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Dr. Burton agrees that cost issues are a major difference between ER treatment and urgent care options.
“There is a substantial price difference, but it depends upon the medical problem and what level of treatment is required before you can make that comparison,” Dr. Burton says. “In general, urgent care charges are less. The ER is equipped to handle much more complicated, costly interventions.”
There are other reasons visiting an emergency room for a relatively minor situation may cost you significantly more than visiting your primary care physician or an urgent care facility. ERs have to charge more because they’re part of a hospital’s overall services and it cost significantly more to operate a hospital than an urgent-care facility. Hospitals must be staffed and equipped to offer higher acuity injuries and illnesses 24/7, 365 days.
Urgent care centers, on the other hand, can exercise the right to refuse uninsured patients or those with a proven inability to pay. This keeps the urgent care center’s overhead expenses lower than those of a typical ER, so an insured patient is not charged higher fees for common medical items. Physicians who provide services at urgent care centers may also agree to put a ceiling on their fees as employees of a private medical company. All this impacts the patient’s bill.
“Treatment at an urgent care center is much less expensive,” Dr. Osborn says. “Insurance copays for an urgent care are considerably less than those at the emergency room.”
While urgent care is usually more expensive than primary physician care, due to paying for the convenience and accessibility, urgent cares often compete among themselves to bring prices even lower.
While cost and time are factors in deciding where to go, when your child is sick or you are bleeding, the primary decision is who can do a better job of treating your health problem. Both Dr. Osborn and Dr. Burton agree on the thresholds of treatment between ER and urgent care.
“Urgent care is structured towards simple, focused problems that are generally minor to moderate infections and minor to moderate trauma,” Dr. Burton says. “The Emergency Department (ED) can do all that, plus has the capacity and training to see much more life-threatening conditions. Urgent care can do simple labs, general X-rays and has simple medicines, whereas the ED has more complex and extended versions of those things. Anything life-threatening or that has a reasonable possibility that it could be life-threatening – trauma, seizure, chest pain, needs to go to the emergency department.”
Other recommended health concerns that should most likely be addressed at an ER include coughing or vomiting blood, difficulty breathing or shortness of breath, changes in vision, severe or persistent vomiting or diarrhea, large open wounds, sudden weakness, major burns, spinal injuries, severe head injuries, loss of consciousness and abdominal pains.
“Things like sinus infections, colds, flus, fractures, sprains, and minor surgical procedures are some examples of things that can be treated at an urgent care facility,” Dr. Osborn explains. “For the convenience of the patient, urgent cares have labs and x-ray capabilities on site. Urgent care visits consist of acute injuries and illnesses that are non-life threatening.”
Some health issues that urgent care can treat include sprains, strains, minor broken bones, mild asthma attacks, minor infections, small cuts, sore throats, rashes, minor burns, urinary tract infections and pelvic infections.
When a patient at an urgent care is in need of treatment more suited to an ER, then 911 is activated and the patient is stabilized as best a possible while awaiting transport to the emergency room.
Looking ahead, there appears to be a growing demand for more advanced healthcare by more and more patients. This is a situation the respective industries will have to address and prepare for.
“With the roll out of the Affordable Care Act, 30 million additional people will have insurance coverage,” Dr. Osborn says. “Additionally, these 30 million more patients will also need convenient access to healthcare and urgent care facilities will help bridge the gap between the emergency room and the shortage of primary care physicians.”
Some healthcare facilities associated with an ER and some urgent care organizations are developing hybrid partnerships that offer patients the best of both worlds. One example of this is the collaborative care agreement between LewisGale Regional Health System and MedExpress Urgent Care. MedExpress Urgent Care is a healthcare provider that has recently opened a center in Salem and plans to open other facilities on Route 419 in the Cave Spring area and Christiansburg.
“Patients who visit urgent care centers often need more advanced care such as referrals to specialty physicians, lab or radiology services, or even a hospital emergency room,” states Victor Giovanetti, President, LewisGale Regional Health System. “Our agreement with MedExpress will help patients receive this kind of care from our health system in an expedited manner.”
“This agreement was developed to help patients navigate the complexities of the healthcare system in the most convenient, seamless way possible,” says MedExpress CEO Frank Alderman, MD.
The partnership between the ER and urgent care means that LewisGale will provide a follow-up system for MedExpress patients who require more treatment or an additional visit with their regular physician or a LewisGale-affiliated specialist.
To make diagnosis and treatment easier and more efficient, MedExpress will also be able to electronically transfer patient records to a LewisGale facility or physician’s office. Patients who normally see a LewisGale-affiliated physician will now have additional options for their urgent care needs during evenings and weekends when their primary care physician’s office is closed, thus playing to the strengths of urgent care’s extended hours of operation.
“We are very pleased to form this partnership with MedExpress,” Giovanetti says. “It’s a win-win for our patients who, through MedExpress, will now have access to several convenient locations and extended evening and weekend hours.”
LewisGale Medical Center is also closely affiliated with PCA, another multi-specialty group in Southwest Virginia that offers urgent care facilities.
PCA is offering another variation on the urgent care model by working to be price competitive with primary care physicians. Normally, urgent care centers are more expensive than primary care due to the convenience of longer hours of operation and quicker access to treatment. PCA currently has four urgent care facilities in the region.
Edwin J. Polverino, DO, the Principle and President of PCA since its inception in 2000, says that urgent care as an industry moves in cycles.
“It’s a bubble,” he says. “We have seen this before in our valley during two prior cycles. This is now the third time I have seen this happen in my career. People try it out, find out that stand alone urgent cares usually charge higher urgent care co-pays, and the patient counts drop.
Polverino says that PCA only charges a primary care co-pay while other facilities charge a specialty or urgent care co-pay. This pricing strategy leads to an average $10 -$75 savings for the patient of typical urgent care and up to a $250-$500 savings compared to ER treatment.
Like in any other industry, as more urgent care facilities open, they will need to develop ways to distinguish themselves and offer more services to their patients at competitive prices. Strategies like partnering with healthcare organizations with ERs and setting pricing and services to be comparable to primary care physicians are two ways urgent care is evolving to meet increased demand for healthcare in a 24-7 world. Polverino says urgent care must continue to evolve to not only compete with emergency rooms, but also with other urgent care facilities in the region.
“I suspect it will be much like it was in the last two cycles,” Polverino says. “The urgent cares will open and people will try them out as they have in the past. More and more of the out of pocket cost of the visits will get pushed back to the patient from the insurance companies in the form of higher co-pays and deductibles. Then patient visits will shift to lower cost urgent care centers.”
“It’s hard for these standalone centers to compete with the lower co-pay issue. I suspect we will see a three to, at best, five year bust cycle and then the centers will change to offer primary care services or they will close.”