MP12-17 ASSOCIATION OF INSURANCE STATUS AND ACCESS TO UROLOGICAL CARE AT URGENT CARE CENTERS

Abstract

INTRODUCTION AND OBJECTIVE: Urgent care centers (UCC) have rapidly expanded in the United States as a venue for primary and emergency medical services. As UCCs are subject to fewer regulations in the patients they treat compared with emergency rooms, we aimed to evaluate how insurance status affected access to care for urological conditions in the United States. METHODS: We conducted a cross-sectional study using a “secret shopper” design study to evaluate access to urological care in the United States. We sampled 240 UCCs across eight states (TX, PA, IL, GA, NC, FL, CT, CO). Using a standardized script, two researchers posed as either a Medicaid or commercial patient with obstructive pyelonephritis. Three types of UCC centers were called: independent UCCs (n=150), non-academic hospital affiliated UCCs (n=74), and academic hospital UCCs (n=16). Each UCC was contacted twice on separate occasions for each insurance scenario. We evaluated acceptance for care as the primary endpoint. Because UCCs are often unable to perform emergent urological services, we also evaluated referral to emergency departments (ED) and factors associated with these outcomes. RESULTS: We successfully contacted all 240 UCCs. Given a patient scenario of obstructive pyelonephritis, a total of 183 (76.3%) UCCs accepted Medicaid, compared to 239 (99.6%) centers that accepted commercial insurance. Non-academic hospital UCCs (OR 5.72, 95% CI 2.16-15.17, p 0.0004) and academic hospital UCCs (OR 16.09, 95% CI 0.95, 273.80, p 0.0107) UCCs were more likely to accept Medicaid compared to independent UCCs (controlling for state Medicaid expansion status and proportion of state on Medicaid). Overall, only 27% of patients were referred to the ED for further evaluation. No significant differences were observed in ED referral rates between Medicaid and commercial insurance (23% versus 31%, p=0.13). However, both Medicaid (OR 3.58, 95% CI 1.60-7.99, p 0.0012) and commercially insured (OR 3.54, 95% CI 1.95-6.43, p <0.0001) patients were more likely to be referred to the ED at UCCs that triaged patients compared to UCCs that did not triage patients. CONCLUSIONS: Patients seeking urological care at UCCs may be limited by their insurance status. UCCs affiliated with hospital networks or academic institutions are less likely to deny care to Medicaid patients compared to independent UCCs. UCCS may also have difficulty recognizing emergent urological conditions, as over 70% were unable to refer patients to the ED for obstructive pyelonephritis. However, triaging with a provider is effective in facilitating further care management. Source of Funding: None