Additionally, she said, the authors are relying on an assumption that these patients would know whether they needed emergency care in a hospital or not. She recounted a story of a man who appeared in an emergency room complaining of simple shoulder pain but who turned out to be having the earliest symptoms of a myocardial infarction. "A few minutes later he was in the cath lab," a life that was saved as a result, she said.
"I don't have any problems with urgent care as a concept. But the trouble is there is variability in that kind of care, and a lay person doesn't know what that variability is."
She added that for a hospital, "you can know if it passed its Joint Commission certification and if it's Medicare-qualified. You can ask about credentials of the doctors. But in a retail clinic, I don't know that you can."
The RAND report suggests that patients with less acute conditions, such as strains, fractures and lacerations, could direct themselves to retail clinics or urgent care centers just as effectively as if they had gone to a hospital emergency room and endured the long wait, saving .2% of the nation's healthcare costs and avoiding long emergency room waits at the same time.
"Although many policy makers may prefer that patients seek care for nonemergency conditions from a primary care provider, acute care is increasingly provided outside of the primary care setting," the authors conclude.
"New initiatives such as medical home demonstrations and accountable care organizations encourage the use of primary care and seek to improve access to it. However, these initiatives are unlikely to provide a widespread solution in the near term," the authors wrote.
While the healthcare reform bill will provide health coverage to as many as 32 million people. But when they have an urgent care issue, they may not be able to see a doctor. Instead, they will further crowd emergency rooms.
The Massachusetts experience is a case in point, the RAND researchers noted, because even as the numbers of insured increased, there was not a corresponding drop in low-acuity emergency department visits.
The RAND researchers based their evaluation of 354 million annual visits for acute care in three types of settings between 2001 and 2004—retail clinics, urgent care centers and emergency departments.