258EMF Urgent Care Centers Deter Some Emergency Department Visits But, On Net, Increase Spending

Abstract

Urgent care clinics (UCCs) have been proliferating rapidly and have the potential to alter many aspects of unscheduled care delivery. These clinics offer low wait times and convenient sites of care. Therefore they could lower emergency department (ED) utilization, but may also increase the total number of visits for minor ailments, offsetting these cost savings. Little is known about their impact on emergency department visits or overall health care utilization. We utilize claims from a large, national insurer involving 14.1 million urgent care clinic visits and 9.8 million ED visits from 2008 to 2018. We use a differences-in-differences framework to study how low acuity ED visits in each ZIP code change when low acuity UCC visits increase. We combine these estimates with the insurer’s cost data to determine how out-of-pocket and overall costs changed in the difference-in-differences framework. Population studied: All individuals covered by a single insurer across 50 states in ZIP codes with greater than 30 enrollees any year in the study period. Values were weighted by the number of enrollees. We confirm a secular decrease in low acuity ED visits and increase in UCC claims over the study period. Overall, mean UCC visits per 1,000 enrollees increased from 56.1 to 129.9 between the early period (2008-2011) and the later period (2015-2018), representing a 73.8 [(73.0, 74.7) 95% CI] increase in visits per 1,000 enrollees. ED visits dropped from 63.7 to 59.9 per 1,000 enrollees, representing a -3.8 [(-4.1, -3.5) 95% CI] decrease. At the ZIP code level, there were 3,895 ZIP codes with a decline or no change in the number of UCC visits, and 20,272 with an increase. In ZIP codes with a decline in UCC visits, ED visits per 1,000 enrollees increased from 55.4 to 57.0 (change of 1.6 per enrollee [(0.7, 2.5) 95% CI]). ZIP codes with an increase in UCC visits experienced 81.8 more UCC visits per 1,000 enrollees but fewer ED visits: from 64.3 per 1,000 enrollees to 60.0 (change of -4.2 per enrollee [(-4.5, -3.9) 95% CI]). Lower acuity ED visits have declined in areas where urgent care visits have increased. However, urgent care visits have expanded much more rapidly than lower acuity emergency department visits have declined. Implications for policy or practice: Unlike retail clinics and telemedicine, urgent care clinics offer the possibility of offsetting some emergency department visits for lower acuity diagnoses. Their impact on the total costs of unscheduled care visits may be more ambiguous.