It’s Friday night, and you have felt sick all day.
All week you have kept it together to go to work, not wanting to miss a day during the holiday season. You don’t have a fever, but you wonder what’s going on, and want to see your doctor for advice. That’s not possible at this late hour, the office is closed until Monday.
You might consider going to an emergency room. After a couple of lab tests, some intravenous fluids, and a prescription for antibiotics, you’d be good to go.
But the cost of the ER visit could end up being upwards of $2,000 — more if additional testing is done like a CT scan or x-ray.
If you had seen your doctor in the office when the illness started — or went to an urgent care center Friday night — the bill might be less than 10 percent of the ER charge.
The Queen’s Medical Center emergency room parking lot. If hospitals had their own urgent care clinics, they could take some of the load off the ERs.
Cory Lum/Civil Beat
ER visits are expensive, and many are unnecessary because they’re for routine conditions like minor bladder infections, colds and coughs, prescription refills, low back pain, twisted ankles, etc.
But often the reason someone goes to the ER is because they feel it could be an emergency, and don’t have the medical training to know otherwise. It might be the only place available after hours, or their symptoms might have gotten worse and they are worried about getting pneumonia, or having a fracture.
There are certainly legitimate reasons to go to the ER, such as people who are seriously injured or fear they are having strokes or heart attacks. It’s these folks who need emergency care, possibly urgent surgery or life-saving medications. However, serving patients who could be somewhere else can tie up ER doctors and make those with real emergencies wait.
There is an alternative for nonemergency visits. Urgent care centers are a great place to get care for many of these conditions. But once someone decides to head to the ER, they have used their best judgment and are on their way.
What if hospitals provided both ERs and urgent care clinics in the same general location.
Simple things could be taken care of at the urgent care area. This would shorten the waiting time for true emergencies.
Patients who show up at the ER could be triaged by highly trained nurses to go to the actual emergency room or to the on-site urgent care section. Everyone would be seen, but the venue would be decided by medical personnel.
Simple things could be taken care of at the urgent care area. This would shorten the waiting time for true emergencies and also allow for an easy transfer to the ER if the person who was seen in the urgent care area needed more help than was anticipated.
Ancillary testing could be provided, with no extra cost to the facility since the services are already available for the ER. This could include x-rays and lab testing — services that are often not immediately available in a separately located urgent care.
This co-location could also be staffed by nurse practitioners and physician assistants that would have direct access to physicians rather than the way some of the current clinics are staffed, which requires transfers via ambulance to the ER for anything that is too complex for the provider to handle alone.
Hospitals would benefit by having another option for care for patients, which would lessen the amount of money they currently spend on highly trained emergency personnel who wind up taking care of low acuity patients.
Uninsured patients would benefit because they would not have to pay for the high cost of emergency care if they only needed something that an urgent care-like visit could handle. Medical bankruptcies from high ER charges might even be reduced.
Insured patients would also benefit because the overall cost of care for all members has the potential to go down, thus lowering premiums for coverage. Given the fact that many visits to ERs are considered unnecessary, there are potentially millions of dollars that can be saved in payments to lesser acuity areas.
Hospitals will not be paid separately for each ER visit in the near future, instead receiving a set amount to care for all of their patients, regardless of which part of the hospital they’re in. Creating a mechanism to identify the correct location is key to the success of these accountable care organizations.
Finding more cost-effective alternatives that will provide comprehensive care options for patients is a must. Co-locating an urgent care next to an ER will put the responsibility on highly trained medical staff to appropriately identify which patients have a true emergency, while alleviating the patients from having to make the choice themselves.
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Kathleen Kozak, M.D., is an internal medicine physician at Straub Clinic and Hospital. She is also a part-time medical director for UHA Health Insurance and is the host of “The Body Show” on Hawaii Public Radio.