The overuse of urgent care

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The overuse of urgent care

For the past several years, employers and insurance carriers have been promoting the use of urgent care centers and clinics for minor acute services because they offer significant savings over the emergency room (ER). However, a recent PWC study “Medical Cost Trends, Behind the Numbers 2017” found that the ease of use of urgent care centers and clinics has led to higher utilization. It draws people who may have forgone care in the past because there are no appointments, short wait times and extended hours of operation. With more people using these facilities combined with their higher cost than that of a primary care office visit, employers are not seeing the savings intended since ERs being less utilized. 

In order to gain the savings that clinics and urgent care centers can generate, it’s important for employers to make an effort to educate employees as to when it is appropriate to utilize them. The primary care physician is still the best first option from a price and continuity of care perspective for most employees but ERs, clinics and urgent care centers are appropriate under certain circumstances:

Emergency Room

The ER should be used for symtoms such as: chest pain, difficulty breathing, severe bleeding, head trauma, severe fratures, intense abdonminal pain or poisoning.

ERs are open 24 hours a day, seven days a week, 365 days a year. They are staffed with professionals that can treat a number of traumatic injuries and illnesses and are required (by federal law) to care for anyone who comes in, regardless of insurance or ability to pay. For these reasons the cost of an ER visit is significantly higher than that of a primary care physician, urgent care center or clinic that are not equipped or staffed to provide services for complicated cases.

Urgent Care Centers

Urgent care centers should not replace an employee’s primary care physician. From a continuity of care and cost perspective, it is important that all employees have a primary care physician.  Use urgent care centers for sprains, minor burns, rashes, cuts requiring stitches,  suspected broken bones, minor asthma attack and other less  serious problems that are beyond the scope of a retail clinic, and when employees cannot get an appointment to see their  primary care doctor.

Most urgent care services can be performed by a primary care physician, but when an employee cannot get an appointment, is traveling out of the area or has an acute problem that happens after office hours, utilize urgent care centers over ERs. 

Urgent care centers are typically physician-staffed, offer extended hours and provide walk-in services for acute, non-emergent, non-urgent and non-life threatening issues. There are more than 10,000 such centers in the United States, according to the Urgent Care Association of America.

Convenient Care Clinics

Clinics can be used when an employee’s primary care physician is not available and can treat things such as minor burns, sprains, minor infections such as bladder, pink eye, sinus and sore throat, skin rashes and upset stomachs. Some may also offer vaccinations, pregnancy tests and routine physicals.

Clinics have been increasing in popularity for several years; they provide walk-in services, typically have a physician-supervised staff and extended hours. CVS, for example, offers more than 1,000 minute clinics across the U.S. and continues to grow.

Employers should work with their consultant to develop an overall education strategy on these and other topics not only during open enrollment, but throughout the year.

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