When sickness or injuries occur there are a variety of places you could go. Emergency rooms, urgent care facilities or a primary care doctor all offer different services, and it can be hard to know which one is the best fit.
For those who have spent hours in the emergency room waiting patiently for a doctor to examine a sprained ankle or evaluate that terrible cold, few things are more frustrating than the unknown. The emergency room sees patients based on a value of high, medium or low priority. If you do not have a life threatening medical emergency, chances are you are in for a long wait. While hospitals are doing their best to meet the needs of patients, including creating systems for shorter wait times in the ER, it seems that urgent care facilities are rushing to assist as well.
With the increasing popularity and demand for urgent care facilities, patients are being seen in record numbers and in record time for non-emergency treatments. According to Dr. Martha Wilber, Associate Medical Director of Hospital and Acute Care at Kaiser Permanente of Georgia, urgent care facilities are a response to overcrowding. "I think most people recognize that we have a real problem of overcrowding in our emergency rooms," she says. "This leads to long wait times, high cost for patients, and all sorts of situations where people with real issues cannot be seen quickly."
Extended hours and the ability to accept walk-in patients makes an urgent care center more accessible for minor injuries or acute illnesses, which may require more immediate attention than making an appointment with your doctor's office. Currently, an estimated three million patients visit urgent care facilities each week, with more than 150 million visits annually.
What to Consider
It is important to understand the difference between a visit to an urgent care facility and an emergency room. When faced with a medical situation, the last thing you want to be doing is hastily searching Google or WebMD for the best course of action. If a medical issue arises, Executive Director Denise Sweeney MSN, RN of the DeKalb Medical Emergency Department, says to ask yourself a few simple questions: Is this a life threatening illness? Can I go somewhere else to be treated besides an ER? Keep in mind if your medical problem occurs at 3 a.m. and you need immediate treatment, then the 24-hour ER room might be your only choice.
"The wait time is much longer in an emergency department, and if your emergency is not life threatening, you will be mixed in with everyone else," she says. "Sicker patients are seen first... if you want to get in and out quickly, go to urgent care. If you're frightened it is a medical emergency, you need to go to the ER."
So what types of emergencies warrant an ER visit versus going to urgent care? "Someone who collapses, or someone with heavy bleeding, difficulty breathing, loss of consciousness, or showing stroke symptoms, needs to go to an ER," Sweeney says. "Something that can have long term effects if not diagnosed properly needs to go to an ER."
However, many non-emergency injuries or illnesses are easily handled at urgent care facilities. They can handle bruises, sprains, stitches, lab tests, sore throats and ear aches, or tackling fevers and the flu. Most urgent care facilities are also able to handle broken bones. "A lot of fractures can be handled in urgent care, as long as there is not a lot of bleeding or bone sticking through the skin," Dr. Wilber says. "If you need an X-ray and are not sure if a bone is broken or not, go to urgent care. They will give you a splint and medication for the pain, and help set up an appointment with an orthopedic surgeon."
Aside from the fast service, an urgent care facility will be easier on your wallet. "You are in and out [of an urgent care center] a lot faster because you are not dealing with life threatening emergencies that take all of the resources," Sweeney says. "As for cost, you are not paying for all of those resources needed for a life threatening emergency, so you can do these things at a much lower price."
According to Concentra, one of the nation's largest workplace health and urgent care providers, more than 84 percent of people who attend the emergency room do not have a true medical emergency, and may pay up to six times more than necessary for treatment. An average self-pay patient cost for an ER visit is $922, whereas the average self-pay urgent care patient cost is $185. While urgent care facilities take most health care insurance, the co-pay will depend on your individual plan.
Dr. Dennis Welch who works in the ER at St. Joseph's Hospital also points out that going to the wrong place could delay proper treatment. "Some complaints, especially chest pain or severe abdominal pain, should always be seen in the ER," he says "If surgery is needed or certain types of tests, going to an urgent care clinic (first) could potentially cause more serious complications."
Lastly, if you are wondering whether or not to see your primary care doctor, keep in mind that you may run into the same long wait time. Piedmont Healthcare recommends asking yourself, "Can this wait until Monday? Do I need to be seen by a doctor now?" If the answer is no, many urgent care facilities are open on the weekends and offer extended hours. In cases where time is not an issue, some people may prefer being attended to by a familiar face and someone who knows and understands their medical history.
