Mistakes to Avoid: Visiting Emergency Rooms over Urgent Care Centers
Posted by Jason Sandler, Principal, OneDigital on 6/15/2017

If you’re faced with an injury or illness, making an informed decision of where to seek medical care could result in receiving more timely medical attention and at significantly lower costs. North of 10% of all visits to the emergency room could have been treated at an urgent care facility or a doctor’s office.

Several years ago, I had a sudden injury early in the morning and sliced the bottom of my foot. The cut was pretty deep and it took nearly ten minutes to stop the bleeding.

My timing was unfortunate as I was leaving for a vacation to the beach in two days. I knew my condition was not severe enough to go to the emergency room, so I went online and found an urgent care facility close to my office that was an ‘in-network’ facility contracted with my insurance carrier. I created an account and selected the option that they call me 30 minutes before they would be ready to see me. Less than an hour later, I received a call and drove to the location and checked-in. After waiting in the waiting room for a short time, I was called back by the nurse and then the doctor cleaned and examined my wound and informed me that I would need stitches to help the cut heal properly. All in all, I was in and out with 5 stitches in just over an hour and only paid a $75 copay. While the visit was very efficient, the news of not being able to go in the ocean was devastating. I would have to be a spectator on the beach and would not be able to submerge my foot in the pool.

Did I make the right decision visiting an urgent care facility over an emergency room?

Let’s start by looking at the differences between the two types of facilities. Emergency Rooms (ER) are designed to handle serious medical conditions and life-threatening illnesses and injuries. While Urgent care (UC) facilities are a convenient solution for many individuals with injuries and illnesses that are not as severe and delaying treatment quickly could cause the condition to escalate into something more serious and/or high levels of discomfort.

When an individual checks in at an emergency room, they are treated based on the severity of the condition. For example, when someone arrives at the ER after a car accident, they will be treated more quickly than someone in my situation above that has a cut at the bottom of their foot, which may result in a few stitches. Someone in my situation would have most likely waited hours to receive treatment on their foot at an ER. To answer my question above, then yes, I made the right decision based on gaining treatment more quickly. For my plan at the time, I shared with you my UC copay was $75 and had I received care at the ER, I would have paid a $250 copay. Personally, I saved myself $175 I would have paid had I visited an ER. Once again, visiting the UC facility was the right choice for me financially.

For those of you who may not have visited an UC, they often have extended hours of care and act as a solution for many individuals who delay receiving care during working hours or when conditions occur or escalate after hours or on weekends. These facilities are NOT designed to care for life-threatening illnesses or injuries. Here are some medical conditions that urgent care facilities are typically equipped to treat:

  • Sprains
  • Strains
  • High Fever
  • Allergies
  • Urinary Tract Infections
  • Vomiting
  • Ear Infections
  • Diarrhea
  • Rashes
  • Wounds that may require stitches
  • Dehydration

On the Cigna website, there is an informative section that helps people understand when to visit an UC or ER facility. In addition, Cigna shares from their internal data in 2013, that the average cost on ER visit is $1,757 compared to the average cost an UC visit is $153. For those larger credit unions or groups managing self-funded plans, this data is very eye-opening. On average, a visit to an ER is approximately 11.5% more than a visit to UC.

What are some strategies to change behaviors and help employees utilize the UC unless it is a significant injury or illness? One strategy is to increase the ER copay to create a bigger spread between the ER copay and the UC copay. For example, companies could make the ER copay $350 and the UC copay $75. This is a significant cost difference and employees would most likely visit an UC if they have the flu than go to an ER. Another great strategy is to provide a telemedicine or telehealth program that allows employees and dependents to contact a licensed medical doctor 24 hours/7 days a week to help treat low-level conditions or help them determine if they should hang-up and go to the nearest UC or ER facility.


Cost estimates are based on Cigna internal analysis of national 2013 averages of participating facilities; actual cost may vary by location, facility, the type or level of services received, and medical plan.

 

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