Urgent Care Visits Increase as Emergency Room Visits Fall

By Jane Farrell

Thanks to convenience and cost, more and more people are visiting urgent care centers for non-critical illnesses or conditions, while far fewer people are going to hospital emergency departments, according to new research.

The study, published in JAMA Internal Medicine, was conducted by Brigham and Women’s Hospital researchers. The analysis looked at patterns among private health-plan enrollees.

Given the high costs of emergency departments, many insurance plans have created incentives to encourage patients to receive that care elsewhere. In response to patient expectations for more convenience and to long wait times at traditional physician outpatient practices, alternative care facilities such as urgent care centers, retail clinics, and telemedicine have rapidly emerged.

“The drop in emergency department visits is quite striking and represents a substantial shift in where patients go to get care for conditions such as sore throat and minor injuries,” said Sabrina Poon, MD, MPH, who was an emergency physician and research fellow at BWH when the research was conducted.

According to a news release from Brigham and Women’s Hospital, a team of investigators focused in the study on the period between January 2008 and December 2015, examining de-identified data from Aetna, a large, commercial health insurance company, which insured approximately 20 million members per study year.

The team found that from 2008 to 2015 there was a large drop in emergency room visits and a substantial increase in the use of urgent care centers. Retail clinics and telemedicine utilization also increased substantially during this time, but when compared to urgent care centers and emergency rooms, they still accounted for a small number of visits.

Visits to the emergency room for the treatment of “low-acuity” conditions decreased by 36 percent, whereas use of non-emergency room centers increased by 140 percent. There was an increase in visits to all other venues, including a 119 percent increase at urgent care centers. Overall, across all acute care centers, the number of visits increased by 31 percent and spending associated with low-acuity conditions increased by 14 percent. The increase in spending was primarily driven by a 79 percent increase in price per emergency room visit for treatment of low-acuity conditions.

The researchers hypothesize that the reason for this growth is due to the increasing number of urgent care clinics, the familiarity and acceptance of urgent care centers as credible alternative venues among the community, their ability to treat a wide range of conditions, their convenience factor, shorter wait times, and lower out-of-pocket costs. Additionally, the investigators also found that among the population of patients with commercial insurance, patients with higher incomes were more likely to use non-emergency room clinics compared to people with lower incomes. Factors such as transportation and availability of alternative options may influence this care pattern.

“The increasing popularity of alternatives to the emergency department is likely being driven by a variety of factors, including cost, convenience, and long wait times,” said Jay Schuur, MD, MHS, emergency physician at BWH and an author on the paper. “The overall increase in spending was driven by a 79 percent increase in price per emergency department visit…In the next few years, it will be important to see how these trends evolve and whether the growth of alternative sites results in lower cost care or more use of medical care.”