Urgent Care Visits Surge as ED Visits Plummet

Poon SJ, et al. JAMA Intern Med. 2018;doi:10.1001/jamainternmed.2018.3205

From 2008 to 2015, there was a significant shift from ED use to use of non-ED venues, such as urgent care, for the treatment of low-acuity conditions, mainly driven by the high costs of ED visits, according to findings published in JAMA Internal Medicine.

“Over the past 2 decades, a variety of new care options have emerged for acute care, including urgent care centers, retail clinics and telemedicine,” Sabrina J. Poon, MD, MPH, from Brigham and Women’s Hospital, and colleagues wrote. “Trends in the utilization of these newer care venues and the ED have not been characterized.”

Poon and colleagues conducted a cohort study to examine how patterns of acute care venue utilization, price and spending for treatment of low-acuity conditions have changed from 2008 to 2015. The researchers reviewed deidentified health plan claims data from Aetna for 20.6 million acute care visits, including visits for respiratory infections, UTIs, rashes and musculoskeletal strains.

Data revealed a 36% decrease in visits to the ED for the treatment of low-acuity conditions from 2008 to 2015 (from 89 visits per 1,000 members to 57 visits per 1,000 members). Conversely, there was a 140% increase in the use of non-ED venues during the same time frame (from 54 visits per 1,000 members to 131 visits per 1,000 members).

Visits to all non-ED venues rose over time, with urgent care center visits increasing by 119% (from 47 visits per 1,000 members to 103 visits per 1,000 members), retail clinic visits increasing by 214% (from seven visits per 1,000 members to 22 visits per 1,000 members) and telemedicine increasing from zero visits to six visits per 1,000 members.

For low-acuity conditions, utilization per person per year had a net increase of 31% (from 143 visits per 1,000 members to 188 visits per 1,000 members) and spending per person per year had a net increase of 14% ($70 per member to $80 per member).

“The drop-in ED visits are quite striking and represent a substantial shift in where patients go to get care for conditions such as sore throat and minor injuries,” Poon said in a press release.

The researchers noted that a 79% hike in price per ED visit for treatment of low-acuity conditions over the study duration (from $914 per visit to $1,637 per visit) was the primary cause of the increase in spending.

“The increasing popularity of alternatives to the EDs is likely being driven by a variety of factors, including cost, convenience, and long wait times. ... 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,” Jay Schuur, MD, MHS, a coauthor of the study who is also from Brigham and Women’s Hospital, said in the release.