Urgent Care Membership Programs May Expand Access, Not Cut Costs

By Lisa Rapaport

August 07, 2020

(Reuters Health) - Urgent care center membership programs may provide convenience and expanded access to care to people who are uninsured or underinsured without necessarily saving them money, a small study suggests.

For the study, researchers contacted five randomly selected urgent care centers in each U.S. state to find out if they offered subscription-based membership programs that provided access to discounted visits in exchange for recurring fees. A total of 15 urgent care centers (6%) offered membership programs.

All of these programs allowed any patient to enroll, regardless of insurance status. Membership fees ranged from $50 to $800 per year (mean $383), discounted visit fees for members ranged from $0 to $125 per year (mean $47), and nonmembers paid full price visit fees ranging from $90 to $275 per year (mean $149).

Visit fees for members were $102 less than for nonmembers, researchers report in JAMA. However, the study team concludes that members are unlikely to save money because of added costs for laboratory and imaging services and because memberships don't count toward insurance deductibles and can't be paid using health savings accounts.

"Since the average cost of an urgent care visit is $100, patients would need to visit a membership urgent care center four times in one year to `cancel out' the costs," said lead study author Walter Hsiang of the Yale School of Medicine and Yale School of Management in New Haven, Connecticut.

"However, the average patient visits an urgent care center less than two times a year," Hsiang said by email.

Patients also need to read the fine print before signing up, because membership programs might not include urgent care services that they need, the study found.

One urgent care membership program in Arizona and another in Colorado, for example, exclude preventive services, motor vehicle crash injuries, durable medical equipment, prescription drugs, and outside imaging or lab tests.

By contrast, researchers identified urgent care membership programs in California, Nevada, and Texas that had annual membership fees of $240 a year and then offered a 10% to 60% discount on services.

Some other urgent care programs - with annual membership fees of $600 and up - offered unlimited primary care and urgent care visits as well as some other benefits such as discounted blood tests and imaging.

Limitations of the study include the small number of urgent care membership programs examined, the fact that several centers in the study were part of the same national network, and a lack of information on any insurance reimbursement that might offset certain costs for some patients, the study team notes.

The cost-benefit analysis was also limited to weighing annual membership fees against costs per visit, and didn't account for potential savings related to things like prescriptions, lab tests or imaging when these things were covered, said Philip Eskew, vice president of clinical development and general counsel at Proactive MD in South Carolina.

"My obvious bias is that an urgent care that chooses to limit its scope to urgent issues only is less valuable than a practice offering broad scope primary care services covering chronic and preventive care as well," Eskew, who wasn't involved in the study, said by email.

Still, urgent care center membership programs might help certain patients save money, and it might make sense in some situations for clinicians to recommend this option to patients, Hsiang said.

"It may make sense for clinicians to recommend urgent care membership programs to patients who frequently come to the office for urgent but non-emergency issues," Hsiang said. "Patients who are seen over 6-8 times a year for issues like recurrent urinary tract infections or frequent allergies may actually receive more cost-effective care at membership programs."

SOURCE: https://bit.ly/3a3pKoL JAMA, online August 4, 2020.

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