Real Health Care Reform: Local Provisions for After-Hours Care
The growth of health savings accounts, higher insurance deductibles with lower premiums, and the practice of paying cash for health care is fueling a quiet health care revolution, one direct mail advertisement at a time.
This revolution is largely unseen by health care policy makers. It often contradicts the results they discuss in academic studies.
The Commonwealth Fund, for example, has developed a cottage industry devoted to producing “studies” that show that the US health care system is more expensive and has lower quality than the government controlled health systems in other countries.
It uses a variety of metrics to measure health system success. One of them is access to after-hours care. A 2006 survey of primary care physicians begins by saying that “Primary care doctors in the U.S. are less likely than those in several other countries to be able to offer patients access to care outside regular office hours…” The conclusion, in bold type so that no one can miss it, is that the “U.S. Performs Poorly in Access After-Hours.”
Yet this conclusion may be completely wrong.
While it may be true that regular practices don’t provide after-hours access, the US has many practices that specialize in just that. They range from urgent care centers that treat all comers to practices limited to pediatrics. In states with reasonable health care regulations after-hours care is readily available, at least in larger cities, and people who need it usually know how to find it.
In Denver, after-hours practices advertise on billboards, through regular physician practices, in the Yellow Pages, and via direct mail. Parents with kids on sports teams all know someone who has used the nearest urgent care clinic and are a prime source for word-of-mouth evaluations.
Under its “Save Money! Save Time!” headline, a single direct mail postcard from AfterOurs urgent care, http://www.rightcarerightnow.com/, demonstrates how doctors are forming new types of practices to satisfy people who are willing to pay for new forms of care, including:
- After-hours access to care for adults and children, no appointment necessary. “8am-Midnight, 365 Days a Year! (Limited hours Christmas & Easter)”
- Pricing information. “Average Co-Pay Only $40”
- Discounts for cash payers. The practice accepts “Major Insurance, Credit Cards, Medicare and Medicaid. Self-Pay Discounts Available.”
- Information on the wait. “Average Wait Time Only 15 Minutes!”
- Transparent information about what the practice does. “Non-Life Threatening Emergencies Illnesses & Injuries,” “On-Site Lab & X-Rays,” “Board Certified Physicians.”
A handy map and a list of addresses is also included.
In view of this, perhaps Commonwealth Fund researchers should rethink their 2005 finding that “U.S. patients were the least likely to have access to after-hours care,” and begin studying why people in some states don’t have this kind of access.
Very good post, Linda. Apparently markets work.
Very good counter to the propaganda I so often see from the Commonwealth Fund.
The queation is: why does Commonwealth ignore information like this. Are they too intent on US bashing?
The Commonwealth Fund doesn’t ignore that information, it’s just that a handful of walk in centers that may be open 24×7 aren’t statistically significant. One more point, they charge a maximum of $275 a visit for people with the cash or a credit card. If you’re poor, and don’t have the cash, you pay a down payment of $75 and then pay an additional 250. So, they take advantage of the poorest by charging them 20% more.
Our group of docs provide after hours phone calls and advice. They will call ahead to the ER if they think we should go. This phone call helps us around the long wait, red-tape ER experience.
This clinic is sliding scale, too, but the docs are experienced, board certified.
When my mother was dying, our doc gave us her home phone # and told us to call any time.
Health care needs some tinkering, but it doesn’t need a massive federal government train wreck disguised as “reform”.
Does anybody know if Medicare or Medicaid will pay the market price (price everybody else is paying) for after hours care?
These bottom-up, localized solutions do not fit into the Grand Plan designed by the Wise Planners. Darn those pesky entrepreneurs, persistent markets and annoying customers. Why won’t they behave like we tell them?
artk: What do you think you would be charged for the same bundle of services in a hospital emergency room?
If you don’t have the money or insurance, an emergency room charges you nothing. If you have the money, a hospital charges you the same if you pay on the spot or if they send you a bill.
I’m sure a hospital emergency room would be more expensive, but hey aren’t running an emergency room. They have very a limited scope and don’t have equipment or resources of a hospital emergency room. They are more like a free standing clinic that’s open all night.
artk:
The point is that the Commonwealth metric consisted of asking regular primary care practices whether they provided after hours care. When they said they didn’t, Commonwealth concluded that the US health care system is inferior.
Accuracy would dictate that Commonwealth researchers recognize that in the US system primary care practices don’t offer after hours care because there are practices that specialize in it. This may be a more efficient way of organizing a health system than the European model due to the efficiency advantages of specialization.
The number of urgent care practices is rather more than the “handful” you referred to. The Urgent Care Association of America says that in 2008 there were 8,000 urgent care centers in the US. There were about 4,600 emergency rooms.
Rather than consider whether the 8,000 urgent care practices provide adequate after hours care, Commonwealth appeared to assume that because primary care practices don’t keep late hours, people in the US have no access to health care outside the emergency room.
The comments about ER costs and the choices of the poor are not germane in this context. Commonwealth was surveying primary care practices, not ERs. Primary care practices are for routine care that people routinely expect to pay for.
Ability to pay is also not at issue here. Cmmonwealth was looking at population medical care, not specifically medical care for the poor. In the US, 80+ percent of people have some sort of third party payment health insurance. A significant fraction of the remainder is eligible for Medicaid, which people can enroll in after they need health care.
The comment that urgent care centers are not as well equipped as an ER is also not applicable as the Commonwealth study was limited to primary care practices which may not be as well equipped as an urgent care center.
Finally, it is not clear that your statements about ER payment policies is correct. Hospitals are becoming much more sophisticated about collecting from ER patients whether or not they plead poverty when they arrive.
Another hospital trend is a determination to collect of cash payments if you want treatment at the ER and your condition isn’t serious. The ER staff will do free triage. If your condition isn’t serious, an increasing number of hospitals will then demand cash to continue. People who demand free care may be offered a regular appointment at the hospital’s federally qualified clinic.
[…] an earlier post on this blog pointed out, Commonwealth appears to ignore the fact that after-hours care in the U.S. is increasingly specialized. Rather than relying on their primary care physicians, who, after all, need their sleep, U.S. […]
I would both echo and update Linda’s post. At latest count (just yesterday) there are 8774 urgent care centers in the country. While most are not open 24/7, they have extended night and weekend hours and do see a broad scope of conditions.
The $275 visit would be a pretty expensive visit in an urgent care center – if you had a fracture that required x-rays and a cast, for instance. In studies that have looked at ER vs. UC costs (for the same kind of visit – which is about 29% of what was seen in the ER) the difference is still about 3 times an urgent care visit for the same thing.
I am delighted to see the original blog post acknowledging the huge, albeit quiet, contribution urgent care centers make to the delivery of health care in the U.S.
Lou Ellen Horwitz
Executive Director
Urgent Care Association of America
Great read. Just a heads up, your Feed option is not working properly in Flock operating on Windows7.