Urgent Care vs. ER – What Is the Most Cost Effective Care for the Consumer?
By Susan Nefzger
With nearly 10,000 walk in clinics currently in the U.S. and 50 to 100 coming online each year, the consumer has more health care choices than ever. And with the advent of the Patient Protection and Affordable Care Act, an increase in people visiting a healthcare practitioner or doctor is positive.
So what are the options and how do they stack up?
Urgent care is suitable for episodic and simple conditions like minor injuries, colds, flu, insect bites, sports physicals, and anything else that is not an emergency.
Many times a deciding factor for people when choosing to visit an urgent care is location, according to Jim Lobel, CEO and partner of Palm Beach Urgent Care with facilities located in West Palm Beach and Royal Palm Beach. He says they are actually seeing more insured patients due to the Affordable Care Act. With another facility in Vero Beach, the company serves more than 40,000 patients a year.
Emergency rooms are appropriate for complex medical cases such serious head injuries, heart attack and stroke.
Now, the question for many consumers is cost. How do the costs compare then for urgent care vs. emergency room care? A good indication of how hospitals determine cost and why they charge what they do, is an abstract published June 10, 2015, in “Health Affairs” titled “Extreme Markup; The Fifty U.S. Hospitals Highest Charge to Cost Mark-Up”, published by Ge Bai professor of accounting at Washington and Lee University in Virginia and Gerard F. Anderson, a professor at Johns Hopkins Bloomberg School of Health, in Baltimore, Maryland. They found that these top fifty hospitals have markups (ratios of charges over Medicare allowable costs) approximately ten times their Medicare-allowable costs compared to a national average of 3.4 and a mode of 2.4.
Analysis showed that forty-nine are for profit, (98 percent), forty-six are owned by for-profit hospital systems (92 percent), and twenty (40 percent) operate in Florida. Not surprising is that one for profit hospital system owns half of these fifty hospitals.
This may affect insured consumers except for co-pay amounts that can be perceived as high. They are not asked to pay the full cost because private and public health insurers do not use hospital charges to set their rates.
However, uninsured consumers are often asked to pay the full charges. At the same time, out-of-network patients and casualty and workers’ compensation insurers are often expected to pay a large portion of the full charges as well. Currently, market forces fail to constrain hospital charges.
How does this relate to the cost of emergency room care?
According to the Centers for Disease Control 116.8 million emergency department visits per year and the most recent national estimate of 27.1% of visits, non-emergency care accounts for approximately 31.64 million of those ED visits.
The difference in cost between an urgent care visit and an emergency department visit for the same diagnosis ranges from $228,583. At 31.64 million non-emergency visits, the cost savings of using an urgent care instead of an emergency department could range from 7.22 18.45 billion dollars annually.
Clearly, there are ways to utilize urgent care centers for appropriate and cost effective treatment of episodic and simple treatments in order to limit the overcrowding in emergency rooms. Insurance carriers are well aware of this information and can easily refer people to urgent care centers for appropriate treatment, thereby categorizing care in such a way that they actually help people in their search for affordable health care solutions.
For more information, visit Susan Nefzger PR & Web Marketing at www.snefzgerpr.com.