Written by Clay Smith
From 2008 to 2015, low acuity care in commercially insured patients has dropped 36% in EDs and increased 140% in non-ED settings, dominated by an increase in urgent care but also, less so, by increases in retail clinic and telemedicine utilization.
Note from lead author, Dr. Sabrina Poon:
“A major limitation to our study was that it is for a commercially insured population only. This may not be happening in other populations, i.e. those without commercial insurance, which has implications for acute care as a whole, perhaps best summarized in this Twitter thread.”
Why does this matter?
Prior study seemed inconclusive about the impact of retail clinics on local ED volume, barely moving the needle even in low acuity patients. This study shows that from a national perspective, care for low acuity illness is shifting away from the ED. This has implications for predicting ED volume, staffing, and reimbursement. This may mean paying patients go to urgent care and non-paying patients still come to the ED.
They really are going elsewhere
This was a study of national U.S. Aetna claims including almost 21 million low-acuity visits to acute care settings over an 8 year period from 2008 to 2015. Low acuity visits to the ED in this commercially insured population dropped 36%, and visits to non-ED venues, such as urgent care, retail clinics, or telemedicine visits increased 140% over that same time period. “Low acuity” visits included were bronchitis, urinary tract infection, rash, and muscle strains. Overall acute care utilization increased over the 8-year time frame. Spending per insured patient increased as well, from $70 to $80 per beneficiary, largely driven by a marked increase in ED charges, from $900 to >$1600 per visit in the ED - an 87% increase). So, patients are seeking more acute care overall but less of it is happening in the ED. The majority of the increase was in urgent care, followed distantly by retail clinics and telemedicine.
Trends in Visits to Acute Care Venues for Treatment of Low-Acuity Conditions in the United States From 2008 to 2015. JAMA Intern Med. 2018 Sep 4. doi: 10.1001/jamainternmed.2018.3205. [Epub ahead of print]
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