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Urgent Care Centers Delay Emergent Surgical Care Based On Patient Insurance Status In The United States
*Walter R Hsiang, *Daniel Wiznia, *Laurie Yousman, *Michael Najem, *Alison Mosier-Mills, *Siddharth Jain, *Akshay Khunte, Kimberly A Davis, *Howard Forman, *Kevin M Schuster
Yale School of Medicine, New Haven, CT

OBJECTIVE(S): Patients may call urgent care centers (UCCs) with urgent surgical conditions but may not be properly referred to a higher level of care. This study aims to characterize how UCCs manage patients calling with an emergent condition based on insurance status.
METHODS: Using a standardized script, we called 1,245 randomly selected UCCs in 50 states on two occasions. Investigators posed as either a Medicaid or privately insured patient with symptoms of an incarcerated inguinal hernia. Rates of direct emergency department (ED) referrals were compared between insurance types.
RESULTS: 1223 (98.2%) UCCs accepted private insurance, and 972 (78.1%) accepted Medicaid. Direct-to-ED referral rates for private and Medicaid patients were 27.9% and 33.7%, respectively. At UCCs that accepted both insurance types, Medicaid patients were significantly more likely than private patients to be referred to the ED (OR 1.32, 95%CI 1.09-1.60). Private patients who were triaged by a clinician compared to clinic staff were over six times more likely to be referred to the ED (OR 6.46, 95%CI 4.63-9.01). Medicaid patients were nearly nine times more likely to have an ED referral when triaged by a clinician (OR 8.72, 95%CI 6.19-12.29).
CONCLUSIONS: Only one-third of UCCs in the United States referred an apparent emergent surgical case to the ED, potentially delaying care. Privately insured patients were less likely to be referred directly to the ED than Medicaid patients. Patients triaged by a clinician had significantly increased likelihood of being referred to the ED; however, the disparity between private and Medicaid patients remained.


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