More patients sidestepping ED for low-acuity problems
- More patients are choosing to treat low-acuity conditions in lower-cost urgent care centers and retail clinics, decreasing demand for emergency department services, according to a study published in JAMA Internal Medicine.
- The researchers analyzed claims data from Aetna between 2008 and 2015 and found ED visits per enrollee for low-acuity conditions like respiratory infections and sprains declined by 36%, while use of non-ED settings increased 140%.
- The shift away from EDs didn't translate to lower overall utilization. In fact, the study showed utilization increased 31% across all acute care venues during the study period — from 143 to 188 visits per 1,000 members.
The findings reflect other recent studies on growth in non-ED care. According to FAIR Health, private insurance claim lines for services provided in urgent care centers soared 1,725% between 2007 and 2016. During the same period, ED claims went up by just 229%.
The news is important as hospitals struggle with lower patient volumes and health systems look to diversify their offerings and improve financials. Last year, Dignity Health and Select Medical merged their urgent care businesses, citing the potential for greater patient access and standardization of best practices.
And in July, Morristown, New Jersey-based Atlantic Health System and MedExpress announced a collaboration to improve urgent care access and care coordination between the companies. Such deals are likely to continue. A recent MarketsandMarkets report predicts the global urgent care market will reach $26 billion by 2023.
The new study found that retail clinics saw the biggest jump in volume for low-acuity issues, up 214% over the study period. Visits to urgent care centers grew 119% and made up the bulk of all non-ED care, while telemedicine encounters went from zero to six per 1,000 members over the course of the study.
"The increase in overall utilization may reflect the woodwork effect — where people who would not otherwise seek care come out of the woodwork to get care — and may indicate that the convenience of these new care venues is associated with increases in the number of patients who seek care," the study authors wrote.
Overall spending for low-acuity conditions increased by 14%, from $70 per member in 2008 to $80 per member in 2015, the study says. Patients who opted for non-ED acute care venues were more likely to be female, healthier and have higher household incomes than those seeking care in an ED.
Convenience and lower costs are driving use of alternative outpatient care sites. Between 2008 and 2015, the price per ED visit for a low-acuity diagnostic code climbed 79% from $914 to $1,637. Out-of-pocket costs for low-acuity ED treatments jumped 125% to $422. By contrast, prices at urgent cares were just over $160, while retail clinics and telemedicine visits cost were well under $100.