Distinguishing urgent from emergency can save time, money
November 3, 2009
If possible, stopping by an urgent care clinic before going to an emergency room can save money and time, according to Dr. Bill Pidwell of the Park City Clinic.
He works part-time in the Emergency Department at the new Park City Medical Center and frequently sees people who he says would have been treated faster and for less sometimes for one-fifth the cost at an urgent care.
He’s not trying to steal patients from the ER, Pidwell cited statistics from the state of Florida saying that state’s emergency rooms are getting bogged down by non-emergencies.
That’s not a big concern for the Park City Medical Center, but it can still happen. Pidwell pointed out that some nights there is only one physician at the hospital’s ER. Non-emergency cases are either going to distract that doctor from real emergencies, or force him to delay the treatment of less-serious problems until the traumatic cases are taken care of.
Pidwell said he recently spoke with a Park City man who spent several hours in the ER to get staples in his son’s head that only took a few moments.
Urgent cares are often stocked with the same caliber of staff as an ER and can treat all the same non-life threatening concerns, he said.
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Amy Roberts, hospital spokesperson, agreed. She said the Park City Medical Center is supportive of the urgent care clinics in town.
"They serve an important role in community," she said. "We work in tandem with them."
Many insurance providers charge a much higher deductible for ER visits, she said.
There’s no easy explanation for what kind of problems should go to urgent care versus an ER, it’s really a case-by-case situation. Some injuries seem minor but are actually more serious; some parents take children to an ER for scratches and sprains, she said.
"There’s no black and white of when to go to which," she added.
But in Pidwell’s experience, he estimates that only 3 to 5 percent of cases he sees in an urgent care need to be referred. Therefore, he believes it’s logical if people viewed it as a "first stop."
When a co-pay at an urgent care will be $30 and at an ER $500, it’s wise to get an expert opinion about the seriousness of a condition before making that financial commitment, he said.
According to Shanae Thornton, Snow Creek Medical Center clinic administrator, the two most common injuries seen in an ER that would have just as effectively been treated in urgent care are fractures and lacerations. Like Pidwell and her own doctors, the same people who staff an urgent care likely staff emergency rooms on other days. Except the most serious of cases, quality care can be given at a fraction of the cost at an urgent care. That’s their purpose, she said.
Emergency rooms practice a different kind of medicine, Pidwell explained. An ER doctor is concerned with ruling out every possible complication to make sure nothing else could be wrong. That’s where CT scans and MRI’s come in. It’s a thorough, but very expensive strategy. Urgent care clinics diagnose and treat a problem. A community needs doctors performing both services, but Pidwell said many people are ignorant of that difference and spend more than they have to because of it.
And the wait in an emergency room during the winter can be as long as six or seven hours, he added.
Broken bones can be seen in an urgent care. If a surgeon is needed, the urgent care can schedule an appointment as well as an ER, and surgeons visit extreme cases in urgent cares the same as they do in ER’s, Pidwell said.
And tests and scans can be sent to the hospital for analysis if needed, Thornton said. Nearly every service that can be performed in a hospital can be done in or through the urgent care.
And by only visiting an ER with really serious concerns, it allows hospitals to focus resources and provide better care, Pidwell explained.
Another common reason people cite for visiting emergency rooms with minor problems is insurance. The uninsured are often worried that a privately-owned urgent care will turn them away while hospitals are required to see everyone by law.
The break in the logic comes when the patient gets a bill in the mail. Whether an urgent care charges up front or a hospital sends it later, the uninsured person will be expected to make the payment. So rather than focusing on timing, they should focus on the amount, Thornton said. Why not pay less even if the payment procedure is different?
A legitimate drawback is hours. Emergency rooms are open 24 hours a day but urgent care clinics close for several hours in the evenings.
Lorie Schumacher learned the difference between the two types of medicine when her son got a serious laceration riding his scooter.
She said the emergency room at the Park City Medical Center was great, but the wound became infected. She kept returning to have the wound treated three days and saw three different physicians.
"You need a sense that someone is overseeing your case and watching it day to day," she said.
So she began visiting a clinic for the long-term treatment of the infection, and was able to see the same doctor every time.