How to Tell the Difference Between an Emergency Situation vs. Urgent Care Needs

Sometimes it can be tough to tell whether you need an emergency room or urgent care clinic services. According to a private Milliman study, anywhere from 44-65% of emergency room visits could have been treated in urgent care settings.

But what signifies an emergency and what is appropriate to bring to urgent care? Keep reading to find out how to tell the difference between an emergency situation and an urgent medical situation.

What counts as an emergency?
Urgent care, while an important facet of medical care, is no substitute for emergency services. In the vast majority of cases, an emergency is any situation that can permanently endanger someone's life. The following are classified as emergency situations:

  • Severe chest pain
  • Convulsions or seizures
  • Deep cuts or gunshot wounds
  • Severe abdominal pain
  • Poisoning
  • Compound fractures

The list goes on, but these are some of the most common emergency situations.

What counts as an urgent medical situation?
While urgent medical situations aren't incidents where someone's life is in danger, they include those situations that require care within 24 hours of the original incident. In addition, urgent care often sees patients who simply can't make it to their primary physician's office on time. Illness and injury aren't things that strike at convenient times. Here are a few of the most commonly treated urgent medical situations:

  • Sprains and strains
  • Skin rashes and irritation
  • Irritated or itchy eyes
  • Vomiting or dehydration
  • Minor fractures (fingers and toes)

The Rise of Hybrid Healthcare Facilities Are Driving Down Healthcare Costs

The Rise of Hybrid Healthcare Facilities Are Driving Down Healthcare Costs

It’s no secret that going to the doctor can be expensive, but visiting a neighborhood emergency room can be even more costly. Many consumers head off to an emergency room (ER) when they become immediately ill or injured. While this might seem like a sound decision, much of the public is unaware that there are lesser cost alternative health care options available when it comes to where they can seek medical care.

Avoidable ER Visits are Costing Consumers Millions

 

It’s no secret that going to the doctor can be expensive, but visiting an emergency room can be even more costly. In the U.S., one of the largest areas of consumer spending is on health care. According to the National Center for Health Statistics, 136 million people in the U.S. visited an emergency room (ER) last year, and each of those ER visits on average cost around $3,712, per a 2015 Milliman Report.
 
According to Truven Health Analytics, more than 70 percent of emergency department visits from patients with employer-sponsored insurance coverage are for non-emergency conditions or conditions easily preventable through simple outpatient care.
 
What is an emergency room? An ER is a health facility that’s open 24 hours a day 365 days a year and staffed by board certified physicians to treat emergency conditions. No appointment is necessary, and wait times are typically 30 minutes (CDC) but can be up to two hours. Patients are billed the emergency room copay designated by the insurance plan they have. Patients may also be required to pre-pay a deductible designated by the insurance provider.
 
“A significant number of all ER episodes – 44-65 percent – are urgent care treatable, which means the injury or illness isn’t serious enough to require an ER visit. The lack of public education and the massive growth in private health care facilities creates confusion when patients are forced to make a decision on their health care choices,” says Dr. Jay Woody, co-founder of Legacy ER & Urgent Care, a 24/7 emergency and urgent care medical services center with locations throughout North Texas.
 
By understanding what other health care facilities are available other than a freestanding or hospital based ER, consumers can reduce their medical costs and save themselves thousands of dollars on out-of-pocket costs, premiums and deductibles. Two alternate facilities consumers can go to for health care services are an urgent care clinic and a hybrid emergency room clinic.
 
What is an urgent care clinic? These are walk-in clinics that focus on treating non-life threatening illnesses that require immediate care but aren’t serious enough for an ER. Most but not all urgent care clinics are staffed by a physician, physician assistants, advanced practice clinicians and nurse practitioners who work independent shifts. These clinics are not required to have a licensed physician on staff. Normal office copays are designated by the insurance provider.
 
What is a dual emergency room and urgent care clinic? They are defined as a walk-in clinic offering both ER and urgent care treatment options under one roof. These clinics are typically staffed by board certified and ER-licensed physicians and have short wait times. At Legacy ER & Urgent Care, the average wait time is less than five minutes, and patients are typically released in less than one hour. Patients are billed based on if their health issue is diagnosed as an ER or urgent care case. This allows patients to only pay for the care they need.
 
Hybrid care facilities like Legacy ER & Urgent Care offer ER and urgent care services under one roof and take a different approach to healthcare. At Legacy ER & Urgent Care, patients meet with board-certified and ER-licensed physicians who review their health issue and determine if they need to be treated as an ER patient or as an urgent care patient. Patients are billed accordingly, allowing them to only pay for the care they need.
 
“Freestanding and hospital-based emergency rooms only have one level of billing and that is at an expensive ER level which includes a facility fee and multiple arbitrary billing opportunities for supplies or procedures. It’s integral that consumers understand that they can get their injuries and illnesses treated for a lower cost at a hybrid care or urgent care facility,” Woody explains.
 
Legacy ER & Urgent Care’s hybrid care model allows them to be more efficient, more cost effective and more focused on the patient.
 
