Lawmakers to CMS: Promote Urgent Care Centers to Address ER Crowding

Urgent care centers can treat many conditions commonly treated in emergency rooms, including sprains, fractures, lacerations, and urinary infections.

More than two dozen members of the U.S. House of Representatives have written a letter to the Centers for Medicare and Medicaid Services (CMS) asking the agency to pursue policies that would encourage patients with non-emergent needs to visit urgent care centers rather than emergency rooms.

Crowding at emergency rooms has become a national problem. According to CMS data, the median wait time for patients in emergency rooms has increased from 2 hours, 18 minutes in 2014 to 2 hours, 40 minutes in 2022. The average overall length of stay for emergency room patients increased from 184 minutes in 2019 to 205 minutes in 2022, according to the Emergency Department Benchmarking Alliance.

Daniel Roth, MD, executive vice president and chief clinical and community division operations officer at Trinity Health, says the health system is experiencing widespread crowding at its emergency rooms.

"Across Trinity Health, we are seeing crowding in our emergency rooms," he says. "It has a negative impact on care and our caregivers, and it leads to long wait times for our patients."

Emergency room crowding results in several negative consequences, Roth says.

"First and foremost, it is not a good patient experience—patients wait a long time in emergency rooms," he says. "Emergency room crowding can have a negative impact on care—care processes get slowed down. Emergency room crowding creates strain on caregivers—it is creating a strain on an already stressed group of nurses, technicians, and physicians, who are working harder than ever."

Solution for ER crowding

Urgent care centers represent a solution to the problem, the members of Congress said in their letter to CMS.

"Despite growing acknowledgment of the challenges caused by overcrowding in emergency rooms, few efforts to mitigate this problem have been successful. Resolving these issues will require significant public and private investment, and we believe that urgent care centers are an easily accessible resource that can reduce crowding by providing treatment to non-emergency patients in a more appropriate setting."

The lawmakers cited two 2019 studies that indicate urgent care centers can ease crowding at emergency rooms and reduce costs. A National Bureau of Economic Research study found that up to half of the annual 137 million emergency room visits could be treated at a less emergent facility. A Medicare Payment Advisory Committee report found that one-third of nonurgent emergency room claims could be appropriately treated in an urgent care center at a third of the cost.

Kevin DiBenedetto, MD, chief medical officer of Premier Health, which specializes in urgent care center joint ventures with health systems and hospitals, says urgent care centers can help ease emergency room crowding across the country.

"There are more than 14,000 urgent care centers in the country, so there are many of them in every state and Washington, DC," he says. "We think there is still room for more urgent care centers, but they are spread across every region of the United States."

DiBenedetto says many conditions that are commonly treated in emergency rooms can be treated at urgent care centers.

"Many conditions treated in hospital emergency departments can be treated at urgent care centers," he says "These conditions include sprains, fractures, lacerations, musculoskeletal injuries, respiratory illnesses, and urinary infections. Urgent care centers also can perform X-rays and diagnostic lab tests."

Urgent care centers are a key element of Trinity Health's care delivery strategy, Roth says.

"We are continuing to work in our partnership with Premier Health and with other urgent care centers across Trinity Health to try to improve access and to make sure patients know they have access to high-quality care in our urgent care centers when they need it and when they want it," he says. "We are committed to growing our urgent care centers, which serve our communities by providing access to healthcare at a low cost with high quality."

What CMS can do to promote urgent care centers

CMS should pursue policies in the Fiscal Year 2025 Physician Fee Schedule to encourage Medicare beneficiaries and Medicaid enrollees to use urgent care centers for non-emergent care needs, the lawmakers said in their letter.

Roth and DiBenedetto say CMS can help raise awareness about the benefits of treating nonemergent patients at urgent care centers rather than emergency rooms.

"Across Trinity Health, we provide communications, marketing, and patient information about what care is appropriate for seeing a primary care physician, urgent care centers, and emergency rooms," Roth says. "We are working in all of our communities to make sure patients have information about where they should go for certain conditions to help them be empowered consumers."

"It is a matter of awareness and getting primary care physicians to refer patients to urgent care centers," DiBenedetto says. "Urgent care centers are open seven days a week and, most of the time, 365 days a year. We are open more hours than a primary care doctor. Patients need to be made aware that no appointment is needed—it is on-demand care."