In a working paper issued in January 2019 by the National Bureau of Economic Research (NBER), researchers examined how urgent care centers (UCCs) impact emergency department (ED) demand.[i] After urgent care centers closed for the day, ED visits for minor illnesses by privately insured patients in locations with multiple UCCs increased by 1.4% (2.4 million ED visits) because UCCs are generally not 24/7 facilities. The study proposes if those 2.4 million after-urgent-care-hours cases could be treated at UCCs, that change would yield an annual savings of $1 billion. Is it completely accurate to assume these cases were treatable at UCC facilities and did not require emergent care? One billion dollars in savings is only 0.033% of the $3.5 trillion national healthcare spend.[ii]
These research findings begin with the statement that “urgent care centers are a cost-efficient substitute to the emergency department for non-emergent conditions,” but where are we in the scheme of saving money? What about something that moves the needle, such as $35 billion or $100 billion in savings? That’s at least a 1 or 3 percent reduction. If we assume each of these 2.4 million cases can appropriately seek care at an UCC, then we assume the same workflow and that patients presenting during the day are the same as patients presenting at night. Are these assumptions accurate? No. What is the additional cost of staffing and keeping the lights on for UCCs, when EDs are already open and staffed 24/7? There is a different cost structure to using UCCs, and this study only examined the impact of shifting privately insured patients to UCCs. According to the CDC, only 5% of ED visits are nonurgent, and 52.5% of ED visits are paid by Medicaid, CHIP, and Medicare combined (private insurance covers 34.3% of visits).[iii]
If the bean counters have found a way to save $1 billion by shifting patients from one source of care to another, it is simply rearranging deck chairs on the Titanic. To what benefit? Would you rather teach people to take better care of themselves, or would you rather push them into a lower-cost care facility to drive an insignificant overall savings? This is the same mindset which led to the rise of HMOs in the 1970s, in an attempt to drive down the cost of healthcare administration and access.[iv] The solution to rising healthcare expenditures isn’t shifting the costs between forms of treatment. The problem—and the solution—is us. What about a way to eliminate the cost of smoking? CDC data shows smoking-related illness costs more than $300 billion annually, broken down to $170 billion for direct medical care and $156 billion in lost productivity.[v] Seventy-five percent of US healthcare costs are for chronic diseases, which can be avoided with lifestyle change and early medical intervention.[vi] Saving money on healthcare expenditures is vital for economic sustainability of the government, employers, and individuals. The biggest movers are not trying to save money by shifting patients from the ED to UCC after hours. Saving money on healthcare requires waking up and making a paradigm shift to become a healthier country. With a shift from sick care to well care, we as a country could dramatically reduce our $3.5 trillion healthcare expenditures.
[i] Lindsay Allen, Janet R. Cummings, Jason Hockenberry, “Urgent Care Centers and the Demand for Non-Emergent Emergency Department Visits,” National Bureau of Economic Research, January 2019, https://www.nber.org/papers/w25428 via MCOL Daily Factoid email newsletter, 16 January 2019
[ii] Robert Preidt, “U.S. Leads Health Care Spending Among Richer Nations, But Gets Less,” HealthDay, 7 January 2019, https://consumer.healthday.com/public-health-information-30/health-cost-news-348/u-s-leads-health-care-spending-among-richer-nations-but-gets-less-741249.html
[iii] Steve Arnoff, “ACEP: Only 5.5 Percent of Emergency Visits are Nonurgent and Wait Times Continue to Improve,” American College of Emergency Physicians, 23 April 2018, http://newsroom.acep.org/2018-04-23-ACEP-Only-5-5-Percent-of-Emergency-Visits-Are-Nonurgent-and-Wait-Times-Continue-to-Improve-CDC-Says
[iv] Martin Markovich, “The Rise of HMOs,” Santa Monica, CA: RAND Corporation, 2003, https://www.rand.org/pubs/rgs_dissertations/RGSD172.html.
[v] “Economic Trends in Tobacco,” Smoking & Tobacco Use, Centers for Disease Control and Prevention, 4 May 2018, https://www.cdc.gov/tobacco/data_statistics/fact_sheets/economics/econ_facts/index.htm
[vi] “Preventive Health Care,” Gateway to Health Communication & Social Marketing Practice, Centers for Disease Control and Prevention, 15 September 2017, https://www.cdc.gov/healthcommunication/toolstemplates/entertainmented/tips/PreventiveHealth.html