“Our unique hybrid approach is important because it could be the difference between a patient paying a small copay (urgent care) or a high deductible (ER) for the same services at a traditional emergency room, where you get billed for ER services no matter what,” he adds.
 
Founded in 2008, Legacy ER & Urgent Care is one of the nation’s first health care models to offer both urgent care and emergency room treatment options under one roof. It has built an exceptional customer service program and rating by providing transparent billing, soothing environments and one-on-one service with board-certified, emergency-trained physicians. Patients have access to immediate, on-site emergency room equipment and only pay emergency care prices when it is truly an emergency.

What Most Healthcare Providers Won’t Tell You. New ER Savings Initiative Educates on Costly Emergency Room Visits

Believing that health care costs should be as transparent as possible to consumers, North Texas’ Legacy ER & Urgent Care has created the ER Savings Initiative. The goal of the ER Savings Initiative is three pronged: first, to engage with consumers, alerting them to avoidable medical expenses; second, to encourage straightforward and honest billing; and third, to promote healthy facility utilization from its health care competitors.

Based on extensive research, the ER Savings Initiative employs a value-based healthcare mindset while revealing the true cost of visiting an emergency room versus visiting an urgent care facility. According to the Center for Medicare and Medicaid Services, the per capita expenditure for healthcare is approaching $10,000 each year. Yet, the ER Savings Initiative reveals that a large portion of those costs could be avoided if consumers are well informed.

 A Truven* analytics study, in conjunction with a Milliman** study sponsored by Legacy ER & Urgent Care, reveals the following statistics for the Dallas MSA:

  • The average cost of an urgent care case is $226.
  • The average cost of an ER case is $3,712.
  • The average cost of an ER case that doesn’t require emergency care and could be treated at an urgent care center is $2,039.
  • For every 1,000 insured individuals, approximately 203 of them will visit an emergency room.
  • 44–65 percent of ER cases are actually urgent care treatable.

Consider this case study: a patient with strep throat (which is not typically an emergency room case) who goes to an urgent care facility for diagnosis and treatment will leave with an average bill of $226. But if that same patient visits an ER for strep throat, costs could exceed $2,000.

“With the growing number of freestanding ER units, the big issue for consumers is understanding where to go,” says Dr. Jay Woody, co-founder and chief medical officer of Legacy ER & Urgent Care. “The average consumer only discovers the difference between urgent, acute and emergency care when they receive their bill. From a marketing standpoint, these terms are nothing but synonyms and this is just bad business. This is exactly why we started Legacy ER & Urgent Care, so that our customers don’t have to choose or self-diagnose themselves and will always be placed as patients above profits. Period.”

On the patient side, consumers need to do their due diligence when it comes to searching for healthcare facilities. Uninformed consumers are urged to take the following steps to avoid unnecessary costs:

  1. Self-education – Knowing the difference between urgent care, ER, retail care and freestanding ER can save money and time, not to mention the assurance that they are visiting facilities congruent with their medical needs.
  2. Patients must save emergency room visits for true emergencies only – 40-65 percent of ER cases are actually urgent care treatable, meaning patients currently incur higher costs by going to the ER when it’s unnecessary.
  3. Visit hybrid model facilities – while hybrid model facilities like Legacy ER & Urgent Care are few and far between, they will begin to increase in popularity as consumers begin the self-education process. However, these will not grow in number as fast as freestanding ERs as the profit margin for hybrid facilities is much lower because patients receive urgent care bills for non-emergency. These facilities are ideal, as their unique ability to bill both urgent care and ER based on what the patient needs, eliminating the guesswork behind deciding which kind of facility visit is truly necessary.

 Not only does this research impact patients, but it plays a vital role in the future of healthcare facilities in general. Health care consumerism will be a driving force behind patient care in the years to come. As patients become more educated on their options, they will likely choose facilities where they can get the best service for the lowest price. Facilities that transition into transparent billing practices during this time period will be successful.

 Facilities will also begin considering facility utilization. Understanding where costs are necessary and where they aren’t allows facilities to operate more efficiently. For example, though Legacy ER & Urgent Care offers both ER and urgent care billing, the facility categorizes – on average – 80 percent of the cases that come through its doors as urgent care and only 20 percent as emergency.

 Legacy’s ER Savings Initiative campaign aims to set the standard for billing and facility processes in the future. The overuse of emergency has been an issue for far too long. Encouraging patients to do their own due diligence and research while facilities adopt a more fair billing practice will certainly improve the future of healthcare.

 Please see attached infographic for a visual representation of the statistics. For more information, visit http://legacyer.com/, facebook.com/LegacyERandUrgentCare ortwitter.com/legacyertx.

*2013 Truven study: Avoidable Emergency Department Usage Study

**2015 Milliman White Paper: Potential Saving When Moving from an Emergency Department to an Urgent Care Setting in Commercial Populations (for Dallas MSA)

About Legacy ER & Urgent Care

Founded in 2008, Legacy ER & Urgent Care is one of the nation’s first health care models to offer both urgent care and emergency room treatment options under one roof. It has built an exceptional customer service program and rating by providing transparent billing, soothing environments and one-on-one service with board-certified, emergency-trained