By Jay Woody, M.D., FACEP, co-founder and chief medical officer of Legacy ER & Urgent Care
It’s no secret that going to the doctor can be expensive, but visiting a neighborhood emergency room can be even more costly. Many consumers head off to an emergency room (ER) when they become immediately ill or injured. While this might seem like a sound decision, much of the public is unaware that there are lesser cost alternative health care options available when it comes to where they can seek medical care.
For example, if a patient were to walk into an emergency room for a strep throat test, they could walk away with a bill upwards of $3,000 on average. Had that same patient gone to an urgent care facility, they could have walked out with a bill of approximately $230 – a major difference in cost, and a major mistake often made. Because the case didn’t require emergency level care it could have been taken care of at an urgent care-level facility, and therefore charged the lesser urgent care pricing rate.
Over and over again, patients are laden with these massive medical bills that just don’t seem to add up or make sense to them. That’s in part because there’s an abundance of confusion about the different types of neighborhood health care facilities, causing consumers to inadvertently choose the wrong type of facility for their specific injury or illness. In fact, studies show that most of these health care visits do not require an ER level of care.
According to a report from Truven Health Analytics, more than 70 percent of emergency department visits from patients with consumer-sponsored insurance coverage are for non-emergency conditions or conditions easily preventable through simple outpatient care. This means that consumers are experiencing higher medical costs due to unnecessary ER resource utilization.
It’s important for patients to do their own due diligence and educate themselves on their health care options and the costs associated with those choices—before it becomes a necessity. Because it may save them thousands in unnecessary medical costs.
What is the Cost?
According to a private study conducted by the independent market research firm, Milliman, approximately 44 – 65 percent of all ER episodes could have been treated in urgent care clinic settings. Consider this: an urgent care-treatable case handled in a hospital emergency room costs an average of $2,039, while the same case treated in an urgent care facility would run approximately $226; that’s a $1,813 cost difference that could be avoided on a case-by-case basis.
Most of the time, patients end up learning the hard way and overspend on a level of medical care when it just isn’t necessary. When a patient visits an ER for a non-emergency case and pays emergency-level rates, this eventually ends up raising the cost of health care for all consumers.
Part of the solution is educating yourself on cost analysis and knowing which health care options are available. It’s a sad fact that many patients simply don’t realize that the health issues they are visiting the ER for could easily be treated at an urgent care facility for a fraction of the cost.
Furthering the Problem: Self-Diagnosis
Complicating things further, patients feel the need―or are even encouraged―to self-diagnose their illness or issue in determining whether to be treated in an ER or urgent care facility. This process forces patients, who obviously aren’t trained physicians, to make uninformed choices on where to seek help or be treated. With this mindset in place, patients all too often end up paying considerably more for their health care than is necessary because traditional ERs are beholden to charge emergency prices, even for non-emergency procedures.
Patients need a better solution that allows them avoid self-diagnosis when choosing the right facility―both for quality of medical care and financial impact. To avoid this dilemma, patients could benefit from a facility or health care clinic that takes the guesswork right out of the equation. That’s where the hybrid health care model comes into play.
A New Medical Model: Hybrid Clinics
Currently, the health care landscape is moving sharply in the direction of consumerism. Instead of health care specialists deciding on the types of care facilities that exist, consumers are learning to choose the type of facilities which best suit them. Because of this trend, alternative health care clinic options are coming to the forefront of the discussion.
One of game-changing alternatives currently being implemented by health care clinics across the country is the integration of the hybrid health care model. The hybrid model combines and incorporates both emergency-level care and urgent care into one facility. Subsequently, this model allows health care providers the ability to establish a cost-effective, more personal and time-efficient way to deliver both forms of medical service. By having both types of care in one location, patients no longer have to guess about what kind of facility they should seek. By taking the guesswork out of where to go, patients can focus on getting the proper diagnosis for their injuries or illnesses. In addition, patients are treated based on the severity of their condition (ER care or urgent care) and only charged for the level of care required at the time of the visit.
In visiting the strep scenario again, if someone walked into a hybrid health care facility with strep, the doctors would be able to categorize them and treat them as an urgent care patient, not an ER patient, thereby resulting in a much lower medical bill.
This next generation hybrid health care model not only takes away the process of self-diagnosis, but removes the guesswork of choosing from similar looking neighborhood health care facilities. Because as we now know, the hidden cost of health care is anything but uniform.
Dr. Jay Woody is the co-founder and chief medical officer of North Texas-based Legacy ER & Urgent Care.