Each day people seek treatment for a variety of minor injuries
and ailments. But where they go for that treatment could make a big
difference in how much money they -- and their insurances companies --
ultimately spend.
Those whose first instinct is to head to the nearest hospital
should consider this: about 17 percent of all visits to hospital
emergency departments across the United States could be treated at
retail medical clinics or urgent care centers, potentially saving $4.4
billion annually in health care costs, according to a new RAND
Corporation study.
Researchers, writing in the September edition of the journal Health
Affairs, reported that emergency rooms treat minor infections,
strains, fractures and lacerations, ailments that could be treated at
less cost outside of a hospital.
"Patient traffic to hospital emergency departments has been
growing, but a significant proportion of patients could be safely
treated in these alternative settings," said Robin Weinick, the
study's lead author and a senior social scientist at RAND, a nonprofit
research organization. "Diverting these patients to alternatives such
as retail clinics and urgent care centers could shorten their waiting
times and save money."
Avoiding the wait
Why do consumers head first for the ER? Because in many cases, they
face long waits for appointments with their physician and limited
after-hours options. Other studies have found the cost of treating of
nonemergency conditions in the emergency department is significantly
higher than in other settings, which can increase patients'
out-of-pocket costs and add avoidable spending to the nation's health
care bill.
Alternative care settings for non-emergency care such as retail
medical clinics and urgent care centers have increased over the past
decade. Retail clinics, located in pharmacies or grocery stores, are
typically staffed by nurse practitioners and a treat a limited range
of health conditions such as sore throats or urinary tract
infections.
Urgent care centers are freestanding physician-staffed facilities
that offer extended hours, onsite x-rays and laboratory testing, and
which can treat a broader range of conditions, including minor
fractures and serious cuts.
Both retail clinics and urgent care centers are open in the
evenings and on weekends and allow for drop-in appointments. Prior
work has shown they are substantially cheaper than an emergency
department.
RAND researchers analyzed information about people who visited
retail medical clinics and urgent care centers and compared it with
profiles of patients who visited hospital emergency departments during
2006. They examined issues such as the severity of injuries and
illnesses seen in emergency departments, as well as the volume and mix
of cases seen when alternative care settings are open.
Many ER visits can be avoided
Based upon the comparisons, researchers estimated that 13.7 percent
of all emergency department visits reviewed could have been treated in
a retail medical clinic, although that proportion decreases to about 8
percent when the analysis is restricted to visits that occur when
retail clinics typically are open.
An additional 13.4 percent of all hospital emergency department
visits could be treated at an urgent care center, although that
proportion decreases to about nine percent when cases are restricted to
those seen when the centers typically are open.
Overall, although the researchers estimated that 27.1 percent of
all hospital emergency department visits could be managed at a retail
clinic or urgent care center, only 16.8 percent could be managed
during the hours the emergency department alternatives typically are
open.
"We've known for a long time that many people go the emergency
department with problems that could be addressed elsewhere, but this
is the first time we have been able to quantify how many of those
visits could be addressed at these alternative locations," said study
co-author Dr. Ateev Mehrotra, a researcher at RAND and an assistant
professor at the University of Pittsburgh School of Medicine.
While the study provides important evidence about the number of
cases that could be managed outside emergency departments, it
did not evaluate whether retail clinics and urgent care centers
currently have the capacity to handle substantially higher numbers of
patients. Researchers note that there is only limited evidence about
whether patients can safely decide when it is appropriate to use one
of the lower-cost emergency treatment options.
There is some evidence that emergency departments, retail clinics
and urgent care centers provide care that is similar in quality, but
more research is needed before large numbers of patients can be
encouraged to seek care in alternative settings, according to the
researchers.
Many ER Visits Could Be Treated
Elsewhere, Study Finds...