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Urgent care center or emergency room? How to choose

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April 6th, 2016
Urgent care logo on building

Urgent care logo on building

According to Consumer Reports On Health, surveys show that on nights, weekends, and holidays, about 73% of Americans cannot access medical care promptly. America’s health care system abhors a vacuum, so quick and convenient care options have sprung up everywhere. 

Urgent care centers (UCCs) began operating in the early 1980s and experienced rapid growth in the mid-1990s. Today, there are over 7,000 of these centers, according to the Urgent Care Association of America.

The word “urgent” isn’t always in the moniker. You might see names such as immediate care, walk-in care, and convenient care. All of these meet the basic criteria for an urgent care center: no appointment necessary, evening and weekend hours, on-site x-ray services, and the ability to perform minor procedures such as stitches and casts. They also typically offer vaccines. Some UCCs provide additional services such as occupational health care, physical therapy, weight loss assistance, and primary care services. Some centers operate just like a doctor’s office, and you can choose a primary care doctor for your comprehensive health care. 

UCCs have proliferated because of the lack of primary care physicians (PCPs) in the United States. According to the Association of American Medical Colleges, there will be a shortfall of up to 30,000 PCPs by 2025.

You can find UCCs primarily in retail establishments and stand-alone centers. They do not operate 24 hours a day, but they are usually open early and close late. Retail clinics tend to be staffed by a nurse practitioner (N.P.) or a physician assistant (P.A.), depending on state law. Free-standing UCCs usually have a physician in addition to N.P.s and P.A.s. Some hospital emergency rooms are now offering so-called fast-track services for minor illnesses and injuries.

Urgent vs. emergent

According to the American Academy of Urgent Care Medicine, free-standing urgent care centers are intended to treat minor, non-life-threatening illness and injuries that require prompt treatment and would not result in disability. Examples are sprains or strains, a household cut or burn, foreign object in the eye, persistent cold, asthma, urinary tract infections, and rashes. Retail clinics are designed for healthy people and treat a limited number of common illnesses. Injuries and medical events that are life-threatening—such as head trauma, chest pain, severe dizziness, and significant lacerations or burns—should be treated in an emergency room. Some emergency rooms have modified their structure and now have urgent care or so-called fast-track care for people who come in with non-emergent conditions.

Quality of care and costs

A recent large study showed that quality scores for three common illnesses (ear infections, urinary tract infections, and sore throats) were similar among retail clinics, UCCs, and doctors’ offices, but lower for emergency rooms.

A study published in 2013 comparing quality of care provided by physicians and nurse practitioners found that patient outcomes were equal to or better for patients treated by N.P.s, and that overall patient satisfaction was similar for the two types of providers. 

At the beginning of the freestanding urgent care boom, many insurance plans did not cover the visits, or patients had to pay out of pocket.  Now, however, most plans pay for urgent care—although in some instances, patients have to pay upfront and submit for reimbursement. UCCs tend to bill as outpatient or office visits instead of emergency care, which can mean lower co-pays for patients. 

In addition, most freestanding UCCs have on-site pharmacies. Prices of prescription medications, however, are often higher than at your regular pharmacy—mainly because of the convenience. 

“No matter how minor you think an illness is, call your doctor before heading to an urgent care center,” says Brian Tremaine, medical director for Eagle’s Trace, an Erickson living community in Houston, Tex. “Most UCC providers are not geriatricians. They are accustomed to treating younger patients and aren’t aware of the complexities and individualization of care necessary for treating seniors.”

According to Mathematica Policy Research (formerly Center for Studying Health System Change), surveys show that many UCCs will not see seniors for problems associated with a chronic disease, such as high blood pressure or diabetes.

In addition, surveys show that, in general, UCCs have no role in arranging follow-up care for patients. “Follow-up is extremely important for continuity of care,” Tremaine says. “Most seniors have at least one chronic problem and take several medications, which means it is very important to avoid fragmented care.”

If for some reason you can’t contact your doctor beforehand,” Tremaine continues, “let them know about the UCC visit afterward—ideally before you start taking any medication that was prescribed—and schedule a follow-up visit.”

If you are advised to go to a UCC, take a list of your medications or the bottles themselves with you. “Tell the staff about any health conditions and allergies you have,” Tremaine advises. “If medication is prescribed, find out why and what you should expect in terms of side effects or medication interactions.” 

Lastly, ask for a written summary of your visit to give to your doctor.

Trends in urgent care

Increasingly, insurance plans and hospitals are becoming affiliated with urgent care centers or purchasing them outright. According to David Birdsall, M.D., a UCC provider and vice president of CEP America, a UCC’s affiliation with a hospital is a way to connect patients with more integrated and comprehensive approaches to their care. “It’s not a one-time visit and it’s over—it’s a touch point for care along the continuum,” Birdsall says. “That is a very critical point of difference that providers are beginning to address.”

 

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