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

Abstract

Musculoskeletal urgent care centers (MUCCs), alongside general urgent care centers, have rapidly emerged across the US, ostensibly as an alternative to emergency departments (EDs) and general urgent care centers. Although these orthopedic-specific urgent care centers have had increased use, their effect on access to musculoskeletal care is unclear. There is conflicting research on the benefits and drawbacks of MUCCs, with some literature demonstrating a potential reduction in both cost of care and wait times and other studies questioning long-term savings associated with use of MUCCs.^1,2 Regardless, the increased access to orthopedic specialists that an MUCC provides is not equally available to all patients. In a recent study of 29 MUCCs in Connecticut, most clinics either denied patients with Medicaid insurance or implemented barriers to care that were not experienced by their privately insured counterparts.³ In a comprehensive national survey of all MUCCs in the US, half of all centers surveyed did not accept Medicaid insurance.⁴ Given the large number of uninsured patients in the US, it is important to characterize the charges that patients without insurance coverage would incur if they were to seek urgent orthopedic care at these centers. Furthermore, freestanding EDs providing urgent care services have been established in areas with a more profitable payer mix.⁵ To our knowledge, no studies have characterized the payment practices of MUCCs for uninsured patients. In addition, identifying the factors associated with charges for care is imperative to understanding how the relatively new and largely unexplored MUCCs fit into the broader system of health care in the US. In conducting this survey, we assessed out-of-pocket costs and factors associated with these costs at MUCCs. We hypothesized that Medicaid acceptance would be associated with a reduction in out-of-pocket charges.