Know Before You Go
While an urgent care visit is quicker and at a lower cost than a trip to the ER, there are a few things to keep in mind. A hospital emergency room is required, by law, to screen all patients who walk in the door, regardless of their ability to pay or not, and must continue treatment for life-threatening emergencies despite an individual's finances. For an urgent care visit, this is not the case. "They are free standing and not bound by the same federal laws, so you need to know if you are able to pay or not," Sweeney says. "A lot of urgent care facilities require payment before you are treated because it is not a medical emergency."
Starting in 2014, the Affordable Care Act will provide access to insurance for everyone, regardless of employment or financial status. If an employer does not offer insurance, you will be able to buy insurance directly in the Health Insurance Marketplace for a lower price than private insurances.
Dr. Jeffrey Oyler of Piedmont Healthcare says the Affordable Care Act will have people managing their health and getting into their doctor's offices more often, but it may also affect pricing within the urgent care business.
"It will be more of a coordination of care. The dollars available to facilities will be tight, and they will need to clamp down on processes," he says. "Urgent care is a cost effective method for people with healthcare, but dollars are going to be tight and the facilities need to be profitable. They have to make efficient choices. With the act, it's going to force people to get with physicians for health management, and it's also going to force hospitals to be more efficient with their business practices."
Another item to keep in mind is the staffing and types of services provided per facility. "It is varied by state what the requirements are [for doctors at a facility], and for many urgent care practices I've seen, they are all over the map," Dr. Oyler says. "Find out who is staffing it and who will be seeing you. A mid-level provider can be excellent for the right condition, but (the provider) needs to have the experience to know what they're treating."
Dr. Wilber recommends calling in advance. Many healthcare providers, such as Kaiser Permanente, have advice nurses available 24 hours a day, who are able to recommend the best place to go per incident. Dr. Wilber says to ask yourself, "What skills do the providers have?"
"If you were to go to a community urgent care, you might want to call ahead and ask if they do X-rays and suturing on site," she says. "There is not a standardization. Do your research."
Take Control of Your Health
Urgent care can be a resourceful way for individuals and families to get the care they need quickly without breaking the bank. "They are efficient. The prices have come down. They're fast," Dr. Oyler says. "I think they are an excellent way to get mass groups of people assistance. Urgent care fills a huge void that was not there 10 years ago." When faced with a medical issue, questions regarding time, cost and severity of the condition should all come into play when assessing where to go. "The key to deciding whether to go to the ER or an urgent care center is to get the best care without delaying proper care," Dr. Welch says. "Your best bet is to call the urgent care center and see if they think they can handle your problem."
The Pros and Cons
It's important to know what to expect when you walk through the door of an urgent care facility.
- Efficient: "They go through basic protocols of treating and do a good job with non-urgent treatments," Sweeney says.
- Fast Service: "A lot of the time, it's closer to your home. It's going to be faster and you can get in and out quicker," Dr. Wilber says.
- Free up time in the ER: "[Atlanta urgent care facilities] can make a quick identification and hand patients off to us," Dr. Oyler says. "They keep people from unnecessarily going to an ER, and it allows us to focus on the really sick people."
- Lower cost: "You usually know up front what it will cost you before they do anything," Sweeney says.
- Be prepared to pay: "You do need to be prepared, it's a business. They are going to want payment up front," Dr. Oyler says.
- It's a new concept: "The path of urgent care is new. There are certain surgeons or ER doctors who are gearing toward learning about urgent care, and it is a time of transition. It will be interesting to see how things unfold," Dr. Wilber says.
- No standardization: "You can hang an urgent care sign out front, and be a nurse practitioner or physician assistant. While they are under the supervision of a board certified doctor, it doesn't mean that is who will be seeing you," Dr. Oyler says. "Then you go all the way to the other extreme with people who are board certified ER physicians, but who are just now doing urgent care."
- Not equipped for major medical emergencies: "If you think it is life threatening, you need to go to an ER," Sweeney says.
Concentra — www.concentra.com
Denise Sweeney, MSN, Dekalb Medical Emergency Department — www.dekalbmedical.org
Dr. Jeffrey Oyler, Piedmont Healthcare — www.piedmonthospital.org
Dr. Martha Wilbur, Hospital and Acute Care at Kaiser Permanente of Georgia — www.kaiserpermanente.org
Urgent Care Association of America — www.ucaoa.org
Dr. Dennis Welch, St. Joseph's Hospital — www.stjosephsatlanta.org