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Saving on Care: Emergency Rooms vs. Urgent Care Facilities

When trying to settle medical bills, don't be afraid to negotiate.(ISTOCKPHOTO/HEALTH)

Emergency rooms are not always the fastest choice for your medical care needs—and certainly not the most cost-effective. For conditions that aren't life-threatening, you may be able to save time—and money—by going to your local urgent care facility. Sometimes called a “doc in a box,” these freestanding walk-in centers usually offer extended hours, and their doctors can treat non-life-threatening medical situations, perform basic X-rays and lab work, and dispense prescriptions.

Emergency room vs. urgent care facility
Franz Ritucci, MD, president of the American Academy of Urgent Care Medicine, recalls a Florida woman in her 40s who came to him with chest pain and heart palpitations. He took her medical history and did a physical exam, including a 3-D electrocardiogram and a check of her blood-oxygen levels. In less than an hour, she was diagnosed with a panic attack, given a prescription for anxiety medication, and discharged. Her cost: less than $400.

Had she gone to the emergency room with the same symptoms, the routine treatment would be far more intensive. “She would get a full panel blood work, probably cardiac enzymes, serial EKGs,” says Dr. Ritucci. “She would be on a heart monitor, probably have a cardiology consult, and maybe an admission to the hospital of less than 24 hours. The standard of care might be excellent, but the costs can quickly get out of hand.” Estimated bill: $2,000 or more.

Next Page: Emergency room

[ pagebreak ]Emergency room
When to go: If you have symptoms of heart attack or stroke, or feel that your "life or limb" is in danger, go immediately to the emergency room. Also, if you think you might be having a medical emergency, but arent sure, go to the ER. According to the American College of Emergency Physicians, you should visit the ER if you have any of the following warning signs:

  • Chest pain or pressure
  • Uncontrolled bleeding
  • Sudden or severe pain
  • Coughing or vomiting blood
  • Difficulty breathing or shortness of breath
  • Sudden dizziness, weakness, or changes in vision
  • Severe or persistent vomiting or diarrhea
  • Changes in mental status, such as confusion

If you have a chronic condition, discuss in advance with your primary care doctor under what circumstances you should go to the ER.

How to find one: If you have a choice of emergency rooms nearby, ask your primary care physician which he or she recommends before you need to go. Also, check with your insurer to see which facilities belong to your insurers network, and whether the amount of ER coverage differs at in-network and out-of-network hospitals.

See how the hospital rates on important quality measures including care for heart attacks, heart failure, pneumonia, or surgery, by checking the U.S. Department of Health & Human Services consumer-oriented Hospital Compare online tool.

Cost: According to the federal Agency for Healthcare Research and Quality, the average cost of an emergency room visit in 2003 (the most recent year for which statistics are available) was $560.

Urgent care center
When to go: Urgent care facilities are for non-life-threatening conditions that need attention right away. These include minor traumas such as cuts, sprains, eye injuries, flu, fever, insect bites, and simple fractures. Patients are usually seen on a walk-in basis, and many centers have extended hours. (By administering an EKG or adjusting your diabetes medication, urgent care centers can even help manage your chronic health conditions after normal business hours, when your family doctor may not be available.)

Most urgent care centers have computerized radiology equipment and the ability to do lab work such as a complete blood count (CBC) test or electrolyte test. They can also run diagnostic tests for conditions such as mono, strep, pregnancy, flu, and viruses, according to Dr. Ritucci. In some states, urgent care centers can dispense the same medications as a pharmacy.

Many urgent care centers are staffed with at least one board certified physician. But they often use “physician extenders,” such as nurse practitioners, who are certified to treat certain ailments, and physician assistants, who generally work in tandem with an MD. “In our center, anytime a patient requests it, they can see the doctor rather than the physician assistant or nurse practitioner,” says Phillip Disraeli, MD, a physician and part owner of Metro Urgent Care in Frisco, Texas, and the director of clinical programs for the Urgent Care Association of America.

How to find one: Its a good idea to locate an urgent care facility close by so you know where to get quick help when you need it, and to research what its medical capabilities are. Pay a visit and ask about their facilities for treating your condition, such as the ability to do lab work, CT scans, or life support if the situation demands it.

To locate urgent care facilities in your state, visit the website of the Urgent Care Association of America (UCAOA). Look for one that is accredited, which indicates that it meets industry standards for ambulatory care.

Cost: As a rule of thumb, one-third to one-half that of an emergency room visit, according to Dr. Ritucci. Urgent care centers usually accept many types of insurance, and many offer discounts to those paying cash.

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