E.R., urgent care vary on price, services

07/16/2014 2:20 PM

07/16/2014 2:21 PM

Kristyn Rowney had a high fever and pounding headache that continued to worsen as she continued to put off a trip to the doctor. As a Mansfield stay-at-home mom with a household and three children to manage, she couldn’t call in sick.

By the time she relented – which wasn’t until her lungs were rattling with every breath – it was the weekend, when doctors’ offices are closed and hospital emergency rooms are often packed and taking patients worst-case first.

So Rowney opted for a genre of medical provider that has become one of the fastest-growing sectors of the healthcare industry in the past few years – an urgent care center, a doc-in-a-box.

Just minutes from her home, she wheeled into the nearly empty parking lot of Expedian Urgent Care Clinic, 980 N. Walnut Creek Drive, and within 20 minutes she was ushered in to see the doctor. He gave her steroids and antibiotics to treat what he diagnosed as pneumonia, as well as specific medication for her headaches, she said.

After a visit totaling no more than 45 minutes, she was headed home.

“It was a great experience,” she said. “It was good enough for me to want to go back.”

Mansfield has been an especially attractive destination for both urgent care clinics and free-standing emergency rooms, which are drawn to affluent suburban neighborhoods and shopping centers frequented by well-insured residents, experts say.

At least five urgent care clinics and two free-standing clinics are doing business in Mansfield, with an eighth provider – Baylor Emergency Medical Center -- set to open at 1776 N. U.S. 287 on July 21.

But before you hurry off to one, know the difference between these neighborhood medical facilities, the level of treatment each is intended to provide and, perhaps more importantly, the costs.

Kim and Steve White could have benefited from that pointer. When the hedge trimmer nipped his finger on a Saturday afternoon in February, they rushed to the nearby First Choice Emergency Room, which opened at 995 N. Walnut Creek Drive in November.

The inch-long cut was stitched and they were sent on their way.

“They were nice enough,” said Kim White, a nurse at a Dallas hospital. “But when the bill came, it was a stunner” -- $1,714.50. It included $940 for a “facility” fee, a revenue source created to help compensate hospital emergency departments for their critical care staff, equipment and other overhead costs.

Since her husband hadn’t met his $2,500 deductible on their insurance policy, they owed the full amount and are paying it off a little each month.

She said she considered going to an urgent care center first.

“I knew I could go there for strep throat for my kid,” she said. “But do they do stitches? I don’t know.”

Urgent care clinics do stitch minor wounds – and much more cheaply, around $200 to $300 – as well as tend to bone fractures and sprains, flu symptoms, chest and back pains, infections and other ailments.

People find them convenient not just on weekends but also when the family doctor’s office can’t immediately squeeze in another appointment.

But some health professionals say it may not be so healthy to rely on urgent care clinics as one’s sole source of medical attention. Primary care doctors have a history and familiarity with their patients that can lead to a better diagnosis, said Maureen R. Courtney, associate professor at UT-Arlington’s College of Nursing and active nurse practitioner.

“Primary care is a much broader scope of care that is designed to keep you healthy, whereas the other ones are just to take care of that one problem,” she said.

Mansfield’s urgent care clinics, like most others, operate generally from mid-morning to the mid-evening hours, every day, although some work shorter hours on weekends. Costs for office visits, which include seeing the doctor or nurse practitioner, range from $120 to $250.

At Bumps N’ Bruises Pediatric Urgent Care, which treats children up to age 18, an X-ray adds about $50 to the bill, and an in-house strep test adds $24, said office manager Julie Lett.

Like Expedia, Bumps N’ Bruises, which opened in December 2012, is locally owned and operated by a board-certified doctor, a pediatrician in this case. Although proud of their independence, the lack of a franchise affiliation makes it tough to build name recognition, Lett said.

“We’re trying to compete with other urgent care clinics that are franchised,” she said. “We’re an individual entity that is trying to survive.”

State law requires free-standing emergency rooms to operate 24 hours a day and meet certain staffing and service levels. Those providers say they offer convenience for patients and give a measure of relief for overcrowded hospital emergency departments.

But they don’t have the critical care resources of a hospital E.R., said John Phillips, president of Methodist Mansfield Medical Center.

“This hospital is fully equipped to take care of life-threatening illnesses and injuries, while a free-standing ER may not be able to care for patients who need immediate surgery or hospitalization without transferring the patient to a hospital, or ambulance fees may apply and precious lifesaving minutes may be lost,” Phillips said in an email response to News-Mirror questions.

“We are the only Cycle IV chest pain center and designated stroke center in the Mansfield area,” he added. “Our ER staff is especially cross-trained in several areas so the patient does not have to wait for additional medical staff to assist with care.”

Texas is a hotbed for free-standing E.R.s, because the state offers a vast supply of affluent communities and doesn’t require certificate of need, said Alan Ayers, content advisor and a board director of Urgent Care Association of America, which represents 2,600 clinics. Although Texas has imposed some regulations on those facilities when some other states haven’t, the fact they don’t have to demonstrate a need for their services has been a big draw, critics say.

“So not only does Texas provide the patient base these entrepreneurs are looking for,” he said, “barriers to entry in Texas are relatively low.”

First Choice Emergency Room, founded in 2002 and now the oldest and largest chain of freestanding E.R.s, is headquartered in Lewisville and has 45 facilities, according to its website. The chain has built 39 in Texas and now has expanded into Colorado with six locations.

Some insurance companies are encouraging their customers to choose lower-cost options. CareFirst Blue Cross Blue Shield in 2012 studied the price difference between urgent care clinics and emergency rooms and detailed a wide disparity, according to its website.

Treating bronchitis at an E.R. costs an average of $814, compared with $122 at an urgent care clinic, the report said. Similarly, treating a sore throat costs $620 at an E.R. and $93 at a clinic, and treating lower back pain cost $751 at an E.R. and $113 at a clinic. (The website noted that the severity of the conditions was not considered.)

Some health professionals and experts worry that the habits of millions of people to seek treatment for minor problems at emergency rooms will force insurance premiums higher. They believe that risk could increase as more Americans become insured under the Affordable Care Act, although the law does fund initiatives to help them explore all of their new healthcare options.

Howard Gershon, a Santa Fe, N.M.-based consultant who works with Texas hospitals, said his firm did a study for a client that found significant overuse of E.R. services.

“Thirty percent of those patients didn’t need any services that they couldn’t have gotten in a doctor’s office,” said Gershon. Texas might do well to follow examples in some other states, he added. “In New Jersey, the only way to have a free-standing E.R. is if it’s run by a hospital. In California, they’re only allowed in rural areas” where doctors and medical care are sparse.

The Baylor facility to open this month in Mansfield likely will be counted as Mansfield’s third free-standing E.R., but Ken Klos, regional marketing director for Baylor Emergency Medical Centers, said he prefers the term “micro hospital.”

In addition to housing eight E.R. beds, the 40,000-square-foot facility will have eight in-patient beds and will be licensed as a hospital rather than a free-standing E.R., he said. It will have onsite imaging, including CT scan, X-ray and ultrasound, he added. “This is the only model of this type in the Metroplex that’s branded by a major health care system.”

Mansfield will be Baylor Health Care System’s sixth such facility. The seventh is scheduled to open Aug. 11 in Colleyville. Baylor opened its fifth emergency center less than two months ago.

“We’re building facilities in areas where it doesn’t justify building a $250 million traditional hospital, but where we want to have a Baylor presence,” Klos said.

As Mansfield’s medical industry continues its expansion, Kim White said she knows she’ll be ready for her family’s next finger cut or head bump.

“You’re going to have to learn that you have to price shop,” she said.

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