In an effort that could eventually send fewer patients to expensive emergency rooms for the flu or weekend warrior injuries, the federal body that advises Congress on Medicare is planning to explore ways to spur more urgent care clinics in the nation as a cheaper alternative.
The issue is arising as the Medicare Payment Advisory Commission plans to recommend in April that the federal health care program for the elderly dramatically reduce payments to stand-alone emergency departments springing up around the country.
Commissioners are already concerned that too many people are going to emergency rooms for relatively minor cases that could be handled more cheaply in urgent care centers and doctors' offices. The stand-alone emergency rooms are coming under criticism because, according to MedPAC staff, they get the same rates as emergency rooms at hospitals, while generally treating less severe cases as they lack the operating rooms and trauma centers needed to do so.
But as they prepare to discourage such emergency rooms, commissioners at a meeting March 1 signaled that they want to turn their attention toward encouraging more urgent care clinics, where they believe that patients with relatively minor conditions should be going instead.
The costs are dramatically different. According to a MedPAC staff presentation in November 2017, Medicare pays emergency rooms, whether stand-alone or at a hospital, $264 to treat a midlevel, non-life-threatening condition. It pays less than half, or $109, to treat the same case at an urgent care center or a physician's office.
"My main concern is paying large amounts more at emergency rooms for patients whose needs can be addressed by urgent care centers," MedPAC Commissioner Paul Ginsburg, director of the USC-Brookings Schaeffer Initiative for Health Policy, said in an email.
Encouraging more urgent centers could be a boost for some hospitals, private equity firms and insurers that have been investing in urgent care clinics and driving an 11% increase in 2017, said Tom Charland, founder and CEO of Merchant Medicine, a retail healthcare consulting firm, in an interview.
Traditionally, the clinics have been owned by physicians, according to a Feb. 7 Urgent Care Association of America white paper on the state of the industry. However, the convenience of clinics open in the evenings and on weekends has made them popular, particularly with those between 18 and 44 years old, according to the paper.
Clinics have opened primarily in suburban areas with large numbers of dual-income parents with insurance for whom "it's chaos when someone in the family gets sick," Charland said.
The market has attracted private investments, including a $1 billion investment that American Development Partners, a private equity and real estate firm, made in 2017 to help American Family Care add 300 urgent care clinics, according to Reuters.
Hospital groups such as HCA Healthcare Inc. have invested in urgent care clinics because it allows its physicians to focus on lucrative chronic cases by sending less serious and less lucrative cases to clinics, according to the association report.
The urgent care group noted in the report that despite the growth of such clinics, a number of factors hold back the creation of more clinics. The group said insurers charge higher copayments at urgent care centers than at physicians' offices and do not cover healthcare screening at the centers.
Charland said Congress could also consider incentives to open more clinics in lower-income neighborhoods, where there could be more demand than in more affluent areas. "People who make higher salaries can take a half a day off work to go to the doctor. For people on the lower end of the income spectrum, if they don't work, they don't make money," he said.
The American Hospital Association, which represents facilities investing in stand-alone emergency rooms and urgent care clinics, opposes cutting emergency room payments. A November 2016 report by an AHA task force, however, recommended creating more urgent care centers in communities with a lack of access to primary care.
Not all members of the commission, however, support creating more urgent care clinics. Rita Redberg, a University of California, San Francisco cardiologist and an editor of The Journal of the American Medical Association, said at the March meeting and in an email that creating more urgent care centers misses the point.
Visits to urgent care clinics and emergency rooms are rising because there are not enough physicians offices. So the answer, Redberg said at the meeting, is to bolster more physicians offices, not "trying to have these sort of retail clinics. ... You can't get the same care at that kind of facility that you can get with a doctor that knows you and takes care of you and has known you for years," she said.
