What Happens When Urgent Care Comes To Town?
By Bapu Jena, MD, PhD
July 30, 2021
Bapu Jena is an associate professor of health care policy at Harvard Medical School, a physician in the Department of Medicine at Massachusetts General Hospital and a member of the 2021 Tradeoffs Research Council. His research interests include the economics of physician behavior and the physician workforce.
Researchers and policymakers are always looking for alternative places for people to get medical care without needing to go to busy, costly emergency rooms (ERs) or physicians’ offices. One of the most popular potential solutions is urgent care centers (UCCs). These walk-in clinics have grown in number by more than 50% since 2013 — I pass about five on my short drive to work each day. But the existing evidence is mixed on whether they actually keep less-sick people from more expensive ER or doctor visits.
In a new NBER working paper, researchers Janet Currie, Anastasia Karpova and Dan Zeltzer examined this question by studying how Medicare fee-for-service spending changed when a zip code got its first UCC. The authors found that introducing a UCC led to a modest increase in total Medicare spending ($300 per person) but had no impact on mortality rates. Prescription drug spending went up slightly, but the largest contributor to the spending jump was increased hospitalizations. Hospitalizations are expensive, so even modest increases in inpatient visits could meaningfully impact spending. The researchers showed that many of these new hospitalizations came shortly after a UCC visit, which could mean UCCs help people identify important clinical needs or that their visits led them to get additional low-value care. This is known as a “care cascade,” a process my fellow Research Council member Ishani Ganguli has written on extensively.
Currie and colleagues also found that when UCCs entered a market, the number of ER visits ending in a hospitalization increased, while those not ending in a hospitalization stayed about the same. Non-UCC physician visits as well as labs and imaging also showed no change. This suggests that UCCs may not achieve their intended goal of reducing costly care. Instead, they seem to add to hospital spending — and the authors astutely point out that UCCs are increasingly owned by or contracted with hospitals and health systems, a relationship they encourage further study into.
There are reasons these results may not be generalizable. The Medicare population is older and sicker than the general population, and the study only looked at traditional fee-for-service Medicare, leaving out the ever-growing Medicare Advantage population. On the other hand, Medicare data allowed the researchers to observe a far greater care universe than most data sets.
Regardless, this study adds to recent evidence that UCCs are not the cost-savers they were hoped to be. Whether they improve health care quality, accessibility or the patient experience is harder to know and worthy of further investigation.