Urgent care physicians have long urged payors to encourage patients to use the much less costly hospital emergency department alternative. Payors around the country are finally figuring this out and developing active programs to divert patients with non-emergency problems to urgent care centers. You won’t even believe the response of the American College of Emergency Physicians’ (ACEP). Instead of applauding this effort to reduce health care costs and unclog overcrowded emergency departments, ACEP has begun an active campaign to establish the importance of ED visits for patients with minor problems.
A TIME Magazine editorial, published in partnership with CNN on Monday defended the American College of Emergency Physicians’ (ACEP) for "launch[ing] a campaign to derail proposed policies to reduce the use of emergency departments (EDs)." The editorial, written by two emergency physicians Drs. Jesse M. Pines and Zachary F. Meisel, argues that efforts to steer patients away from visits to the ER in order to drive down health care costs in the U.S. are misguided and devalue emergency medicine because these efforts miss what the headline calls “the real value of emergency care.”
Is this just simply self-interested nonsense, or is it an authentic effort to maintain what is good about our healthcare system? Drs. Pines and Meisel say that “some emergency care could probably be avoided if there were adequate alternatives, like clinic doctors who are responsive to their patients’ urgent needs. But the fact remains that for many there are no convenient alternatives to EDs.” Nonsense! The U.S. has more than 8,500 “convenient alternatives.” They are called urgent care centers, and they are overwhelmingly staffed by “clinic doctors who are responsive to their patients’ urgent needs.”So do the doctors discuss the urgent care alternative? No; it might seem incredible, but the words “urgent care” do not appear even once in the TIME editorial. One must wonder if the doctors thought that by ignoring the viable “alternative,” urgent care would somehow disappear from the debate.
Even the examples selected show their extraordinary bias. They mention “a young woman with an uncomfortable urinary-tract infection on a Saturday.” What a perfect case for a visit to an urgent care center! Instead, the editorial describes the woman’s sole alternative to an ED visit on Saturday as “wait[ing] until Monday when the doctor's office is open.”
Drs. Pines and Meisel state that retail clinics are “typically built in rich suburbs,” so they are not available across the country in small towns and big cities. Are they unaware of urgent care centers that in recent years have rapidly been opening in small towns and urban areas? As far as the lack of viable alternatives in poor urban areas, does that mean that the ED is the right place for treating these non-emergency issues? Maybe, instead, it means that CMS needs to focus on efforts to fund urgent care centers in poorer neighborhoods, where overuse of hospital EDs is an even bigger problem and the need for less costly alternatives to the ED is critical.
They, also, argue that hospital EDs are important because they are open 24 hours a day. Indeed, few urgent care centers are open 24 hours. But most urgent care centers do offer significant evening and weekend hours, and very few non-emergency problems need treatment outside of the typical urgent care center hours of operation: 8AM – 8PM. True emergencies should absolutely be treated at a hospital ED, and urgent care providers are quick to send emergency cases directly to the ED. But for those after-hours issues that require immediate treatment but are not life-threatening, urgent care centers are a great alternative.
Drs. Pines and Meisel obfuscate by waxing eloquence for the importance of the hospital ED as a place for treatment of the “entire cross-section of human illnesses.” Are they really serious? The hospital emergency department is designed, staffed and ideally suited for the treatment of emergency conditions—not the “entire cross section” of medical conditions.
The editorial goes on to state a ridiculous reason for patients to utilize the hospital ED for minor problems: “The fact is that nobody knows if they are having an emergency when they go in [to an ED] ... We all need to recognize the value of figuring it out, explaining what the problem is and providing reassurance...” Just because of the outside chance that my sore throat is an emergency, should I go to an “emergency” department? What nonsense! In my over 20 years of practicing urgent care medicine, I have only transferred a few patients to a hospital with true emergencies, and I have never had a single patient code in the urgent care. With very few exceptions, people have proven themselves quite capable of triaging true emergencies to hospital EDs.
More concerning is Drs. Pines and Meisel’s statement that the “marginal cost of an ED visit is actually lower than that of an off-hours clinic visit.” What? Are they saying it costs less to be treated in a facility that costs more than twice as much per square foot to construct and uses doctors and nurses who are paid twice the salaries of urgent care physicians and nurses? Forget about the intentionally confusing (and questionably accurate) statistic of “marginal cost;” what is the cost to the insurers and the patient? The truth is that emergency departments generally charge patients three times the fees for the same services in an urgent care center. If the marginal cost of an ED visit is so low, why not reduce ED charges by 60%? Then the ED would really be a cost neutral alternative to urgent care.
An informed reader will note that the editorial does not marshal a single valid argument for payors to cut their public awareness programs for urgent care. If an urgent care center was readily available in every single community in the USA and if patients were aware of the proper use of such centers:
• then hospital EDs could focus on what they do best—care for emergencies
• and then patients could get what they need most—appropriate, timely and economical care for their medical conditions.
If all patients don’t currently have ready access to urgent care centers, then the editorial simply underlines the fact that the USA still does not have enough urgent care centers.
Payors have every reason to educate patients as to the value of urgent care. Patients have a right to know that they do have an alternative to the ED for non-emergency medical problems that need timely treatment. In fact, this knowledge will inevitably drive down health care costs, when patients begin choosing the cheaper, more convenient and more cost-effective alternative—urgent care.