2014 ACEP URGENT CARE POLL RESULTS

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1 2014 ACEP URGENT CARE POLL RESULTS PREPARED FOR: PREPARED BY: 2014 Marketing General Incorporated 625 North Washington Street, Suite 450 Alexandria, VA toll free telephone fax

2 Table of Contents Study Background... 2 Sample Characteristics... 3 Findings... 8 Page 1

3 Study Background This survey is designed to capture a snapshot of the current trends in emergency medicine. Invitations to participate were sent on September 1, 2014, to a list of 26,900 current ACEP members. Of the 26,900 invitations sent, 1,382 s bounced, resulting in a net total of 25,518 sent invitations. To boost response rates, a reminder was sent to non-responders and noncompleters on September 4 th. A final reminder was sent the morning the survey closed on September 8 th. The survey officially closed on September 8 th at 11:59 p.m. EDT. Those respondents who indicated they only worked at an urgent care center were terminated from the study, as they were unable to answer the majority of the questions that asked about emergency departments. Therefore, a total of 2,853 surveys were completed, providing a response rate of approximately 11% and a margin of error of 1.8%. The margin of error, or standard error, is a statistical term used to measure the random fluctuations inherent in samples; the smaller the standard of error, the more accurate the measurement of the population or universe. This study s significance level of.05 carries with it a 95 percent confidence interval. The confidence interval is established as the likelihood that the same results would be achieved in a similar study, meaning that if we were to conduct this study 100 times, the same results plus or minus the margin of error (1.8%) would occur 95 out of 100 times. Page 2

4 Sample Characteristics Number of Responses per State STATE COUNT PERCENT STATE COUNT PERCENT Alabama 33 1% Missouri 54 2% Alaska Montana 8 -- APO AE 2 -- Nebraska 16 1% Arizona 52 2% Nevada Arkansas New Hampshire 23 1% California 230 8% New Jersey 74 3% Colorado 66 2% New Mexico 21 1% Connecticut 47 2% New York 214 8% Delaware 20 1% North Carolina 89 3% District of Columbia 9 -- North Dakota 3 -- Florida 123 4% Ohio 123 4% Georgia 73 3% Oklahoma 25 1% Guam 1 -- Oregon 56 2% Hawaii Pennsylvania 177 6% Idaho Puerto Rico 5 -- Illinois 131 5% Rhode Island 25 1% Indiana 53 2% South Carolina 43 2% Iowa 21 1% South Dakota 7 -- Kansas 17 1% Tennessee 30 1% Kentucky 31 1% Texas 205 7% Louisiana 33 1% Utah 29 1% Maine 19 1% Vermont 8 -- Maryland 67 2% Virginia 89 3% Massachusetts 71 3% Washington 90 3% Michigan 136 5% West Virginia 9 -- Minnesota 60 2% Wisconsin 60 2% Mississippi 17 1% Wyoming 4 -- Page 3

5 Top 11 Participating States STATE COUNT PERCENT 1. California 230 8% 2. New York 214 8% 3. Texas 205 7% 4. Pennsylvania 177 6% 5. Michigan 136 5% 6. Illinois 131 5% 7. Florida 123 4% 8. Ohio 123 4% 9. Washington 90 3% 10. North Carolina 89 3% 11. Virginia 89 3% Page 4

6 What is the emergency department patient volume where you work the majority of your time? Up to 10,000 2% 10,001-20,000 6% 20,001-30,000 9% 30,001-40,000 40,001-50,000 12% 12% 50,001-75,000 25% 75, ,000 19% 100, ,000 9% 151, ,000 More than 200,000 0% 1% n = 2,853 1% Work only at an urgent care center 4% 0% 5% 10% 15% 20% 25% 30% About 41% of respondents work in emergency departments with up to 50,000 patients. 44% of respondents work in facilities with a patient volume between 50,001 and 100,000. The largest percentage of participants (25%) report working in an emergency department with a patient volume between 50,001 to 75,000. Page 5

7 Are you involved in any way (e.g., ownership, management, staff, etc.) with urgent care centers? 18% Yes No n = 2,812 82% A large majority of respondents (82%) report that they are not involved in urgent care centers in any way. Page 6

8 In what type of geographic area is your emergency department located? 13% 47% Urban 40% Suburban Rural n =2,744 Nearly one half of participants (47%) indicate that they work in an urban emergency department. Page 7

9 Findings What percentage of patients in your emergency department are self-pay? Up to 10% 17% 11-25% 41% 26-50% 15% 51-75% 3% More than 75% 1% None 1% n = 2,738 22% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 41% of respondents report that approximately 11% to 25% of patients are self-pay. Page 8

