Emergency Room Use Unchanged by Retail Clinic Access

Study hints employers may need to increase incentives to use low-cost retail clinics for routine care.

Employers hoping to reduce their health care expenses by encouraging workers to use low-cost retail health clinics instead of expensive hospital emergency rooms for colds and sore throats may want to keep tinkering with health benefits strategy.
That’s the takeaway from a new study that found that the introduction of retail health clinics into a market as low-cost and easy-to-use alternatives to expensive physician office visits and trips to the hospital emergency room for common illnesses may not be working as well as planned.
The study, which appeared in the journal Annals of Emergency Medicine, found that the use of hospital ERs for common illnesses was unchanged despite patients having access to newly opened retail health clinics nearby.
Funded by the U.S. Agency for Healthcare Research and Quality, health researchers from the Rand Corp. examined patients’ use of emergency rooms at 2,043 hospitals in 23 states, including Minnesota, from 2007 to 2012 for 11 “low-acuity” medical conditions. The conditions included colds, flu, sore throats, bronchitis, sinus infections and ear aches.
The researchers then looked at patients’ use of the same ERs for the same medical conditions as more retail health clinics opened within a 10-minute drive of the hospital over the six-year period starting in 2007 and through 2012. As retail health clinic penetration increased, the use of ERs by patients for the 11 non-emergent medical conditions stayed the same, the researchers found. Specifically, 133 of every 1,000 ER visits were for one of the 11 medical conditions, and that rate was statistically unchanged over the six-year study period, according to the researchers.
The researchers then broke down the rate of ER use by the type of health insurance patients carried—private health insurance, Medicare, Medicaid and no insurance. Patients with private health insurance were the only group that went to the ER less often over the study period, according to the researchers. Their rate of non-acuity ER use dropped slightly to 108 for every 1,000 visits in 2012 from 119 for every 1,000 visits in 2007.
“Many retail clinics have opted to open in communities with higher incomes and higher rates of private insurance such as outer-ring suburbs and not in low-income, inner-city area,” the researchers said. “Therefore, patients with private insurance might be most affected by the entry of retail clinics.”
Two other studies point to stronger financial incentives as the key to getting more people to use retail health clinics instead of hospital ERs for minor illnesses:  

  • Some 42 percent of 2,000 consumers recently surveyed by Oliver Wyman, the Chicago-based management consulting firm, said they would use a retail health clinic “only if my health plan covered some or all of the cost.”
  • The percentage of employers whose health plan benefits cover care provided to workers by retail health clinics rose to 61 percent this year from 43 percent in 2010, according to the latest annual Employer Health Benefits Survey by the Kaiser Family foundation and the Health Research & Educational Trust. This year’s survey is based on responses from more than 1,900 employers. However, the percentage of employers offering financial incentives to workers to use a retail health clinic instead of a traditional physician’s office for routine care inched up to just 6 percent this year from 5 percent in 2010.

Employers that want to save money by steering workers to low-cost retail health clinics may have to spend a little more up front to get their desired return on investment on their health benefit costs.