|[May 03, 2012]
Emergency Room Visits on the Rise Due to Low Co-Pay Costs But Some Visits May Not be Necessary, According to 2012 Employee Medical Plan Trends Report
BOSTON --(Business Wire)--
Employees and their families are making more trips to the emergency room
(ER), urgent care facilities and specialists' offices as relatively low
co-pay costs are narrowing the gap between those and other services -
notably primary care physicians. The trends in employee co-pay are among
the latest findings in the 2012 Medical Plan Trends Report conducted by HighRoads
Executive Board (CEB) (NYSE: EXBD).
According to plan data, the average ER visit co-pay is just $76. The
relatively low costs may be leading employees to visit the hospital for
symptoms that a primary care physician or other provider could easily
and more cost-effectively treat. For example, toothaches and sprains are
among the 10 most common conditions for which Americans visit hospital
emergency rooms. While some ER visits are also likely attributable to
patients who lack insurance, the steady increase in visits appears
predominantly to be tied to co-pay costs.
The analysis also found the average plan has a relatively minimal price
differential between urgent care, in-network co-pay ($32) and primary
care physician (PCP) co-pay ($17). As a result, employees may be
choosing urgent care facilities simply for convenience since they tend
to keep evening and weekend hours and be open holidays.
Similarly, the price gap between specialists and PCPs is narrowing. From
2010 to 2012 the price differential has dropped from 82 percent to 35
percent higher for specialist visits. Analysis shows that the closer the
two costs get, the more likely employees are to see a specialist for an
issue that could have been addressed by their PCP.
"The interesting data on co-pays show employees are basically acting as
price-sensitive consumers and going for what they perceive as the best
value and convenience for the price," Ania Krasniewska, senior director, CEB.
"However, it also sounds a warning that some visits to ER and urgent
care facilities should, in fact, be handled at the more cost-effective
primary-care level. Not only does this affect cost to the employee in
the end, but in large quantities, this significantly affects the cost to
the organization," she observed.
In other new data, The Lab found:
Roughly one-third of plans charge no co-pay for cancer screenings, and
on average, co-pays are lower than PCP visits co-pays.
Nearly 40 percent of plans charge low ($10 or less) co-pays for
children's preventive care visits compared to for adults. Almost all
employers report that non-employee dependents are responsible for at
least 40 percent of the organization's health care costs.
It costs employees nearly twice as much to order a prescription
through their plan's mail order option, compared to visiting a retail
pharmacy. While mail-order co-pays are higher, they pay for a greater
quantity of the prescription medication (typically 90 days versus the
standard 30-day retail prescription).
"It is encouraging that the data shows good cost incentives for
employees to participate in cancer screenings," said Maureen Cotter,
Senior Principal, HighRoads. Preventive screenings are an absolutely
essential part of an effective wellness program for both employees and
The findings in this report are the result of the joint study conducted
by CEB and The Lab® benchmarking repository of health care benefit plan
data, covering more than 34 million lives and representing more than
For a copy of the report please contact Petra Marino at firstname.lastname@example.org.
The world's leading employers choose HighRoads to gain complete control
over their health care costs and compliance. With HighRoads' service,
employers have online access to benefits plan information and pricing,
competitive benefits benchmarks, and complete benefits management. The
privately-held company is headquartered in Woburn, MA. For more
information, visit www.HighRoads.com.
[ Back To TMCnet.com's Homepage ]