Unnecessary emergency room claims can drive up your company’s healthcare costs. However, it may be possible to reduce those claims and related expenses significantly, simply by better educating employees on their choices. Helping employees understand when to seek treatment at an emergency room vs. an urgent care or walk-in clinic can make a huge difference in the amount of premiums you — and they — pay for health insurance year over year.

Of course, there are times when employees need immediate medical attention, and they should be able to get the care they need when they need it. Employees who experience life-threatening illnesses or injuries should seek the emergency care they find most appropriate.

Not every incident needs to be treated in an emergency room setting, but an employee may not want to — or be able to — wait to try to get an appointment with their primary care doctor. For health issues that are uncomfortable but not life-threatening, such as a severe sore throat, allergies or minor cuts and sprains, sometimes a visit to an urgent care center is not only more convenient, but also more cost-effective, for both employees and employers. 

Urgent Care Centers Cost Less

An Urgent care center is a walk-in clinic that treats illnesses or injuries requiring immediate care, but that aren’t serious enough for an emergency room visit. And in today’s increasingly virtual world, seeking healthcare by telemedicine (if your plan offers it) means employees don’t even have to leave the house.

Urgent care centers have been around since the 1970s, but they have proliferated in recent years. In fact, the number of urgent care centers in the U.S. reached more than 9,600 in 2019 — a 9.6% increase from 2018. Employees can seek medical attention at urgent care centers for a variety of conditions, including earaches, sore throats or coughs, flus and fevers — even Covid-19 testing. The staff at urgent care centers includes doctors and nurses, and some even offer advanced services such as x-rays, labs and MRIs. Many urgent care centers also offer extended hours that serve individuals with illnesses and injuries outside the scope or availability of a primary care physician, but that don’t require emergency care. 

Despite the number of urgent care centers and treatment options available, employees may still choose to visit the ER (especially if their doctor is closed and they get sick on a weekend) because they feel they need care right away. However, seeking treatment for common, non-life-threatening ailments in an ER can result in costly and unnecessary claims. Employers, and employees, may end up paying far less if these conditions are treated in an urgent care center, or even by telemedicine, when available.

In fact, unnecessary ER visits for medical care that could be handled in an urgent care facility costs the U.S. healthcare system an extra $32 billion a year, according to a study from UnitedHealth Group. Much of that cost is absorbed by employers in the form of rising healthcare insurance premiums.

In addition, 18 million of the 27 million ER visits that occur each year are avoidable, according to the same study. Patients can receive the same, or better, quality care, safely and effectively, in lower-cost settings like an urgent care.

The average cost of treatment for 10 common primary care treatable conditions at a hospital emergency room is $2,032, the UnitedHealth Group study noted. That is 12 times higher than the cost of visiting a primary physician’s office ($167), and 10 times higher than an urgent care center ($193). These common conditions include: bronchitis, cough, dizziness, flu, headache, low back pain, nausea, sore throat, strep throat and upper respiratory infection.

If you offer a high-deductible health plan with a health savings account (HSA), the savings can be even more significant: For instance, employees may pay $180 for an urgent care visit vs. $2,200 to go to the ER. 

What’s more, the average wait time at an urgent care is around 15-30 minutes vs. two hours or more in the ER. If employees can seek treatment safely at an urgent care, the time and cost savings are well worth it. Many times urgent care centers can give you wait times and put your name on a waiting list online. 

Increasing Employee Awareness is Key

Of course, it isn’t enough to offer urgent care benefits as part of your health plan and expect employees to take advantage of it. As an employer, you must communicate to your workforce about available benefits, and when and why to use them. 

For instance, consider educating employees about the advantages of using urgent care vs. the ER — especially the cost savings — during annual open enrollment, as well as throughout the year. Remind them of the types of care they can seek at urgent care and the ER, and the potential financial impacts of choosing one vs. the other. It can also be helpful to provide a list of urgent care facilities in the region, as well as a list of services they offer, to encourage employee uptake. Make sure the list indicates which providers are in-network to avoid unnecessary out-of-network fees and claims. Also reminding employees of telemedicine options that might be available under the plan can offer convenient care at the comfort of one’s home. 

Reminders about urgent care during other key times of the year, including allergy and flu season, sports and school physicals, and summer vacations can also help encourage employees to use this valuable benefit.

Effective education can help eliminate unnecessary ER claims and encourage employees to use their urgent care benefits instead when it makes sense to do so. These simple changes can help employers and employees save money by keeping claims and insurance costs down year after year.

Need assistance getting the word out to employees about the benefits of urgent care? Talk to your healthcare broker, or HR Benefits Inc., a subsidiary of WTIA, for help. Contact Raven Mencias, Senior Sales Director, Benefit Programs, at rmencias@washingtontechnology.org to learn more about how we can support your healthcare program.