically, what if the urgent care center charged little or nothing to the uninsured, based on a very simple sliding scale?
Before you decide I'm completely crazy, let's break the numbers down just a bit. According to the American Hospital Association, in 2012 hospitals had uncompensated care costs of $45.9 billion, spread across about 5,000 hospitals (including both charity care and bad debt). That equates to 6.1% of their total expenses, the AHA reports.
While the cost of building an urgent care clinic is nontrivial -- one estimate I heard was in the $750,000 range -- it pales in comparison with the uncompensated ED care hospitals pay year after year for patients who didn't even need the care they got. Besides, most hospitals have the advantage of starting out with real estate in hand, be it in medical office buildings or in the hospital itself. That could defray costs.
Also, having a pleasant urgent care clinic affordable by more or less all clears the halls of the ED and lets the specialists there focus on the extremely demanding work that they do. I wouldn't be able to tell you what it costs to have a doctor busy with a non-urgent patient when someone at death's door comes in, but it can't be good for workflow overall.
What's more, many hospitals won't have to start from scratch. The AHA data notes that 24.4% of 4,054 community hospitals have urgent care centers. Now all they have to do is make it easy for patients who would have visited the ED in simple desperation to visit the urgent care clinic.
I know, I know, giving away care to empty out the ED may sound like a fool's errand given that even charity-driven hospitals have to keep the lights on. But depending on just how much your hospital is spending on charity care today, particularly on low-income patients who probably can't pay more than a fraction of their bill, maybe it's best we don't force them into the ED in the first place.