When You Need Care Now But aren’t Likely to Die, Urgent Care is the Answer
According to a Wall Street Journal article, urgent care centers are becoming Americans medical home away from home – mainly evenings and weekends when their primary care providers are not available. About two-thirds of patients at urgent care centers have a family physician.
There are an estimated 10,000 urgent care centers in the United States and another 1,400 are expected by 2020. Increasingly, traditional providers are getting in on the act. Hospitals are building, acquiring or partnering with urgent care providers. Walk-in patients are welcome, although many allow patients to make an appointment. Wait times are 30 minutes or less whereas a wait in the emergency room can run eight times that length. The average cost at an urgent care center is about $150, compared to $1,354 for an emergency room visit. Centers are usually open evenings and weekends when doctors’ offices are closed.
When a retail clinic won’t do, this sounds like a much better solution that non-emergent ER visits or waiting a week for a physician visit. It would be even better if these facilities were integrated so you could choose the level of provider (and price level) you need. As one of the commenters said in the WSJ article, why doesn’t every hospital have one of these next to the emergency room? I’d go even farther; why doesn’t every hospital have one of these with a retail clinic inside next to the ER?
Retail clinics and urgent care centers are probably not subject to EMTALA nor should they be though emergency rooms are. So, there would still be an incentive especially for low income people to access the ER for non-emergent care. People who are covered by insurance that only requires a relatively modest copay of $50 for an ER visit won’t care about the higher cost to the insurer either.
EMTALA doesn’t require caring for all who walk through the doors. It requires stabilizing a patient if their life is in danger or they are seriously ill. The program needs reform. Many hospitals are afraid to send away patients who clearly don’t qualify since the fine for being wrong is something like $50,000.
I wonder what would happen if the ER had a door on one side that said Urgent Care Clinic, and a triage nurse went through the crowd and sent people who did not need to be in the ER to the urgent care center? A patient who was not likely to pay their bill (maybe because they had a cold and the average ER bill is $1,350) could be sent to an affiliated retail clinic or the urgent care clinic.
Of course, most ERs don’t want to cannibalize their paying customers. But some of the customers don’t need to be there and are unlikely to pay their bill regardless.
The WSJ article said some hospitals are opening urgent care clinics near the ER. I would be interested in finding out how that worked.
Devon — That would all be fine by me. Most stand-alone urgent care clinics are not open around the clock, however, I just went to one last Sunday that was open from 8:00 AM to 8:00 PM seven days a week. They sent me to the ER after examining me so my insurer will get to pay for both visits. Remember also that for many hospitals, half of their inpatient admissions come through the ER.
How does building a wall between an ER and an adjoining urgent care generate cost savings? The ER needs to be open 24/7 and occupying the facility anyway. Wouldn’t consolidation allow the urgent care to generate revenue from otherwise unused ER capacity?
I would like to think the hospital ER is competing on price and convenience. Sending people to the urgent care center could (at least in theory) result in more people actually paying their $150 bill rather than becoming a $1,350 bad debt write-off. Over time the Convenient Hospital ER could become the “go to” place for all manner of problems that need immediate attention.
But, you’re probably correct that hospital ERs don’t want to risk losing the Medicaid / Medicare and insured customers whose health plan will pay much of their $1,350 bill. It doesn’t take but a few paying customers to make ERs profitable.
Most hospitals claim that ER’s lose money. I think that’s because of how hospitals allocate costs and revenues. For example, I was in the ER last Sunday and received chest x-rays, a CT scan and had blood tests done. I’ll bet the radiology department got credit for the revenue generated by the imaging test revenue while the lab got credit for the blood test revenue. The ER will probably get credit for the hospital facility fee and the doctor will bill separately unless he’s a hospital employee in which case his fee will be credited to the ER but his salary is an ER expense. If the patient is admitted, all of the admission revenue will be credited to other hospital departments.
When I was an accountant for a large hospital system, they claimed the ER lost money due to the high proportion of bad debt write-offs. The facility was in an urban area so they got a lot of what they called The Knife & Gun Club patients in the ER. Yet, a few years later I was driving by my old employer and noticed they were in the process of tripling the size of the Emergency Department. There are also free-standing ERs popping up on every corner in the Dallas area. There must be some money in emergency room treatments.
It is well known that ER visits are a function of government insurance. I talked to someone earlier in the week who said seniors in Medicare Advantage plans are supposed to pay co-pays of $75 for ER visits to discourage unnecessary visits. But, hospitals often tell seniors they will merely bill them and not worry about paying the bill.
The two reasons that originally came to mind were accounting magic and marketing magic. It sounds like government billing is another.
Maybe there could be two separate entrances and waiting rooms leading to the same set of treatment stalls. Kind like the rural Chinese men’s and women’s restrooms.
The triage nurse station could have two windows, like a priest in a confessional booth. Sorry for the mixed metaphors.
“When you need some care…but not likely gonna die…who ya gonna call? Urgent Care!”
Other than the possibility for ghosts ( who y gonna call?), urgent care centers are not always an effective tool for the patient as some insurances subject you to hospital like deductibles when visiting an urgent care center. The MD Now urgent care center near me is not better than a physicians office but they charge triple the fee of an insurance and it all applies towards my deductible so I have to pay out of pocket. That’s the last time I go to urgent care. Granted, it’s cheaper than a hospital but not any better quality of care than my $20 copay PCP.
Theres an old saying in the ER field…”if it’s loss of life, limb, or eyesight – go to the ER. All others go to Urgent Care or Primary care physician.”
Maybe they should put that in the ER doors.
That’s definitely a good idea!
You could also try calling your insurer’s nurse hotline if it has one. I’ve done that several times including once when I was on vacation in Utah 2500 miles from home. It saved me a trip to both the ER and an urgent care center and it was free. Sometimes, of course, they tell you to go to an ER or an urgent care center or your PCP if you can get a timely appointment depending on the complaint.
I wish more insurers would do a better job of organizing and explaining the tools enrollees have at their disposal. I don’t even know whether or not my insurance has a nurse call line. I don’t know whether there are tools to steer me to cheaper providers. Most of the tools available are proprietary information by third-party vendors. Some employer health plans partner with these third party vendors. Yet, insurers themselves don’t do enough in this regard. I have never understood why.