Study shows impact of urgent care centers on nonemergent ED usage
- A new study suggests urgent care centers are impacting the use of emergency departments for minor illnesses and injuries, but only in locations with multiple UCCs.
- The multistate study by the National Bureau of Economic Research compared nonemergent ED use when UCCs were open and closed. The results showed a 1.4% uptick in ED visits after the last center in an area closed for the day — or about 2.4 million ED visits annually. The effect was limited to privately insured patients, the primary targets of UCCs.
- The study — the first to measure the effect of UCCs on ED use, according to the researchers — could inform strategies to reduce use of expensive ED services and help rein in costs.
The findings come as hospitals and health systems are struggling with smaller patient volumes and lower reimbursements and looking to diversify their services and bolster financials. The shift to value-based care has helped to drive growth in the $18 billion urgent care industry, a mix of for-profit freestanding centers and health system-owned facilities.
In 2017, Dignity Health and Select Medical merged their urgent care businesses, citing the potential to increase patient access and standardize best practices.
More recently, two Arizona-based urgent care companies — FastMed Urgent Care and NextCare Holdings of America — announced a definitive agreement to merge. The combined company will have 251 clinics in 10 states.
A analysis of claims data from Aetna from 2008 to 2015 found ED visits per enrollee for low-acuity conditions like respiratory infections and sprains dropped 36% over that time period, while use of non-ED settings like urgent cares and retail clinics rose 140%.
This study suggests urgent cares could play a larger role in reducing overall healthcare costs. With a nonemergent case costing about $414 more in an ED versus UCC, the effect of 2.4 million fewer ED visits translates to about $1 billion in savings per year, the researchers say.
That effect was only evident, however, in areas with multiple UCCs. "Since urgent care centers are smaller than EDs, it is unlikely that a single urgent care center will drive meaningful change in nearby ED use," the researchers said.
The potential to reduce healthcare costs by substituting UCCs for EDs in nonemergent cases may have its limits as well, they add, noting the 7,600 existing urgent cares were likely placed in areas with high privately insured patient demand. "As the market matures, there may be diminishing returns to opening new clinics," the researchers note.
They also point out that the evening spike in ED visits occurred at a time of day when such visits are normally higher. There may not be as many low-acuity ED visits for UCCs to impact during their operating hours.
Still, given that just about 5% of sampled ZIP codes had more than one UCC, "urgent care companies may be incentivized to increase their supply in certain areas, which would bolster their impact," the researchers said.
- National Bureau of Economic Research Urgent Care Centers and the Demand for Non-Emergency Emergency Department Visits