10 What percentage of patients in your emergency department are Medicaid recipients? Up to 10% 6% 11-25% 34% 26-50% 28% 51-75% 6% More than 75% 1% None 1% 24% n = 2,738 0% 5% 10% 15% 20% 25% 30% 35% 40% About one third of respondents (34%) indicate that between 11% and 25% of their patients receive Medicaid. Further, 28% report that 26%-50% of patients in their emergency department are Medicaid recipients. Page 9

11 In the past year, has at least one urgent care center or more operated within 10 miles of your emergency department? 7% 8% 10% n = 2,745 76% Yes, only one Yes, more than one No 86% of participants report that at least one urgent care center operates within 10 miles of their emergency department, with 76% indicating more than one in operation. Page 10

12 In the past year, has the number of visits to your emergency department been affected by an urgent care center operating within 10 miles of your emergency department? 24% 21% n = 2,342 39% 16% Yes, emergency visits have decreased Yes, emergency visits have increased No, there has been no change Over one-third of respondents (37%) have noticed a change in the number of patients visiting the emergency department as a result of a local urgent care center. 21% have reported a decline in emergency visits while 16% have reported an increase in emergency visits. 39% of respondents indicate that over the last year there has been no change in the number of visits to their emergency department due to an urgent care center operating within 10 miles. Page 11

13 In your opinion, how is the growth in urgent care centers affecting the use of health care resources (such as physician visits, medical tests, procedures, etc.)? 29% 40% Increasing use of health care resources Decreasing use of health care resources No change in use of health care resources n = 2,659 22% 9% 40% of participants indicate that there has been an increase in the use of health care resources due to the growth in urgent care centers, while 22% report that there has been no change in the use of health care resources. Page 12

14 Has the growth of urgent care centers caused a change in the types of patients you see? 14% 15% n = 2,556 43% 29% Yes, significant change Yes, little change No change 43% of respondents indicate that the growth of urgent care centers has not caused a change in the types of patients they see, while 29% report that they have seen only a little change in the types of patients seen. Page 13

15 How have your patients changed as a result of the growth in urgent care centers? Check all that apply. More complicated issues 77% Less insured Lower income 54% 53% Older 39% Younger Less complicated issues More insured 3% 2% 4% Higher income Other 1% 6% n = 1,090 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% An overwhelming majority of respondents (77%) report that the main change due to the growth in urgent care centers is that they see patients with more complicated issues. 54% report their patients are less insured, and 53% say that their patients have a lower income. Page 14

16 Will urgent care centers pull more patients from emergency care or primary care? Both 51% Primary care 22% Emergency care 13% Neither 6% 8% n = 2,663 0% 10% 20% 30% 40% 50% 60% Just over half of participants (51%) indicate that urgent care centers will pull patients from both emergency care and primary care, while nearly a quarter of respondents (22%) report that urgent care centers will pull more patients from primary care. Page 15

17 Are urgent care centers in your area marketing themselves as alternatives to the emergency department? 10% 15% 21% 54% Yes Some, but not all No n = 2,659 More than half the participants (54%) report that urgent care centers in their area are marketing themselves as alternatives to the emergency department. 21% indicate that only some of the urgent care centers are doing so. Page 16

18 Should urgent care centers be subject to EMTALA regulations? 12% 49% 39% Yes No n = 2,661 Nearly half of respondents (49%) indicate that urgent care centers should be subject to EMTALA regulations, while 39% disagree. Page 17

19 Should states have specific staffing or equipment criteria for urgent care centers? 9% 1% 18% Yes n = 2,662 72% No A large majority of participants (72%) believe that states should have specific staffing or equipment criteria for urgent care centers. 18% of respondents, however, do not think states should have such criteria for urgent care centers. Page 18

20 How often are patients referred to your emergency department from an urgent care facility? More than once in a day 54% Once a day 17% Once or twice a week 19% Once or twice a month 4% Once or twice a year 1% Never 1% 5% n = 2,556 0% 10% 20% 30% 40% 50% 60% Over half the participants (54%) report that patients are referred to their emergency department from urgent care centers more than once a day. Only 1% of respondents indicate that patients are never referred to their emergency department from an urgent care center. Page 19

21 What are the primary reasons that patients are redirected to an emergency department from an urgent care facility? (Select top 2 reasons.) Medical condition was potentially more serious than patient thought 90% Limited equipment and staffing compared to emergency department 65% Did not have appropriate insurance or ability to pay at time of urgent care visit 14% Could not get a timely appointment 3% Other (please specify) 6% n = 2,623 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% A vast majority of participants (90%) report that patients were redirected to the emergency department because the medical condition was potentially more serious than the patient thought. Further, 65% indicate that the patient was redirected to the emergency department from the urgent care center because of the limited equipment and staffing at the urgent care center. Page 20

