Confusion over medical clinic can be costly
Walking into one type of neighborhood medical clinic instead of another can be a $2,000 mistake. Or at the very least, a big surprise, a Rice University study warns.
Walking into one type of neighborhood medical clinic instead of another can be a $2,000 mistake. Or at the very least, a big surprise.
That is the finding of a new Rice University study that examines the proliferation of free-standing emergency rooms in Texas in recent years, which to the uninformed patient can look a lot like their lower-cost storefront cousin, the urgent-care clinic.
The difference, though, is very real. The average overall cost of a visit to a free-standing clinic can be 15 times higher than the average visit to an urgentcare clinic, an analysis of three years of insurance claims found. In 2015, the average price was $2,199 versus $168, respectively.
The study, published last month in the Annals of Emergency Medicine and made public Thursday, looked at more than 16 million insurance claims processed by Blue Cross and Blue Shield of Texas between 2012 and 2015.
“The sticker shock is alarming,” said study lead author Vivian Ho, a health economics professor at Rice’s Baker Institute of Public Policy.
Others researchers involved in the study were from Baylor College of Medi-
“The data have to be taken into context.” Carrie De Moor, CEO of Code 3 Emergency Partners
cine, UTHealth’s School of Public Health and Blue Cross and Blue Shield.
Patients frequently pay at least one-third of the costs out of pocket because care at the centers is out of network for many insurance plans, the study found. Even if insurance picks up the bill, the higher cost ultimately gets passed on to consumers in the form of more expensive premiums down the road, Ho said.
On Thursday afternoon, the free-standing emergency room industry pushed backed, calling the conclusion that patients are confused by the two types of care both overstated and outdated.
“You must have been hiding under a rock if you haven’t seen all of the news stories about this in recent years,” said Dr. Carrie De Moor, CEO of Friscobased Code 3 Emergency Partners and president of the American College of Emergency Physicians’ free-standing emergency centers section.
She added it is misleading to compare services at the two types of facilities since free-standing emergency room centers are equipped for a higher level of treatment, are subject to stricter regulation and are required to treat everyone while urgent-care clinics are not.
Ho acknowledged that free-standing emergency rooms do have some higher costs because they are subject to certain state licensing requirements and are better equipped to treat more complicated and serious conditions.
But she is not buying that accounts for the entire disparity.
For instance, the research found 15 of the 20 most common diagnoses treated at free-standing emergency departments were also in the top 20 for urgent-care clinics and not all involved critical care.
Most commonly treated at free-standing emergency rooms is “other upper respiratory infection,” which costs an average of $1,351, the report found. That is eight times higher than the $165 price for same diagnosis at an urgent-care clinic.
It is even higher than the $1,074 charged if the patient had gone to a traditional emergency room in a hospital.
Even a relatively common procedure like a shot has an enormous price difference. At an urgent-care clinic, a typical price for a “therapeutic injection” was $17. At a free-standing emergency room, the same treatment cost $203.
De Moor, again, disputed the findings.
“The data have to be taken into context,” she said, arguing that while a medical coding might appear to be for the same condition, her type of facility could be offering more in-depth treatment that is costlier.
In the long run, she said, free-standing emergency centers like hers actually bring down the cost of health care in America because they reduce patient admissions in hospitals.
The problems and confusion for patients is closely linked to the explosion of storefront care.
While people still use hospital-based and urgentcare clinics more often than free-standing emergency care, the growth of the latter is outpacing the others.
Use of free-standing emergency rooms rose 236 percent between 2012 and 2015, compared with 10 percent growth in the use of hospital emergency departments and 24 percent for urgent-care clinics.
The study concluded that free-standing emergency rooms should be limited in how much they can “balance bill,” or the difference between what a patient’s health insurance agrees to pay and what a provider has charged. That can lead to hundreds if not thousands of dollars of costs borne by the patient.
It also urged more transparency in pricing.
An estimated 200 freestanding emergency rooms have opened in Texas in a little more than a decade, making the state one of the nation’s leaders in the trend, De Moor said.
“Texas is a great place to do business,” she said.