Primary Care, Urgent Care Or Emergency Room?
Choosing The Most Suitable Level Of Health Care
Is Key To Manage Your Health Care Costs
by Shideh Kerman, BS, MBA
Inappropriate use of health care raises medical costs for everyone. Many of us don’t know where to go for our health care needs. It is very common that people become confused with the difference of family practice, emergency rooms and urgent cares.
A study conducted by the National Center of Disease Control in 2011 found that 79.9 percent of adults visited the emergency room due to lack of access to other providers and not necessarily because of the medical emergent situation.
Anyone who has visited an emergency room knows that it can be very costly and it’s not always necessary to go to a ER. Walk-in clinics or urgent care clinics typically offer the equivalent medical attention in 30 to 60 minutes, while a hospital ER incurs a wait-time up to four hours. In addition the ER costs for the same procedure are about 4-5 times higher.
For example, the costs of being seen for an IV (intravenous) can vary widely, depending on where treatment is sought. The same diagnosis and treatment come with very different price tags (lab fees may be additional).
Typical family practices and convenience care clinics such as those at pharmacies cannot perform such procedures. Walk-in clinics offer these services for about $130-$195. In an urgent care the same procedure will cost $140-$250. If you choose to go to the ER, the cost will be highest at around $800-$1,200.
To clear up all of the confusion, here is an easy to follow guide that differentiates primary care provider office visits, urgent care visits and emergency room visits, so patients can be confident with the doctor visit they’ve chosen.
Primary Care Provider Office Visits
A primary care provider (PCP) is a family physician, who takes care of a patient’s basic needs across a wide continuum of different problems. He or she is the first point of contact for a person with a medical or health concern and gets to know the patient personally over time. The primary care provider cares about the patient’s whole health condition including aspects of preventative care such as immunizations, mammograms and colonoscopies. This provider makes sure the patient receives the proper care and coordinates with specialists as needed.
Primary care practices provide health promotion, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of chronic illnesses in a variety of health care settings such as office, inpatient, long-term care, home care, day care, etc,.
Primary care practices are usually not set up to see patients with acute illnesses or injuries, since most of them are not equipped with x-ray and in-house laboratory.
The copay of primary care provider visits are often the lowest copay defined on health plans. And that is why we encourage patients to visit their primary care provider if available. For some illnesses, if your symptoms come on gradually or you already know the diagnosis, such as a urinary tract infection, you may want to try to get a same day appointment with your primary care provider. While urgent care clinics or emergency rooms are always available, your primary care physician will have a better picture of your overall health for a more accurate diagnosis.
Urgent Care Visits
Urgent care clinics are walk-in clinics and can handle a variety of conditions that need to be treated right away but are not a life or limb threatening emergency.
“I can’t wait..it’s URGENT!”
An urgent care is an option for when primary care provider appointments are unavailable or if you need treatment outside of office hours. If you wait days or weeks for an appointment with your primary care physician, you run the risk of your condition getting worse and requiring more complex treatment.
In addition urgent care is also a good option for any acute illnesses and injuries since it offers x-ray and lab services in-house, which can provide the results within minutes and allow the provider to determine a more accurate diagnosis.
Urgent care bridges the gap between an injury that can’t wait for an appointment at the primary care physician and the life-threatening situation that calls for a trip to the emergency room. Built around patient convenience, urgent care clinics are often found with extended hours, and are sometimes even open on holidays. Although all clinics are different, you can sometimes find them where no appointment is necessary.
Some symptoms that can be treated at urgent care include:
- Fever without rash
- Minor trauma such as a common sprain
- Painful urination
- Persistent diarrhea
- Severe sore throat
- Vomiting
- Accidents and falls
- Sprains and strains
- Moderate back problems
- Breathing difficulties (i.e. mild to moderate asthma)
- Bleeding/cuts — not bleeding a lot but requiring stitches
- Diagnostic services, including X-rays and laboratory tests
- Eye irritation and redness
- Fever or flu
- Vomiting, diarrhea or dehydration
- Severe sore throat or cough
- Minor broken bones and fractures (i.e. fingers, toes)
- Urinary tract infections
Emergency Room Visits
According to the CDC (Centers for Disease Control and Prevention), “one in five Americans reports visiting an emergency room at least once in the past year.” Perhaps not surprisingly, the CDC points out that the most common reason for adults to visit the emergency room are injuries. This might explain why 35 percent of adult visits to the ER require x-rays.
Children, on the other hand, are more likely to make it to the emergency room as a result of cold symptoms. This is especially true in children under four years of age.
In general, an emergency condition is one that can permanently impair or endanger the life of an individual.
Some examples of most common conditions that require emergency medical care according to CDC include:
- Severe chest pain or difficulty breathing
- Compound fracture (bone protrudes through skin)
- Convulsions, seizures or loss of consciousness
- Fever in newborn (less than three months old)
- Heavy, uncontrollable bleeding
- Deep knife wounds or gunshot wounds
- Moderate to severe burns
- Severe abdominal pain
So when you’re sick or injured, deciding where to get care is the last thing you want to worry about. Understanding your options now will make decisions easier when you need care immediately.