Health insurers and employers are dedicating more time and resources toward educating and incentivizing their members to make better choices when accessing medical services. It’s estimated that more than $18 billion a year could be saved if patients with non-emergency conditions visited more appropriate care settings.
With the rise of consumer driven plans that demand more out-of-pocket costs, healthcare consumers are also becoming more savvy with their healthcare dollars and want to know what qualifies as legitimate emergencies that require an ER visit and when a less costly alternative will be sufficient. Hospital emergency departments provide initial treatment for a variety of illnesses and injuries that are typically life threatening and require immediate medical care. Emergency care involves patients who need medical attention within 1 minute to 2 hours of injury to survive or avoid life-changing consequences. The National Hospital Ambulatory Medical Care Survey estimated that nearly one-third to one-half of all ER visits are for non-emergency care. The top 3 reasons for the ER visits were small injuries/contusions, sprains and strains, and upper respiratory infections. Alternatives to emergency room care are urgent care centers, retail health clinics, workplace health services, and 24/7 nurse call lines, which offer convenience, excellent care and lower costs.
Urgent Care Centers
Urgent care centers handle immediate problems, that aren’t life threatening like stitches, sprains, x-rays and animal bites. Urgent care centers have extended hours, usually including nights and weekends, to be more convenient for patients. These centers’ prices are substantially cheaper than ER prices, ranging around $71 to $125 per service and with accepted insurance; out of pocket expenses are comparable to doctor’s office copays.
Retail Health Clinics
Retail health clinics provide convenient routine medical services like treatment for colds, vaccinations and minor ailments. Retail clinics can be found in major pharmacy stores such as Walgreens, CVS, Target and Walmart and are open to the public on an appointment and walk-in basis. You can find price lists for all services at these clinics and with insurance, costs are even lower, again similar to doctor’s office copays at about $25-$35.
Workplace Health Services
Workplace health services are employer-sponsored health centers staffed with medical personnel dedicated only to the employees and their families. Typically large companies offer this as part of a competitive employee benefits plan, but they can also save significantly by reducing their claims expense. Services include primary care services, free generic prescriptions and disease prevention services. In most cases, the employer will not require copayments or deductibles to use these services.
24Hour Nurse Hotlines
24hour nurse hotlines are another option. Available to address health concerns and provide answers to questions, this service typically arms the patient with ample information to self-treat and avoid an unnecessary medical visit. Nurse lines are available 24 hours for advice, guidance and support to callers with health questions or medical problems typically at no additional cost to health plan members.
By promoting appropriate utilization of care settings, payers are able to reduce their claims costs while reducing the unnecessary burden on hospital emergency departments. A non-emergency respiratory condition at the ER may cost more than $500, while treating the same condition at an urgent care clinic is about $90 and at a retail clinic, $35. Other reasons patients and payers may choose alternate care settings include:
- Significant savings on out of pocket costs for patients.
- Better quality of care delivered in terms of wait time and appropriate course of action decided on what is best for the patient’s needs, not time.
- ER resources can be dedicated to those who truly need emergency care