In a perfect world, accidents would only happen during business hours and primary care physicians would manage these problems. Now when a patient has an emergent problem most primary care physicians immediately refer him to an Urgent Care or Emergency facility for treatment. Available appointments with the primary physicians are few and far between.
This brings us to the current growth of Urgent Care and Emergency facilities. The public’s demand for immediate access to 24-7 medical care has fueled this growth. The rise in growth started in the 1990s and continues to increase today. The increase in accessibility has made the choices more confusing for patients. With the Affordable Care Act and increased patient deductibles, patients are often influenced by the financial aspects of their care rather than focusing on what is the best care for their situation. Cost and long wait times at hospital-based Emergency Rooms also encourage patients to seek care elsewhere. Patients are left to make important decisions regarding their health without the proper medical expertise.
In the event you are like the one in four Americans requiring unplanned medical care, this will serve as a guide to help you navigate the best care at the proper facility.
First and foremost, if you have a primary care physician, pediatrician, or OB/GYN, it makes sense to check with their office, even after hours, for their recommended referral. It is pertinent that you know your history, insurance benefits, and current medications and doses prior to seeking any emergency care. It is a good idea to have this information available at all times.
Retail Health Clinics
Retail health clinics are generally found in drugstores or supermarkets or superstores. They are owned by the stores and their existence is to increase pharmacy revenues. They are typically staffed by NP (Nurse Practitioners) or PAs (Physician Assistants). These clinics do not have x-ray or lab facilities. Often the providers cannot provide suturing. These facilities are best for Flu vaccines and routine immunizations; uncomplicated sports physicals, minor skin irritations, and mild cold and flu symptoms. Any chronic conditions or more serious issues should not be treated at these clinics.
Urgent Care Clinics
Urgent care clinics have increased in number because of the benefits they provide to patients. Many of these centers are free-standing walk-in clinics that are independent or owned by hospitals in the area. They are often opened 12 hours a day, 7 days a week. They are usually staffed by emergency physicians (< 5%), family physicians (75%) and PAs (48%). The wait time is typically 30 minutes or less. Urgent Care centers often provide basic x-ray and lab services. They rarely provide U/S, CT or MRI services. Most centers require insurance or payment in full when services are rendered. The visits are generally covered by insurance (after a deductible is reached) and the cost for the visit is often significantly less than an ED visit but more than a retail clinic.
Urgent Care facilities are not recommended for chronic more serious or life-threatening conditions.
They are never staffed by specialists so if additional care is needed patients are referred or transferred to an ED facility at the patient’s cost.
Urgent Care centers are best for minor non-cosmetic suturing of wounds, immunizations, routine school and sports physicals, minor fracture care, sprain or dislocation, ear infections, cold and flu management, gastroenteritis, uncomplicated urinary tract infections, and minor skin irritations. Some, but not all Urgent Care facilities can manage IV fluids for dehydration.
Research the Urgent Care facilities to make sure they have Urgent Care Accreditation. This is a voluntary accreditation that measures the quality of the services and outcomes as compared to national standards.
Emergency room visits now number 110 million annually and have increased by a million visits despite a decrease by 9% in the number of ERs. There are two types of ERs; hospital-based and free-standing. Both have the capability to handle significant medical emergencies like chest pain, trauma, or stroke In general, if symptoms come on acutely and are severe, it is best to seek care at a hospital-based Emergency Room.
Hospital-based ERs typically have longer wait times due to more complex medical conditions being treated and to the onslaught of uninsured patients using the ER for minor care. Free-standing ERs generally have a shorter wait time because in general, they see a quarter of the number of patients and, based on locations in the community, are seeing only insured, paying patients.
Typically, ERs are fully staffed 24-7 by Emergency Room Physicians and registered nurses who specialize in emergency care. Costs and wait times are increased to support this coverage and level of care.
An ER visit maybe four to five times the cost of an urgent care visit.
Typically it is fully covered by insurance (after deductibles) when the care is warranted.
Both types of ERs have full laboratory and radiology capabilities including CT and MRI and U/S in most cases. Free-standing ERs do not always have extensive on-site imaging and referral to the hospital may be required for a complete assessment. Hospital-based ERs also have specialist availability on-site or on-call for more complex situations or if conditions require surgery or a procedure, like a heart catheterization. Free-standing ERs do not have this option. If a higher level of care is needed at a free-standing ER, transfer to a hospital is required, often at a cost to the patient. This transfer for treatment only further delays care.
Free-standing ERs are often found in affluent neighborhoods or rural areas and can be more attractive to patients because of this. The cost of the free-standing ERs is very similar to the cost of a hospital-based ER. They should not be used for the treatment of conditions easily treated at an Urgent Care. Given the potential limitations of Free-standing ERs, unless a hospital is an unsafe distance for a patient, the hospital-based ER is preferred.