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The Waste of Freestanding ERs and Retail Clinics

October 22, 2017
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I have written about both issues before: freestanding ERs and retail clinics. Two recent studies continue to show how useless they both are in helping create a better more efficient healthcare system.

The freestanding ER study  examined the number of these facilities and population characteristics where they locate. They identified 360 freestanding ERs, mostly in Texas, Ohio, and Colorado. This will come as no surprise, they were located in areas with better payer mixes, higher incomes, and lower Medicaid patients. There were a few small differences between the 3 states, but nothing major or particularly noteworthy. The retail clinic study  examined if retail clinics reduced the number of low acuity visits to ERs.  Once again, no surprise, the answer was a resounding no.

As I’ve written about before,  I don’t blame the business people, investment bankers, and brokers building these facilities. They see them as profit opportunities and that’s what business is for: to make a profit. They are merely profiting off of the fact that Medicare pays an ER $1000 – $2000 to manage a cough, back pain, a fever, and so on, and a family physician no more than $100. Insurance companies just follow the relative weightings of Medicare. ERs sometimes charge much more if an overnight observation of questionable necessity is ordered. Some of the freestanding ERs have morphed into mini-hospitals equipped to house patients for overnight observation stays. Even for Medicare, the total bill could be several thousand more and patients are often stuck for even higher bills when they find out that some or all of the people billing them are out of network.

Surely the non-healthcare industry in America understands why the money flows the way it does. I have much less faith that they understand why. They often blindly trust insurance companies to look after their interests, but I’ve heard none of the corporations or insurance companies call for Medicare to reset the relative weighting of how ER visits are valued vs. family medicine visits. Until they do, America will keep getting what it pays for: narrow-minded fragmented care at an exorbitant price.

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2 Responses to The Waste of Freestanding ERs and Retail Clinics

  1. Linda Miller, DO on November 12, 2017 at 10:38 am

    I have spent years working in both traditional ERs and a standalone ER/high acuity urgent care. From reading your article and the research article, I think you’re making a broad judgement, based on biased opinion, using limited information.

  2. Gary M Gaddis MD PhD on November 18, 2017 at 6:31 am

    Thanks for the broad disrespect of what we do, Richard. Perhaps you should go to work for Anthem-Blue Cross. We would both agree that chronic illnesses are best managed in an office-based setting by a doctor who has a longitudinal view of the patient’s health. However, much care is episodic, and how is the patient to know when they have an emergency, and when they don’t? Even doctors need to take a history and discern things about which the patient may not have thought, and physical findings that the patient may not be able to interpret. Then, there is the matter of testing and making judgments, mindful that no test has 100% Sensitivity and Specificity. It is ALWAYS easier to look smart and efficient when viewing things through a retrospective view.

    I am thankful to often have the opportunity to tell patients that, to the best of my scientific ability, they do not have to worry so much about the symptoms that brought them to come to my care. However, to take broad swipes at my specialty, without acknowledging that our job is two-fold (Try to diagnose the problem AND be very sure that “badness” that could be fatal is not going on), then you are standing on a very non-firm foundation

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