Hospital ER, Freestanding ER, or Urgent Care

Let’s say your child has a high fever, things are getting worse and you need quick medical attention. Where do you take them?

If you go to urgent care your provider might suggest you be transferred to an ER for higher level of care. You can’t afford to pay for two sets of bills, but your child needs medical attention now. What do you do?

Many people base their decision on cost. Both hospitals and Freestanding ERs can handle everything that an urgent care can, but that “one-stop shop” convenience usually comes with a hefty price tag.

While there are many sides to this debate, there are some solid guidelines that can help you determine which venue is best for your acute medical need.

Choosing Between an ER and Urgent Care

Freestanding ERs and Hospital ERs both provide great emergency care. The biggest decision is when to choose an ER versus an urgent care. Really, price can’t factor into this call. The decision should be driven only by the severity of the medical problem. If there is a definite medical emergency call 911 or go to your nearest emergency room. Serious bleeding, head injuries, major fractures, ingestion of poison, chest pain, stroke like symptoms – these types of conditions all need immediate and serious attention and there is no substitute for the ER in these circumstances.

Hospital ERs are a trusted and reliable choice, but as we know they are not always convenient and they definitely are not cheap. The good news is that According to an independent survey, only 1/3rd of people attending an E.R needed actual emergency care! If you know loss of a limb or life are not on the line, spare your pocket book. There are better choices out there.

So What are Urgent Care Centers For?

Urgent Care Centers bridge the gap between the services provided in an emergency room and services provided in a primary care physician office. They treat a broad range of acute, but minor medical conditions. Examples include, cough, fever, sore throat, urinary infections, and ankle sprains. They often provide flu shots and school physicals as well. The majority of urgent care centers are open 7 days per week and appointments are not required. Wait times vary, but are generally shorter than at a hospital ER. Most all are open until 8 or 9 pm and some as late as 11pm. They are usually staffed by mid-level providers or family care physicians. They can provide most of the same services available in a local physician’s office with the addition of onsite labs and x-ray machines. They usually do not have the specialized medical equipment or emergency trained doctors needed for life-threatening medical conditions. Cost is the biggest benefit here. They often offer cash-pay options if you do not have insurance and most are in-network with major insurance plans. This means they have a contract with your insurance company so there are no surprise battles to fight later.

Freestanding versus Hospital Based ERs

Whether you have a cold or have suffered a gunshot wound, both facilities are capable of providing quality and emergency care 24 hours a day. While people understandably want convenient access to medical care whenever they need it, both types of ERs should really be reserved for real emergencies. This is especially true for hospital ERs where the same ER doctors treating coughs and urinary infections are usually simultaneously entrenched treating heart attacks, strokes, and trauma victims. Those critical patients will require the physician’s attention and may cause you to wait longer to be seen if you are more stable.

Because of the myriad of complaints and their sheer volume hospitals they have to use a strict triage system to decide who gets seen first. Time is important to everyone. In order to judge if a freestanding may be a better alternative, it is helpful to understand the hospital’s triage system. Triage usually consists of 5 levels based on severity. Level 1s are the most critical patient’s who can die without immediate life-saving interventions. This includes acute cardiac arrest patients who are receiving CPR. Their hearts have actually stopped beating and all the hospitals resources are brought to bear in the attempt to save the patient’s life. They garner the immediate attention of everyone on the team. Level 2s are the next most critical patients who should receive some medical attention within the first 15 minutes of arriving to an ER. These patient’s usually have abnormal vital signs or life threating complaints like chest pain and shortness of breath. Without quick treatment, these patients have the potential to become level 1s! They go to a room as soon as possible. Level 4s and 5s are much less sick and the most stable patients. These patients usually require no more than 1 X-ray or 1 lab test. Examples include ankle sprains, flu symptoms and bug bites. These are shuffled to the ER’s ‘fast track’ area where wait times are typically around an hour. Basically 1s, 2s, and even 4s and 5s all get seen pretty quickly. The problem is the guys in the middle – the dreaded level 3s. These are the abdominal pains, high fevers, headaches, complex lacerations, broken bones, concussions, dehydration and asthma exacerbations. Abdominal pain could be something serious like appendicitis, but it could also be constipation or gas. An asthma attack can turn deadly serious but the patient may just need a breathing treatment or a med refill. When everyone needs the doctor ‘now’ triage is the answer and Level 3s go to the back of the line and they wait the longest. They are too sick for an urgent care or the fast track area, but not sick enough to get sent quickly to a room. Getting triaged to Level 3 means going to the purgatory of the ER. Put simply, if there is a four hour wait, and you are designated a ‘level 3’ you will wait in the lobby for the entire four hours.

“So, what do I do if I may be a level 3?”

One option is a freestanding ER (preferably with a board-certified ER doctor who has trained in hospital ERs). Many Freestanding ERs employ the same board-certified ER doctors as the major hospitals, and they can provide the same initial stabilization and treatment of most anything that walks through their door. They have CT scanners, Ultrasounds, X-ray and on-sight, hospital-quality labs. They can test for heart attacks and meningitis. They can safely sedate patients for painful procedures like setting broken bones. They are even equipped to place someone on temporary life support in preparation for transport to a hospital if needed. If someone needs admission to a hospital they can often have them transferred directly to a room in that hospital faster than if they had gone to that hospital’s own ER. In-short they are a great solution for the level 3s.

The primary concern with freestanding facilities is that they bill similar to hospital ERs and some are located in shopping centers and get mistaken for retail urgent care facilities. The trick is to look for the word “Emergency” on the building and to use them for emergencies only. Level 3s are true emergencies. They can turn into fatal situations and no one plans for these.

Another complaint is that the freestanding facilities are often out of network with insurers. Fortunately, insurers are required by law to cover all legitimate ER visits under their in-network plans regardless of whether the visit was at a freestanding ER or located in a hospital. It is important to note that many hospitals and/or their ER doctors are ‘out-of-network’ as well. Insurance companies and the state government recognize that no one has time to check the network status of an ER in the middle of an emergency.

To make it even easier, some freestanding ERs actually partner with an on-site urgent care that provides both services under one roof taking out ALL of the guess work.

If you have questions about your local freestanding ER, give them a call. Ask if their doctors are board-certified in emergency medicine. Ask if they balance bill. Ask if they have an urgent care on site for minor complaints.

In summary, all three types of facilities address the need for quick medical assistance. If you would typically visit your doctor, but they are unavailable due to the time or day, then urgent care is usually the next best place to seek medical assistance quickly. If you think you may have a level 3 complaint give your local freestanding ER a try. If you know you or your loved one needs immediate lifesaving care call 911.

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