Blues plan exec: Urgent care centers don't pay

Insurers have turned to urgent care centers to curb costs by diverting patients with minor problems from the emergency room, but it remains to be seen whether the centers actually save money, The Buffalo News reported.

"The centers have not yet been successful at controlling health costs, and they have pulled volume away from primary care doctors," Raghu Ram, M.D., vice president and chief medical officer at BlueCross BlueShield of Western New York told the Buffalo News.

Blue Cross Blue Shield of North Carolina also has banked on urgent care clinics to help it defray the cost of hospital ER visits, noting that if just 5 percent of non-emergency patients sought treatment at urgent care centers instead of emergency rooms, medical spending could drop by $8 million a year, FierceHealthPayer previously reported.

But despite intentions to reduce costly ER use, BCBS of Western New York saw urgent care visits increase 135 percent from 2010 to 2012 among its members, while ER visits also rose 18 percent.

However, at Univera Healthcare, the Buffalo-area arm of Excellus Blue Cross Blue Shield, ER visits dropped 3 percent for the year ending in March. Physician office visits increased 3.7 percent and urgent care visits increased 27.3 percent.

As urgent care centers quickly emerge as a popular, cost-effective alternative to the ER, insurers are partnering with specific centers, the article noted, but not without conflict. For example, as of this month BlueCross BlueShield omits Immediate Care a participating provider after the urgent care organization company rebuffed its reimbursement rates.

Insurers also have problems with urgent care centers attracting patients with conditions that primary care physicians could treat at a lower cost.

"An urgent care infrastructure--with X-ray, CT scans and labs--has been built to treat higher-level conditions--things like lacerations and minor fractures," Blues' Ram told the newspaper. "Yet centers tend to treat a lot of low-intensity medical problems that should go to doctors. That has to change if we're going to get value out of the centers," he explained.

For more:
- here's the Buffalo News article

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