After primary care doctors close their doors on weekends and evenings, patients turn to urgent care facilities, pharmacy ‘minute clinics’, and emergency rooms to get the care they need. In doing so, they may also be contributing to the nation’s skyrocketing health system costs.
“When a patient shows up in the emergency room, the assumption is usually that they are more likely to be sick than not,” says Dr. Anthony Jerant, a professor of family and community medicine at the University of California-Davis School of Medicine.
Just being inside an emergency room is expensive. “[The doctor] might be thinking ‘wow, if they felt bad enough to come to an urgent care or emergency room they must be sick. So we should do a pretty through work-up and do every test known to man.’” And since emergency room providers are unfamiliar with a patient’s medical history, they will order multiple tests “because they don’t want to miss something,” Jerant says.
All of this adds up — but Jerant and his team of researchers at the UC Davis Center For Health Care Policy Research published a study in the September/October Annals of Family Medicine that offers a suggestions that can help patients avoid this scenario.
The study was based on data collected from 2000 to 2008 regarding more than 30,000 patients between 18 and 90 years old, all of whom had a usual source of health care. Each patient was followed for two years, and reported whether their health care provider offered extended office hours — the point for researchers’ comparison of the patients’ expenditures and utilization rates. The study also adjusted for the differences in chronic conditions, health status, health insurance and health care utilization among patients.
The researchers found that when physicians expanded their office hours, patients’ health care costs were reduced by more than 10 percent.
Patients with “access to extended hours had less use and lower related expenditures for all subcategories of use,” according to the report. “People who said their office provided extended hours had lower prescription drug costs, and they had lower office visit billing costs, which is really essentially ordering tests,” Jerant says.
Part of the explanation could be the type of patients that seek out practices that have hours that accomdate them, he adds.
“It could be that [they] are already cost conscience. They are the type of people who don’t want to miss work and may be in favor of being thrifty in general. … That could help explain why the costs are lower. It may be more about them and their viewpoints and behaviors than anything the extended hours are actually doing.”
Jerant says his own clinic at UC-Davis in Sacramento extended its hours last year. “I think the biggest reason most practices do it, if they can swing it, is because patients like it. It’s the way to keep working patients in your practice essentially. … So I think it’s been positive in that regard,” Jerant says.
