Urgent Care Centers Divert Patients From PCPs, EDs Alike

July 12, 2013

Urgent care centers (UCCs) save money by treating patients who otherwise may land in a more costly hospital emergency department (ED), but they also boost healthcare spending by diverting patients from primary care practices (PCPs), according to a new study published online today by the Center for Studying Health System Change (HSC).

Given these findings, UCC executives, ED directors, and health plan network managers interviewed in the study are uncertain about the overall effect of UCCs on cost, write lead author Tracy Yee, PhD, and coauthors. On a more positive note, these healthcare industry figures generally perceive UCCs as improving access to some services for privately insured patients "without significantly disrupting continuity of care," according to the study, which focused on 6 metropolitan areas.

The number of UCCs has grown rapidly during the last 20 years, giving patients an alternative to crowded EDs as well as booked-up PCPs. UCCs are not designed to handle car accidents or resuscitate patients at death's door, but they do treat minor injuries such as cuts and minor fractures, as well as the ear infections and strep throats of primary care. The Urgent Care Association of America puts the number of UCCs at 9000, with physicians or physician groups owning 35% of them. In addition, corporations own 30%, hospitals own 25%, and nonphysician individuals or franchisors own 7%.

The authors of the HSC study found that UCCs mostly treat patients covered by Medicare and private insurance and tend to avoid Medicaid patients. Lately, private insurers have tried to steer patients from EDs to UCCs by making co-pays for the latter less than ED co-pays. At the same time, however, insurers have begun to price UCC co-pays higher than those for primary care office visits.

Most healthcare industry figures interviewed by the authors do not think that UCCs disrupt the relationship patients have with their primary care physician or make care less coordinated. The acute needs such as lacerations and broken legs typically treated at UCCs "can be handled in isolation from other healthcare needs or conditions."

Although vaunted as a less expensive alternative to EDs, UCCs also drive up costs when they treat patients who could have been seen in a PCP, Dr. Yee and coauthors write. They heard this said by none other than an executive of an UCC chain: "Urgent care can add to costs, in that people use these centers as primary care, rather than developing relationships with [primary care physicians]," the executive said. "Somebody like myself, I don't have a chronic illness. I'm young. If I need to see a doctor, I just go to an urgent care center. I haven't developed a [primary care physician] relationship. It probably adds to the cost of primary care."

UCCs could significantly bend the cost curve downward, the authors write, if they became more accessible to low-income patients, "many of whom currently have no viable alternatives to EDs." Accessibility could improve, for example, if Medicaid managed care plans increase their payment rates for UCCs. In addition, UCCs could become more cost-effective as they integrate into accountable care organizations and other new payment models favored by the Affordable Care Act (ACA). At the very least, write the authors, UCCs could come to the rescue if the surge of newly insured patients under the ACA swamps PCPs, as many predict. "UCCs could grow as an attractive alternative," they write.

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