Study: Texans paid approximately 10 times more at EDs than urgent care centers for same diagnosis

OR Efficiencies

Texans are likely to pay more at freestanding emergency departments than at hospital-based EDs or urgent care centers, according to a study published in Annals of Emergency Medicine.

For the study, researchers examined more than 16 million Blue Cross Blue Shield of Texas insurance claims from 2012 to 2015. During that time period, Texans’ utilization of freestanding EDs rose 236 percent. That compares with a 10 percent jump for hospital-based emergency departments and a 24 percent jump for urgent care clinics, according to a news release.

Researchers also found the average price per visit at freestanding EDs was $1,431 in 2012 compared with $1,842 at hospital-based EDs. In 2015, the average price per visit was $2,199 at freestanding EDs and $2,259 at hospital-based EDs. However, the average price per visit at urgent care centers was $164 in 2012 and $168 in 2015, according to the study.

The study also looked at out-of-pocket liability. At freestanding EDs, patients’ out-of-pocket liability increased from 32 percent in 2012 to 35 percent in 2015, researchers said. At hospital-based EDs, the increase was 29 percent to 33 percent. And at urgent care centers, patients saw out-of-pocket liability go from 36 percent in 2012 to 38 percent in 2015.

“There was 75 percent overlap in the 20 most common diagnoses at freestanding EDs versus urgent care centers and 60 percent overlap for hospital-based EDs and urgent care centers. However, prices for patients with the same diagnosis were on average almost 10 times higher at freestanding and hospital-based EDs relative to urgent care centers,” researchers said.

The study’s authors concluded the higher prices at freestanding and hospital-based EDs “imply potential inefficient use of emergency facilities.”

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