22 Of your patients who could have been safely treated at an urgent care center, why did they choose to go to the emergency room? (Select top 2 reasons.) Did not have appropriate insurance or ability to pay urgent care center Patient thought emergency room was a better option to take care of them Patients thought symptoms indicated a medical emergency 31% 33% 44% Urgent care center was closed Could not get in to see a physician in a timely manner (either appointment or walk-in) Unfamiliarity with urgent care centers 19% 22% 21% Perception that the quality of care at emergency room is safer Other (please specify) 4% 14% n = 2,494 0% 10% 20% 30% 40% 50% According to 44% of respondents, patients chose to go to the emergency department although they could have been safely treated at an urgent care center because of a lack of appropriate insurance or inability to pay the urgent care center. One third of participants (33%) also say that another primary reason is that the patient thought the emergency room was a better option. Page 21

23 Are urgent care centers in your area staffed by physicians on site? 5% 10% 44% 40% No Yes Some, but not all n = 2,654 44% of participants indicate that some of the urgent care centers in their area are staffed by physicians on site, but not all of them are. Moreover, 40% report that all the urgent care centers in their area are staffed by physicians on site. Page 22

24 Do urgent care centers in your area have access to on-call specialists? 9% 35% 22% Yes Some, but not all No n = 2,659 34% Just over one third of participants (35%) indicate that the urgent care centers in their area do not have access to on-call specialists. However, 22% of respondents report that some urgent care centers do have access to such specialists, while 9% say the urgent care centers in their area do have access to on-call specialists. Page 23

25 Do urgent care centers in your area take Medicaid? 14% 46% 19% Yes No Some, but not all n = 2,658 21% Only 14% of respondents indicate that urgent care centers in their area take Medicaid, while 21% say that some urgent care centers do, but not all of them. 19% of participants say that urgent care centers in their area do not take Medicaid. Page 24

26 Do urgent care centers in your area have a triage process? 20% 63% 4% 13% Yes No Triage not needed n = 2,655 Only 20% of respondents indicate that the urgent care centers in their area have a triage process. 13% of participants report that urgent care centers near them do not have a triage process. Only 4% say that triage is not needed at the urgent care centers in their area. Page 25

27 How many patients would you estimate your emergency department treated in the past year that first went to urgent care centers for life-threatening conditions (e.g., chest pain, stroke symptoms, difficulty breathing, etc.), instead of going directly to the emergency room? % % % 6% % % 7% % 501-1,000 More than 1,000 8% 9% n = 2,537 None 1% 25% 0% 5% 10% 15% 20% 25% 30% About 30% of respondents report that over the past year their emergency department has treated up to 100 patients who originally went to urgent care centers for life-threatening conditions, and close to one-quarter (23%) indicate that were patients who originally went to an urgent care center were treated in their emergency department for a lifethreatening condition. 9% of respondents report their emergency department had more than 1,000 patients who originally went to an urgent care center for a life-threatening condition. Page 26

28 How concerned are you that patients with serious medical conditions may go to urgent care centers first before going to the emergency department? 2% 23% 20% Very concerned Somewhat concerned Not at all concerned n = 2,647 56% A total of 76% of participants indicate that they have at least some concern about patients with serious medical conditions going to an urgent care center before going to the emergency department. Less than one quarter of participants (23%) say that they are not at all concerned. Page 27

29 Using a prudent layperson standard (i.e., people should seek emergency care based on their symptoms and not final diagnosis), what percentage of patients treated in your emergency department in the past year could have gone to an urgent care center instead? Up to 10% 21% 11-25% 45% 26-50% 24% 51-75% 5% More than 75% 1% None 0% 5% n = 2,544 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Just less than one half of participants (45%) report that approximately 11% to 25% of patients treated in their emergency department in the past year could have gone to an urgent care center instead. Page 28

30 What percentage of patients can determine for themselves whether or not they require emergency care? Up to 10% 18% 11-25% 24% 26-50% 24% 51-75% 13% More than 75% 8% No patients 3% 11% n = 2,651 0% 5% 10% 15% 20% 25% 30% Nearly one quarter of participants (24%) indicate that between 11% and 25% of patients can determine for themselves whether they require emergency care. Moreover, 24% of respondents believe that between 26% and 50% of patients can determine for themselves if they need emergency care. Page 29

3+ 3+ N = 155, 442 3+ R 2 =.32 < < < 3+ N = 149, 685 3+ R 2 =.27 < < < 3+ N = 99, 752 3+ R 2 =.4 < < < 3+ N = 98, 887 3+ R 2 =.6 < < < 3+ N = 52, 624 3+ R 2 =.28 < < < 3+ N = 36, 281 3+ R 2 =.5 < < < 7+

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