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Is It An Emergency? Helping Your Employees Understand the Cost Difference Between Emergency and Urgent Care

Posted June 29, 2022

When it comes to the appropriate utilization of high-cost services like the emergency room (ER), one of the best ways employers can help reign in their healthcare expenses is through employee education.

By design, ERs are expensive to manage and run because of the high-tech equipment, maintenance and supplies required to treat medical emergencies as well as the personnel needed to keep them open and operating 24/7. When your employees unnecessarily over utilize the ER for their care, these costs eventually affect your company’s bottom line via soaring healthcare costs and rising premiums.

Research shows a large percentage of ER visits are unnecessary. Those unnecessary visits cost the U.S. healthcare system anywhere from $4.4 billion up to $32 billion annually according to the Agency for Healthcare Research and Quality. Why does this happen? Because when faced with where to seek care after hours and on weekends when their physician’s office is closed, many people go to the ER when they should be choosing an urgent care setting.

The cost difference between the two is also staggering. ER visits for common conditions cost 10 times more than treating the exact same condition in an urgent care center. One of the best ways to help deter unnecessary trips to the ER is by assigning these visits a higher out of pocket cost via copays and deductibles in employees’ annual premiums. Doing so will force your employees to think twice about whether the reason they’re seeking care in the ER is truly emergent.

What Constitutes Emergent Care?

The simplest way to think about whether something requires emergency care is to consider whether the health condition is threatening to life or limb, meaning it could permanently impair or endanger a person’s life. While it’s sometimes a judgment call, reasons to go to the ER include severe chest pain; fracture; shortness of breath; high fever (which could signify a life-threatening infection); consistent vomiting; poisoning; head and eye injuries; internal bleeding; severe allergic reaction; significant headache; or unconsciousness. ER visits are prioritized based on severity – meaning long wait times should be expected for patients with non-life-threatening injuries.

On the other hand, conditions that are non-emergent, but still require immediate treatment for symptom relief, are appropriate for an urgent care center. These include fevers, flu and cold symptoms, ear infections, sore throat, animal bites, cuts, sprains and strains, mild asthma, and urinary tract infections. Urgent care visits are generally first-come, first-served.

Helping Your Employees Make Smart Healthcare Decisions

Employees have the right to decide where to seek care based on what they deem emergent; however, monetarily incentivizing them to be more deliberate in their decision making doesn’t hurt. Whether your company is self-insured or fully funded, excessive ER costs will eventually drive-up renewal rates and costs for both employer and employee. It’s also important to note insurance companies can deny paying a claim if they believe appropriate care could have been sought elsewhere – leaving your employees with a hefty bill.

The best way to help your employees make more informed healthcare decisions is to build robust employee education through your internal communication channels. Some things to consider include:

  • A symptom checker list with guidance on whether treatment should be sought in an ED or urgent care setting.
  • Education about the cost of an ER visit (including transport by private ambulance) during open enrollment or ongoing employee education meetings.
  • When to call 9-1-1.
  • A regional list of in-network urgent care settings and providers, including hours and days of operation, addresses and phones numbers.
  • Virtual alternatives to urgent care like telehealth options and nurse hotlines covered under their plan.
  • Quarterly reminders about the value of urgent care during cold, flu or allergy season, sports seasons, school and summer vacation.

Need help spreading the word? Ask your insurance broker or your company’s public relations or human resources team for ideas.