Urgent Care Centers Delay Emergent Surgical Care Based on Patient Insurance Status in The United States

Authors

Walter R. Hsiang, Yale School of Medicine, New Haven, CT.Follow
Daniel Wiznia, Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, CT.
Laurie Yousman, Yale School of Medicine, New Haven, CT.
Michael Najem, Yale School of Medicine, New Haven, CT.
Alison Mosier-Mills, Yale School of Medicine, New Haven, CT.
Grace Jin, Yale School of Medicine, New Haven, CT.
Siddharth Jain, Yale School of Medicine, New Haven, CT.
Akshay Khunte, Yale School of Medicine, New Haven, CT.
Kimberly A. Davis, Department of Surgery, Division of General Surgery, Trauma, and Surgical Critical Care, Yale School of Medicine, New Haven, CT.Follow
Howard P. Forman, Yale School of Medicine, New Haven, CT.
Kevin M. Schuster, Department of Surgery, Division of General Surgery, Trauma, and Surgical Critical Care, Yale School of Medicine, New Haven, CT.Follow

Document Type

Article

Publication Title

Annals of surgery

Abstract

OBJECTIVE: Patients may call urgent care centers (UCCs) with urgent surgical conditions but may not be properly referred to a higher level of care. This study aims to characterize how UCCs manage Medicaid and privately insured patients who present with an emergent condition. METHODS: Using a standardized script, we called 1245 randomly selected UCCs in 50 states on 2 occasions. Investigators posed as either a Medicaid or a privately-insured patient with symptoms of an incarcerated inguinal hernia. Rates of direct emergency department (ED) referral were compared between insurance types. RESULTS: A total of 1223 (98.2%) UCCs accepted private insurance and 981 (78.8%) accepted Medicaid. At the 971 (78.0%) UCCs that accepted both insurance types, direct-to-ED referral rates for private and Medicaid patients were 27.9% and 33.8%, respectively. Medicaid patients were significantly more likely than private patients to be referred to the ED [odds ratio (OR) 1.32, 95% confidence interval (CI) 1.09-1.60]. Private patients who were triaged by a clinician compared to nonclinician staff were over 6 times more likely to be referred to the ED (OR 6.46, 95% CI 4.63-9.01). Medicaid patients were nearly 9 times more likely to have an ED referral when triaged by a clinician (OR 8.72, 95% CI 6.19-12.29). CONCLUSIONS: Only one-third of UCCs across the United States referred an apparent emergent surgical case to the ED, potentially delaying care. Medicaid patients were more likely to be referred directly to the ED versus privately insured patients. All patients triaged by clinicians were significantly more likely to be referred to the ED; however, the disparity between private and Medicaid patients remained.

First Page

548

Last Page

553

DOI

10.1097/SLA.0000000000004373

Publication Date

10-1-2020

Recommended Citation

Hsiang, Walter R.; Wiznia, Daniel; Yousman, Laurie; Najem, Michael; Mosier-Mills, Alison; Jin, Grace; Jain, Siddharth; Khunte, Akshay; Davis, Kimberly A.; Forman, Howard P.; and Schuster, Kevin M., "Urgent Care Centers Delay Emergent Surgical Care Based on Patient Insurance Status in The United States" (2020). Surgery. 43.
https://scholar.bridgeporthospital.org/surgery/43

Identifier

32932304 (pubmed); 10.1097/SLA.0000000000004373 (doi); 00000658-202010000-00003 (pii)