Hello and welcome to the first installment of the Health Policy Mini-Fellowship blog. In May Hannah, Brenda and Dr. Foley helped lead the journal club discussion at the ACEP Leadership and Advocacy Conference (LAC) in Washington, DC. We presented an article by Weinick et al titled “Many Emergency Department Visits Could be Managed at Urgent Care Centers and Retail Clinics,” that you can find here. This article addressed an argument we often hear, that ED visits are expensive and managing “non-emergent” conditions in an alternate setting would result in substantial savings to the healthcare system.
The Weinick article sought to identify which ED visits were “non-emergent” and estimated the potential savings of diverting these visits. The authors compared the diagnoses treated at each location, basic demographics for the patients treated and the categories of drugs prescribed. They concluded that when you adjusted for the hours retail clinics and urgent care centers are typically open 16.8% of ED visits could be diverted to these alternate settings. The authors went on to say that this could result in savings of $4.4 billion annually or approximately 0.2% of national healthcare spending.
There are many issues with this paper, the data was not representative of all retail clinics or urgent care centers, the diagnoses were compared based on ICD-9 codes which are retrospective and the Billings algorithm which was used to determine which ED visits were non-emergent was not designed or intended for this purpose. But more importantly perhaps the authors were asking the wrong question, is diverting these visits really better for patients and the healthcare system? Even if we accept the authors estimate, saving 0.2% of annual spending is hardly going to drive down the cost of healthcare.
Patients choose the ED because it is convenient, open 24/7/365 with laboratory and radiology services with the same hours. Emergency Departments cannot turn patients away based on insurance status, they are located in low income neighborhoods where urgent care centers and retail clinics are unlikely to open, and patients believe (rightly so!) that they provide a high level of care. Emergency Departments provide a public service and have fixed costs to stay prepared to treat emergency conditions and manage public disasters, how will they be funded if the non-emergent visits which help to pay those fixed costs now are diverted elsewhere?
Are urgent care centers and diverting ED visits really the answer to the lack of primary healthcare in this country? This debate is not going away, as more people become insured under the Affordable Care Act more players will be competing for their business. This is an opportunity for Emergency physicians to join the debate and help shape the future of the specialty and the American healthcare system.
What do you think? Are urgent care centers the answer? What role do you think the ED has in the future of healthcare?
Look for a post next month from Claudia with an update on the roll out of the Affordable Care Act.
By Dr. Hannah LoCascio