THE RISE OF MEDICAL CONSUMERISM, SELF-TRIAGE AND THE IMPACT ON THE HEALTHCARE DELIVERY SYSTEM

Abstract

The increased out-of-pocket payments required from today’s insurance plan designs is leading to the advent of patients acting more like regular consumers. They are shopping for the best value for their personal spending on healthcare services. This is leading to an increased use of less hospital and health system centric delivery sites. Enabled by the availability of information on the internet, more patients are using alternative settings such as urgent care centers, retail clinics, etc. Specifically, patients are opting for Urgent Care Centers (UCC) in lieu of the hospital emergency room (ER), principally due to higher out-of-pocket costs for unscheduled care but also a desire for a better overall service experience with amenities and a service orientation towards the consumer/patient. This shift in patient behavior raises questions as to how UCCs compare to ERs. To better understand this, two studies were conducted: the first examining the relative patient experience at UCCs versus ERs, and the second examining the effect of UCC visits on overall cost of service. To better understand the patient experience in UCCs compared to ERs, a quantitative analysis of reviews posted on Yelp for hospital emergency room and urgent care center was conducted. UCCs received significantly higher Yelp ratings than emergency rooms. Machine learning was used to determine which topics in Yelp reviews were most closely correlated with 5-star and 1-star ratings. 16,447 ER Yelp reviews were analyzed from 1,566 hospitals, and 84,502 reviews from 5,601 UCCs. There were more 5-star UCC reviews (n=43,487, 51%, p<0.05) compared to 5-star ER reviews (n=4,437, 27%, p<0.05). The study determined that 5-star reviews for ERs tend to focus on clinical care while UCC reviews focused on convenience. Online patient reviews provide an understanding of what patient’s value in their unscheduled care experience offering insights for health systems and providers in planning the future care delivery systems. To determine if urgent care centers are a less-costly substitute service to hospital-based emergency rooms or a complementary, cost-amplifying service, a second study was completed. The study compared the pre- and post-period spending differences, for selected low-acuity patient conditions, between patients who started their treatment at an urgent care center versus starting at an emergency room using difference-in-differences analysis. The study methodology was based on a sample University of Pennsylvania Health System employees and their dependents seen at an urgent care facility or in the emergency room between 2012-2017 with a primary diagnosis among 15 most common low-acuity conditions seen in those settings. The sample included 3,055 episodes with initial index visits in urgent care and 3,650 initial index visits in a hospital emergency room. Patients who visited the ER spent $1,323 (p < 0.0001) more than those who visited urgent care centers within 30 days following the visit, and $2,152 (p < 0.0001) more within 6 months following the visit. Visiting the emergency room corresponded to a 68.0% greater change in pre- to post-index period cost when evaluating the first 30 days and 40.0% comparing costs over 6 months. Thus, this study demonstrated the significant cost advantage of urgent care centers for treating selected conditions as compared to a hospital emergency rooms when the unit of analysis is total health care spending at 30-day and 6 months.