ER vs Urgent Care Jun 15,2017

Medical ( General Medical Subjects )


 

Emergency Room vs Urgent Care

Which One is Appropriate?

Patrick O’Neil, PA

 

 As a Physician Assistant who has been practicing for quite a few years now, I have had the opportunity to work in Family Practice Clinics, Urgent Care Centers, and Emergency Departments.  One of the things that constantly amazes me is that most people use them arbitrarily and with complete disregard to their intended uses.  It’s as if they have no real concept when to use which facility.  I have seen a patient come into an Emergency Department knowing full well he had athlete’s foot.  He knew what cream he needed, but he wanted it in prescription form.  I almost lost my mind!  The guy had waited for 6 hours to pick up a prescription for a medicine that is sold over-the-counter for $6.  I can’t even begin to think how much that tube ended up costing:  The cost of the ER to the insurance company; what the patient’s copay was; the ER staff time spent seeing something ridiculous and backing up the wait times even more for everybody else.

I have also been on the other end when an elderly patient came into my Urgent Care Clinic with chest pain, clutching his chest, sweating profusely, in obvious respiratory distress.  He was having a pretty severe heart attack.  Now here’s the kicker…..he passed a hospital to come to Urgent Care because he knew the Emergency Room bill would be a lot higher.  This guy actually thought a small neighborhood Urgent Care was capable of treating a heart attack.  I don’t mind telling you my “pucker factor” was maxed out while we dialed 911, ran an EKG, put an IV in his arm, and gave him aspirin and oxygen.  That was the extent of what I could do.  I had no cardiac medications, no cardiac lab tests, or advanced airway, cardiac cath, telemetry, etc.  The hospital Emergency Department has all that necessary stuff.  That knucklehead caused me to lose even more hair off my balding head!

My goal for this article is to give you the biggest bang for your healthcare dollars.  In other words, going to the appropriate facility that can meet your needs, without you spending too much of your hard earned cash.

 

THE PRIMARY CARE FACILITY

This is your Family Practitioner or Pediatrician’s office.  This will be your least expensive option for most routine illnesses.  They can handle the run-of-the-mill infections, sprains/strains to the joints, constipation, diarrhea, nausea, vomiting, sore throats, dry coughs, sinus infections, etc.  This will be your most economical way to treat a minor ailment.  The reimbursement rates from the insurance companies and your copay will be the least expensive when you go to your FP or Pediatric clinic. 

Know your clinic!  For example, my current Family Practice clinic has X-ray, Ultrasound, CT Scan, and MRI capability.  We can also do some basic labs.  We are a Family Practice clinic on steroids!  Very few primary care clinics have the capabilities that we possess.  We can handle a vast majority of ailments, diseases, and injuries that may affect our patients.  Other clinics may only have the bare minimum labs to check blood sugar and urine.  If your clinic does not have an x-ray, and you think you may have a fracture…..well, don’t go to your clinic!  Knowing what your clinic is capable of handling will save you time and money.  If you go to your clinic and they assess you; a bill will be coming your way.  Even if they tell you they can't handle it and you need to go to an Urgent Care or ER, they will bill you because you were triaged, and the doctor spent his valuable time to see you and determine he could not meet your needs at that moment.  You can avoid a "double bill" by knowing what they can/cannot treat. 

Here’s one of the biggest problems with primary care:  In most cases it is very difficult to get a “same day” appointment with your Primary Care Provider (PCP).  It can even be difficult to schedule a “next day” in many cases.  It’s not that your provider doesn’t care about you or your sick kid; it’s the nature of the healthcare business these days.  For FP and Pediatric practitioners to remain “in the black” economically, they have to fill every appointment slot they can. They might leave a couple slots open for “same day,” but not many.  They may even double book an appointment or two, but they can’t do that too much or it backs up the appointments and the other patients get mad because they have to wait an hour past their original appointment time.  Your best bet to obtain one of those "same day" appointments is to be the first person calling in the morning.  These appointments are filled quickly.  Now, let's say you cannot obtain a "same day" appointment.  This is when the Urgent Care Centers become your next best option for minor illnesses or injuries.

