Several years ago, a group of us concerned about health care costs and outcomes met with some local HR benefit managers. One was the head HR person of a city. In part of the conversation, she raved about a local chain of urgent care centers. She loved the fact that she could go to one after work to get her steroid shot for her colds. I had enough experience dealing with these types of people to know better than to quote the science that says steroid shots are absolutely worthless for colds and that the urgent care center was probably charging $50 for about $1 worth of drug. And this from a woman who was responsible for making health insurance coverage decisions for probably 3,000 to 4,000 people at a cost of roughly $30 million per year.
There has been a nice collection of research that has been published recently on the ER/urgent care industry. I’ll summarize them.
A study in JAMA Internal Medicine found that antibiotics were much more likely prescribed for colds/bronchitis/asthma in visits to urgent care centers (39%), retail clinics (36%), and ER visits (13.8%) than medical office visits (7%). I’ve often criticized ERs in my posts for wasteful care, but I have to acknowledge that they only doubled the inappropriate rate of office visits, not the factor of 5-6 in the urgent care/retail clinics. 54% of the visits to urgent care centers were for upper respiratory symptoms. Way to go, ERs!
A study in Annals of Emergency Medicine used Blue Cross Blue Shield data in Texas and found that the average charge in a freestanding ER compared to a hospital-based ERs were similar in 2015 ($2,199 vs. $2,259). The urgent care average price was $168. There was a 75% overlap in the 20 most common diagnoses. While this might sound like a great plug for urgent care, remember that for the common diagnoses, Medicare and many insurance plans will only pay a family physician’s office $70-100 to handle the same issue.
A study in Annals of Emergency Medicine studied if the opening of retail clinics reduced ER usage for low acuity conditions such as colds, bladder infections, and so on. Retail clinics are the Minute Clinics and similar facilities in Wal-Marts, CVSs, Walgreens, and so on. They used a database of claims from 23 states and compared those data to data on the penetration of retail clinics in those states’ markets. They found that retail clinic penetration was not associated with a reduced rate of low-acuity ER visits. Just analyzing insured patients, they found that a 10% increase in retail clinic penetration was associated with a 0.3% reduction in ER visits. All the retail clinics did was increase the total number of visits to the healthcare industry.
A study in JAMA Internal Medicine just published online used an Aetna database and examined acute care visits for low-acuity conditions over the last 8 years. They found that the rate of ER visits decreased by 36%, but the rate of urgent care visits increased by 119% per 1000 members, retail clinics by 214%, and telemedicine grew from zero to about 13% of the rate of urgent care visits. They did not analyze the similar change in primary care clinics.
I assume with 100% confidence that the rate of colds, flu, and bronchitis have not exploded in the last ten years. Sadly, I bet my HR acquaintance wouldn’t even flinch at hearing the results of these reports. I suspect she would translate these findings into some belief that this is great because lots of pneumonias were prevented (total crap), lots of her employees felt better faster and got back to work faster (total crap), and she saved her city employer money by buying insurance that had lots of convenient care options (total crap).
A high-quality family physician protects his or her patients from the harm of overprescribing useless medications. Because of the complexity of the work I do, I will sometimes write for antibiotics that I think are really not going to help, but my rate is low. Never be rigid in family medicine I tell my residents.
But the benefits people don’t understand this. The insurance people don’t understand this. Politicians don’t understand this.
Richard Young is a family physician who blogs at American Health Scare.
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