#3: How Do the Costs Differ by Facility Type?

The cost to receive care from one type of healthcare facility versus the other can be significantly different.  While you will always want to seek the right level of care for your injury or illness, most people do not want to spend $5634.58 for acute abdominal pain when they could have paid $151.49, a difference of $5483.09.  For families on a tight budget who have high-deductible plans with copays, that kind of bill could be devastating.

Why is there such a difference?  In healthcare settings, the total cost to the patient is a product of the cost to run the health facility and the care and services received. The fundamental differences between FSERs and urgent care staffing, space, and available services result in significant differences in costs.

(Image Source: Urgent Care Association of America. http://www.ucaoa.org/page/faq)

Average Cost:  Free-Standing Emergency Rooms 

FSERs are typically associated with higher costs than Urgent Care Clinics (or “retail” or “walk-in” or “convenience” clinics). This is a result of their 24/7/365 staffing and the broader scope of services they provide. Facility fees are generally charged, which may come as a surprise to many consumers. According to Ayers (2013),2 facility fees have been, “historically charged by hospitals to cover the overhead of being prepared to handle any situation that presents, offset losses incurred in treating Medicaid populations, and to subsidize charity care/sliding fee scales serving the poor and indigent” (p.2).

Average Costs:  Urgent Care Clinics 

According to Boyle and Kirkpatrick (2012),4 urgent care services tend to be less expensive than the same services offered in an FSER setting, but can vary depending on the clinic’s size, staffing, and capacity. As urgent care clinics grow in size, offer more complex and advanced services, and hire physicians instead of nurse practitioners or physician assistants, they tend to charge higher rates to pay for higher levels of care. 

Even so, urgent care clinics tend to be less expensive than FSERs because they are free to operate only at peak-flow hours with no requirements to be staffed and open 24/7 like hospital-based emergency rooms and free-standing emergency rooms. Operating during “peak flow” means those times during the day when the majority of patients visit a clinic. Peak flow hours will vary from location to location, but can be advantageous when compared to a physician office in that no appointment is necessary and patients can walk in as desired.

Average Costs Comparison 

The Center for Improving Value in Health Care (CIVHC)[i] used data to create the following graph showing the most frequent reasons people visit free-standing emergency rooms and compare the median payments made for those services at FSERs in comparison with the median payment for the same services at urgent care clinics.  The information below attempts to provide a helpful comparison of the cost of FSERs and Urgent Care facilities.

Here is the same data presented in a different format, showing the actual dollar difference (possible savings).

Event FSER Cost UCC Cost Difference*
Abdominal Pain, generalized $4,180.93 $141.90 $4,039.03
Abdominal pain, other specified site $5,634.58 $151.49 $5,483.09
Acute bronchitis $1,139.11 $123.10 $1,016.01
Acute pharyngitis $955.51 $130.51 $825.00
Acute sinusitis, unspecified $786.23 $124.58 $661.65
Acupe upper respiratory infestions $1,114.04 $124.26 $989.78
Fever, unspecified $1,245.08 $135.73 $1,109.35
Headache $3,177.67 $135.64 $3,042.03
Open wound of finger(s) $1,034.78 $133.57 $901.21
Urinary tract infection $1,200.15 $112.43 $1,087.72
*What you would save by choosing an urgent care clinic over a free-standing emergency room. Based on original data from CIVHC chart above.

Conclusion 

There are significant cost differences between different types of facilities.  It is important for consumers to know the difference between facility types and choose wisely in their moment of need.

[i] To learn more about Center for Improving Value in Health Care’s work in, “advancing an exceptional health care system for Colorado,” visit their website: www.CIVHC.org.