Charges for Initial Visits for Uninsured Patients at Musculoskeletal Urgent Care Centers in the US

• Published in: JAMA network open Vol. 5; no. 5; p. e229968
• Main Authors: Yousman, Laurie C, Hsiang, Walter R, Khunte, Akshay, Najem, Michael, Jin, Grace, Mosier-Mills, Alison, Jain, Siddharth, Wiznia, Daniel
• Format: Journal Article
• Language: English
• Published: United States American Medical Association 02.05.2022
• Subjects: Ambulatory Care Facilities; Fees and Charges; Humans; Insurance Coverage; Medicaid; Medically Uninsured; Online Only; Original Investigation; Orthopedics; Patients; Postal codes; Reimbursement; United States; United States; United States > US
• DOI: 10.1001/jamanetworkopen.2022.9968
• ISSN: 2574-3805

In recent years, specialized musculoskeletal urgent care centers (MUCCs) have opened across the US. Uninsured patients may increasingly turn to these orthopedic-specific urgent care centers as a lower-cost alternative to emergency department or general urgent care center visits. To assess out-of-pocket costs and factors associated with these costs at MUCCs for uninsured and underinsured patients in the US. In this survey study, a national secret shopper survey was conducted in June 2019. Clinics identified as MUCCs in 50 states were contacted by telephone by investigators using a standardized script and posing as uninsured patients seeking information on the out-of-pocket charge for a new patient visit. State Medicaid expansion status, clinic Medicaid acceptance status, state Medicaid reimbursement rate, median income per zip code, and clinic region. The primary outcome was each clinic's out-of-pocket charge for a level 3 visit, defined as a new patient office visit requiring medical decision-making of low complexity. Linear regression was used to examine correlations of price with clinic policy against accepting Medicaid, median income per zip code, and Medicaid reimbursement for a level 3 visit. Of 565 MUCCs identified, 558 MUCCs were able to be contacted (98.8%); 536 of the 558 MUCCs (96.1%) disclosed a new patient visit out-of-pocket charge. Of those, 313 (58.4%) accepted Medicaid insurance and 326 (60.8%) were located in states with expanded Medicaid at the time of the survey. The mean (SD) price of a visit to an MUCC was $250 ($110). Clinic policy against accepting Medicaid (β, 22.91; 95% CI, 12.57-33.25; P < .001), higher median income per zip code (β, 0.00056; 95% CI, 0.00020-0.00092; P = .003), and increased Medicaid reimbursement for a level 3 visit (β, 0.737; 95% CI, 0.158-1.316; P = .01) were positively correlated with visit price. The overall regression was statistically significance (R2 = 0.084; P < .001). In this survey study, MUCCs charged a mean price of $250 for a new patient visit. Medicaid acceptance policy, median income per zip code, and Medicaid reimbursement for a level 3 visit were associated with differences in out-of-pocket charges. These findings suggest that accessibility to orthopedic urgent care at MUCCs may be limited for underinsured and uninsured patients.