Commentary Search

The health care system needs your help: The emergency room or urgent care center?

  • Published
  • By Lt. Col. Joyce Beaty
  • 90th Medical Support Squadron commander
As I made the transition from flight commander to squadron commander, I've done so in one of the most financially challenged times in recent Air Force history. We're scrutinizing all expenditures, cutting costs and working diligently to be great stewards of our tax payers' dollars. As a leader, I feel compelled to reach beyond my squadron and group to a larger audience that potentially has no realistic idea of the impact their choices have on our health care budget, which affects our beneficiaries.

One of the most stressful things that happens to us occurs when our daily routine is interrupted by an unexpected health issue. Illness-stricken patients and anxious parents alike are typically not thinking about the cost of care at times when they need health services the most. As a result, through habit, a great many automatically elect to receive health services in an emergency room setting.

The heavy use of expensive emergency rooms has motivated health care planners to create a viable alternative we know as urgent care centers. The military health system has contracted with a range of outpatient service providers to cover the continuum of care needed by its beneficiaries. Each outpatient service is billed separately to the Department of Defense with the most expensive bill coming from ER visits.

In 2012, F. E. Warren beneficiaries utilized ERs an average of 311 times a month, while using UCCs 337 times per month, almost equal. A typical ER visit in our area is approximately $500 dollars while an UCC visit is one fifth of that cost, coming in at roughly $94 a visit. Last year alone F. E. Warren beneficiaries spent $1.7 million dollars on ER visits. Of the 3,743 ER visits in 2012, only 272, or approximately 7 percent, resulted in a patient being admitted into the hospital. The rest were treated and sent home.

We see cases of members going to the ER for a fever blister or because they had blurry vision and after a CT scan, lab work, eye dilating and an extensive amount of ER doctor's time, it was discovered that the member was issued prescription eyeglasses but refused to wear them on a regular basis. It's these types of uses that must stop and solid judgment must take precedence when deciding to seek care after duty hours. While the majority of our local ER use might be necessary, if we don't choose the appropriate level of care, we could see our medical benefits change to align with those in the civilian sector.

A study done for the Health and Human Services Commission states that in most cases, commercial health insurers have addressed the use of the ER with significant cost-sharing requirements for recipients. In the commercial market, standard co-pays are charged for using the ER, regardless of whether an emergency or nonemergency condition exists. For example, when an individual with private health insurance coverage determines it is necessary to take a child to the ER because of a high temperature, a co-payment of $50 to $150 or more may be charged. These types of high co-pays are intended to discourage unnecessary use of the ER and becomes part of the decision-making process as the parent decides how, when, and where to seek medical care for the child. While this currently is not the practice for TRICARE, our rising health care costs could drive this type of change in our very robust health care benefit.

Studies indicated that patients at a typical UCC also benefit by choosing it over an ER visit. On average physician availability is better at an UCC and that reduces the patient's average wait time.

The patients are in the best position to help themselves, while at the same time saving the DOD money by choosing an UCC when it's appropriate place to receive emergent care. In the long-run, patient care will suffer if health care dollars continue to be used to purchase care that is more expensive than what is required.

So the real question becomes, how does a patient or parent choose between the two outpatient settings when it inevitably becomes the time to choose?

If a condition arises and you do not feel it can wait until you can schedule an appointment with your primary care manager, urgent care may be an appropriate choice for your care. You should always contact your PCM before deciding to go to urgent care. You can contact your PCM during regular office hours, or request a referral to urgent care after hours by calling 773-3461. The nurse triage service can assist you over the phone and help you decide on the most appropriate care. In general, if the illness or injury is something for which you'd normally see your PCM but for which you can't get an appointment within access standards or it's after hours, urgent care is the right choice. Some reasons your PCM may direct you to go an UCC are: minor lacerations, urinary tract infections, earaches, migraine headaches, sprains, rising fever, etc.

An ER is prepared to treat life threatening illnesses and injuries 24/7. The ER sees patients in order of priority, based on the seriousness of their conditions. If you use the ER for non-emergency conditions, you may wait for a prolong period of time and your visit will certainly cost significantly more than a UCC visit. It's important to keep hospital emergency departments open for true emergencies.

If someone is unconscious, having trouble breathing, has suffered a serious injury, or may be having a heart attack, call 911 immediately. Don't try to drive yourself, or anyone else, to the hospital if the condition appears serious. Paramedics who respond to 911 emergency calls are specifically trained to stabilize emergency patients and coordinate their care with the most appropriate hospital ER for their treatment. Some examples of serious medical conditions or symptoms requiring emergency care are: severe bleeding, chest pains, no pulse, inability to breathe, spinal cord/back injury, severe eye injuries, broken bones, etc. The medical layman's standard is conditions that risks a loss of life, limb or eyesight.

By making prudent choices when seeking treatment at an urgent care clinic or hospital ER, you are obtaining the care you need in the appropriate setting. When you are able to choose an UCC, you'll reduce your wait time and will significantly save not only in terms of costs but also quality, efficiency and appropriateness of care.