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"When possible, we recommend that our members visit their primary care physicians for non-emergency treatment," said Dr. Robert McCormack, Blue Cross and Blue Shield of Georgia (BCBSGA) medical director. "If that's not an option, in cases where patients are looking for treatments related to allergies and colds--such as sinus infections, sore throats, ear infections and bronchitis--it just makes more economic sense to go to a retail health or urgent care clinic."
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In addition, the study, conducted by HealthCore, Inc., BCBSGA's parent company's outcomes research subsidiary, showed that few patients who received care at retail health clinics or urgent care clinics needed follow-up care for their ailment, implying that they received the appropriate level of care, said John Barron, HealthCore director for health plan research.
Members may pay less by using retail health clinics, often located in retail stores, supermarkets and pharmacies, or urgent care clinics, typically staffed full-time by physicians, rather than hospital emergency rooms for mild upper respiratory ailments commonly associated with allergies and the common cold.
The comprehensive study of members in 14 states found that nearly one in five ER visits (19.4 percent) were for non-emergencies, including conditions such as upper respiratory infections, sore throats, or urinary tract infections. This is during a time when ER visits have increased 31 percent in 2005 over 1995 and ER waits to see a physician have increased from 38 minutes in 1997 to 56 minutes in 2005, according to federal government statistics.
Bronchitis, one of the more expensive conditions to treat, cost $646 to treat in the ER, compared with $97 for an urgent care visit and $54 for a retail health clinic visit, according to the study. Average costs for ER visits for all conditions studied ranged from $441 for the ER to $98 for urgent care and $52 for retail care. These costs represent total costs, including the portion paid by the health plan member.
The HealthCore study showed that for every member treated at retail health clinics, about 15 others are treated in the ER for the same condition.
The study also looked at overall costs to treat individual episodes over a two-week period for ailments associated with allergy, cold and flu, along with conjunctivitis and urinary tract infections. In this case, ER episodes cost an average $500, while urgent care cost $150 and retail health clinic cost $90.
Generally, retail health clinics and urgent care clinics may be used for the following:
Emergency rooms should be used for those with the following conditions:
*Savings are based on the difference in patient co-pays, as well as those patients with high deductible plans who may pay the entire cost of the ER visit.
About HealthCore
HealthCore, based in Wilmington, Del., is the clinical outcomes research subsidiary of WellPoint. HealthCore has a team of highly experienced researchers including physicians, biostatisticians, pharmacists, epidemiologists, health economists and other scientists who study the "real world" safety and effectiveness of drugs, medical devices and care management interventions. HealthCore offers insight on how to best use this data and communicates these findings to health care decision-makers to support evidence-based medicine, product development decisions, safety monitoring, coverage decisions, process improvement and overall cost-effective health care. For more information, go to www.healthcore.com.
About Blue Cross and Blue Shield of Georgia:
Blue Cross and Blue Shield of Georgia, Inc. and Blue Cross and Blue Shield Healthcare Plan of Georgia, Inc. are independent licensees of the Blue Cross and Blue Shield Association(® ). The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Additional information about Blue Cross and Blue Shield of Georgia is available at www.bcbsga.com.
-- Minor allergic reactions -- Mild asthma -- Coughs, sore throat -- Bumps, minor cuts, scrapes -- Rashes, minor burns -- Sprains, strains -- Minor fevers, colds -- Minor headaches -- Ear or sinus pain -- Burning with urination -- Eye swelling, irritation, redness or pain -- Back pain -- Nausea, vomiting, diarrhea -- Minor animal bites -- Vaccinations -- X-rays -- Stitches
SOURCE Blue Cross and Blue Shield of Georgia, Inc.
