Helping Members Avoid Unnecessary ER Visits

This article by Marc-David Munk, Senior Vice President and Chief Medical Officer for MinuteClinic, was originally published by CVS Health Payor Solutions.

A MinuteClinic infographic.

At an average total cost per visit of $1,900, the emergency department, or ER, is one of the most expensive places to receive medical care.i Not surprisingly, consumer out-of-pocket costs are also high. According to one study, patients with upper respiratory infections personally paid an average of $377 per ER visit.ii

Despite these high costs, there were nearly 137 million ER visits in 2015.iii A sizable portion of these visits are for conditions that clearly merited emergent care — trauma, fractures, chest pain — but many others could be successfully treated at easier-to-access and more affordable sites of care. In fact, it’s estimated that 30 percent of ER visits could potentially be treated in walk-in clinics like MinuteClinic.iv

The emergency department is a critical component in our health care system, and crowding has become a concern among hospitals, policy makers, providers, and payors. Avoidable use among patients with low-acuity problems contributes to long ER wait times and suboptimal care. Avoidable visits cost the system $38 billion a year.v

Why People Choose the ER

In a survey, most ER users cited the severity of their medical problem as the primary reason they sought care in the emergency department. However, 7 percent cited lack of access to a primary care provider, and 12 percent went to the ER because their provider’s office was closed.vi With extended hours and walk-in care, retail clinics are a convenient choice for these groups. Retail clinics are a particularly attractive option for younger people who may not have established a relationship with a primary care provider.

The Neighborhood Option for Care

Many of the concerns that bring people to a hospital emergency department can be effectively treated in walk-in medical clinics. Earaches, sprains, skin conditions such as rashes or poison ivy, sore throats and infections of the respiratory system or urinary tract can all be treated at MinuteClinic. In fact, MinuteClinic can treat more than 125 different conditions in patients above 18 months of age.

Helping plan members and plans avoid unnecessary ER visits remains a part of CVS Health’s vision for building a better, more affordable health care system. MinuteClinic, with 1,100 locations in 33 states and the District of Columbia, offers care seven days a week, including times when many physician offices are closed. Most services at MinuteClinic cost approximately $100. A visit to MinuteClinic — as opposed to an urgent care center or hospital emergency department — costs as much as 90 percent less.

Read the full article at CVS Health Payor Solutions.

For more information about CVS Health’s efforts to improve access to quality care across the nation, visit our Quality & Access information center and the CVS Health Impact Dashboard. To stay informed about the latest updates and innovations from CVS Health, register for content alerts and our bi-weekly health care newsletter.

11.06.18

i  https://www.beckershospitalreview.com/eds/cost-of-er-visits-increased-31-between-2012-16-5-findings.html
ii  https://www.bcbs.com/sites/default/files/file-attachments/health-of-america-report/BCBS.HealthOfAmericaReport.Retail.pdf
iii  https://www.cdc.gov/nchs/fastats/emergency-department.html
iv  https://www.bcbs.com/sites/default/files/file-attachments/health-of-america-report/BCBS.HealthOfAmericaReport.Retail.pdf
v  http://wellness.totalaccessmedical.com/blog/the-consequences-of-emergency-department-overuse
vi  https://www.cdc.gov/nchs/data/nhsr/nhsr090.pdf