The Evolution of Health Care Now

bedsidemannerIt wasn’t that long ago when patients had two choices for accessing health care. You could make an appointment with your primary physician for some distant point in the future or go to the emergency department for an evaluation immediately – or at least after several hours of waiting.

Today there are several options for same day, often without a wait, unscheduled, walk in health care. These range from freestanding emergency rooms, urgent care centers and retail clinics associated with pharmacies or retail outlets. Each has their positives and negatives.

Free Standing Emergency Rooms have seen rapid growth over the past 5 years. They have the word “emergency” in their name and are regulated by the state to have the same capabilities as a hospital based emergency room. To qualify they must be open 24/7 and have an emergency physician on premises 24/7, a complete lab, CT scanner and ultrasound equipment. They are seldom very busy so the wait times are usually minimal. That is because the charges for a freestanding emergency room are the same as a conventional hospital based emergency room. Because there have been so many complaints about the unexpected large bills, the state has passed legislation that requires these facilities to prominently display information intended to educate a patient that the cost will be the same as a hospital based emergency room. In addition any patients requiring hospital admission will need to be transferred to an in-patient facility. So this type of facility is best for a patient who has an injury or illness too severe for routine walk in clinics, but probably doesn’t require admission to an in-patient facility. Or for someone who does not mind paying a huge premium for immediate care. Fees for a visit for strep throat can range from $800-$1500.

On the other end of the spectrum are retail clinics, usually found in pharmacies, grocery stores or large retail chains. These are open limited hours and staffed by Physician Assistants or Nurse Practitioners. Wait times depend on how busy it is, but is usually between 0-2 hours. These clinics are able to handle simple, non-complicated illnesses or injuries. They have very limited lab testing and no x-rays on sight. A young healthy person with a sore throat is a typical patient for this visit. Patients with additional co-morbidities such as diabetes or hypertension or other chronic illnesses are often referred out to a more complex clinic environment. With no x-ray available on site, evaluations of injuries are limited. The cost is much less expensive than freestanding emergency rooms. It is usually dictated by the insurance carrier and may have a copayment of $20-$50, or approximately $100-$200 for a cash paying patient.

In between these extremes sits Urgent Care Clinics. A good urgent care practice should be able to take care of more than half of the patients who would normally present to an emergency room. This type of practice offers walk in appointments, more lab testing than a retail clinic, x-ray capability, and additional procedures. It is usually staffed by physicians and has nurse practitioners and physician assistants to care for the patients. Generally, urgent cares are open extended hours but not 24/7. The typical patient can range in age from 3 months to 102 years. Typical presenting complaints include sore throats, fever, dehydration, lacerations, broken bones, abscesses and ingrown toenails. The cost is similar to a retail clinic in that it is directed by a patient’s insurance carrier, and may have a co-payment. For patients paying cash – not using their health insurance – the price can start at approximately $100 and depending on what services are required may increase. Generally, patients with co-morbidities such as diabetes or hypertension can still be treated safely at an urgent care clinic. But all urgent care practices are not the same. Although most urgent care practices are open 8-8, seven days a week, some have limited hours. Different urgent care practices often have different specialties. In San Antonio there are practices that are almost exclusively occupational medicine, some that are orthopedics only, and one that is the only practice in San Antonio certified in concussion management.

All of these practices are intended to care for episodic medical needs. Preventative health screenings and management of chronic illness is best handled by a stable, long-term relationship with a primary care practice.

In summary, the same day or no appointment necessary options have improved and increased in recent years. There are strengths and weaknesses in all the options. Any patient would be well served to spend a few minutes investigating these practices to find out what they cost, are they in network with their insurers, what services are available and who will be caring for them. How much less stressful would it be if you have gathered the information and had a plan in place before you actually needed it?


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