Given the high costs of emergency departments, many insurance plans have created incentives to encourage patients to receive that care elsewhere. But the jury is still out on how much of the shift is digital.

Consumers are using the emergency room far less frequently than before, but it’s too early to see how many patients are shifting to telehealth.

In new research from Brigham and Women’s Hospital in Boston, hospital researchers looked at more than 20 million emergency room visits over seven years from 2008 through 2015. The research found that there was a large drop in emergency room visits and a substantial increase in the use of urgent care centers. Retail clinics and telemedicine utilization also increased substantially during this time, but when compared to urgent care centers and emergency rooms, they still accounted for a small number of visits, says Brigham and Women’s.

Visits to the emergency room for the treatment routine, or low-acuity, conditions decreased by 36%, while use of non-emergency room centers increased by 140%. There was an increase in visits to all other venues, including a 119% increase at urgent care centers. Overall, across all acute care centers, the number of visits increased by 31% and spending associated with low-acuity conditions increased by 14%. The increase in spending was primarily driven by a 79% increase in price per emergency room visit for treatment of low-acuity conditions, the hospital says.

Specific findings include:

  • Visits to the emergency room for the treatment of routine conditions decreased by 36% (from 89 visits per 1,000 members in 2008 to 57 visits per 1,000 members in 2015).
  • Use of walk-in clinics and urgent care centers increased by 140% (from 54 visits per 1,000 members in 2008 to 131 visits per 1,000 members in 2015).
  • There was an increase in visits to all urgent care centers (119% increase, from 47 visits per 1,000 members in 2008 to 103 visits per 1,000 members in 2015); retail clinics (214% increase, from 7 visits per 1,000 members in 2008 to 22 visits per 1,000 members in 2015), and telemedicine (from 0 visits in 2008 to 6 visits per 1,000 members in 2015).
  • Spending per patient per year for routine conditions had net increases of 31% (from 143 visits per 1,000 members in 2008 to 188 visits per 1,000 members in 2015) and 14% ($70 per member in 2008 to $80 per member in 2015), respectively.

“The increasing popularity of alternatives to the emergency department is likely being driven by a variety of factors, including cost, convenience and long wait times,” says Jay Schuur, emergency physician at Brigham and Women’s and researcher. “In the next few years, it will be important to see how these trends evolve and whether the growth of alternative sites results in lower cost care or more use of medical care.”

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Treatment for new health problems, or acute care visits, encompass over one-third of all ambulatory care delivered in the U.S. Given the high costs of emergency departments, many insurance plans have created incentives to encourage patients to receive that care elsewhere. In response to patient expectations for more convenience and to long wait times at traditional physician outpatient practices, alternative care facilities such as urgent care centers, retail clinics and telemedicine have rapidly emerged, the hospital says.

But given the newness of telehealth and the timeframe of the data studied by Brigham and Women’s before the rapid advancement of the number of hospitals rolling out digital doctor services, it’s too soon to tell how many former trips to the emergency room will be handled by digital health alternatives.

“The drop-in emergency department visits are quite striking and represent a substantial shift in where patients go to get care for conditions such as sore throat and minor injuries,” says Sabrina Poon, an emergency physician.

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