 

THE URGENT CARE CENTER

Urgent Care facilities sprang up because there was a need that had to be filled.  If the Primary Care docs could not see their patients in a timely manner, the Urgent Care could.  Most of these facilities are built to accommodate “Urgent” needs.  They are not really there to fill chronic medications, or serve as a family practice that runs routine labs, etc.  They are there to handle the flu, sinus infections, diarrhea, constipation, pneumonia, minor lacerations, eye infections, sprains/strains of the joints, most closed fractures, most skin infections/abscesses, asthma attacks, urinary tract infections, etc.  I think you get the general idea.

Urgent Care Centers almost always have an X-ray, and can do basic labs looking for infection, anemia, blood loss, urine infections, and pregnancy.  They are at least equal, and in many cases, superior to Family Practice for the acute injuries and illnesses that may occur.

Most of these are “Walk-In” clinics and don’t have appointments.  Now, that being said, I am starting to see more of them offering on-line appointment scheduling.  In my opinion, having worked both, the Urgent Care is an outstanding option if you cannot see your regular doctor…..and the problem is fairly minor.

This convenience does come with a price.  Urgent Care Centers are allowed to bill slightly higher than a Family Practice office visit.  This is not routine care and is of a more acute nature.  It will cost more.  The X-ray in the Family Practice Clinic is probably going to be a little cheaper than the same exact X-ray in the Urgent Care.  Everything is more expensive in the Urgent Care, but you get seen that day.  It is also far less expensive than going to the Emergency Department.

 

The Emergency Department

The name “Emergency” is all you should need to know.  This is the place you go when you are having chest pain, vomiting blood, an open fracture, severe shortness of breath, severe abdominal pain, thoughts of suicide, etc.  This is for true emergencies!  

You don’t go to the Emergency Room for medication refills, acne problems, skin rashes (unless they are advancing incredibly fast and painful), tooth pain, routine infections, hemorrhoids, etc.

Emergency Rooms are staffed with a team of professionals that are there for severe trauma and severe medical conditions.  Think of the ER as the place you go to have your life saved.  They have every diagnostic and laboratory test available to them.  They have specialists within the hospital they can bring into the ER for a consultation.  You have to think of the Emergency Department in terms of dire necessity.  Ask yourself, “Is my condition severe enough to warrant an ER visit?”  If the answer is “yes” or “I’m not sure,” then you should go to the ER. 

As you would expect, all those specialized Physicians, Registered Nurses, X-ray techs, lab techs, respiratory techs, all come with a pretty hefty price tag.  You can expect your Emergency Room bill to be a LOT higher than an Urgent Care or Family Practice office visit.  You are paying for all that expertise, even if it wasn't needed.....your bill is going to be pretty darn high.  A day doesn’t go by that I don’t see a patient for a Hospital Follow-up and they are absolutely shocked at how expensive the bill was.  They will spend weeks to months paying off a bill that could have been much cheaper if they had gone to the right facility.

 

What Should I Do if I am Sick or Injured?

You have to evaluate your condition in a calm manner.  Be realistic.  If you have had cold symptoms for a week, do you really need to run down to an ER?  Probably not.  I would try to get an appointment with my PCP and see how long I would have to wait.  If it is a day or two, fine…..I’ve waited a week already, I can wait another couple of days. 

If my symptoms are bad enough that I decide I really need to be seen that day, then I will go to an Urgent Care.  It will cost a bit more, but I am paying for the convenience of being seen that day.

If my symptoms are severe (there is that “severe” word again!) then I may consider going to the Emergency Room. 

Injuries are a different matter.  If you think there is any chance you have a fracture of a major bone or a deep laceration that is very difficult to stop bleeding…Go to the ER.  Don’t wait.  That’s what they are there for.  Anything that you believe could possibly need a surgery, an overnight admission, is cause to seek an ER visit.

Most people know when an Emergency Department visit is absolutely necessary.  The main issue is knowing when an Urgent Care is sufficient to meet your needs.  If you can differentiate between the two, you will save yourself a LOT of money.  It will also relieve the ER's of having to see patients that are not "emergent" and cut down on ER wait times.  Evaluate your condition and try to choose the best option for your needs.  As always, when in doubt of the serious nature of the injury or illness, and you are unsure where to go......err on the side of caution and go to the ER.  Don't be that guy who shows up to an Urgent Care with chest pain and you are in full blown cardiac arrest.  It will delay your treatment and you will scare the hell out of the provider at the Urgent Care.      

 

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