How to (Maybe) Avoid Sticker Shock at the Emergency Room

1. How to (Maybe) Avoid Sticker Shock at the Emergency Room By Richard Klasco, M.D. and Richard Zane, M.D. Sept. 7, 2018 New York Times https://www.nytimes.com/2018/09/07/well/live/emergency-room-costs-medical-bills-urgent-care-virtual-care.html?

2. Where to Go? • Depending on what a patient’s symptoms are, it may be worth considering options other than Emergency Room for same-day care. In order of increasing services that can be provided, and increasing price, the options are: primary care, virtual care, retail clinics, urgent care centers, and emergency departments (E.D.s). • Primary care: Although it may be difficult to see a physician on short notice, primary care providers can often handle the problems of established patients by telephone at no cost. • Virtual care: Accessible by smartphone, tablet or computer, virtual care is available in most states and is usually the least expensive option for unscheduled care. Websites such as Doctor On Demand and UCHealth Virtual Visits are staffed by physicians or advanced practice providersand are aimed at providing treatment for simple medical problems. Virtual care is covered by most insurance. Costs are typically $40 to $80 per visit. • Retail clinics: For unscheduled, in-person care, retail clinics — found in pharmacies, supermarkets and other retail locations — are the least expensive option. They are designed to provide quick care for minor problems like sore throats. As an example, CVS Minute Clinics typically charge $99 to $129. Care is typically rendered by a nurse practitioner or physician assistant.

3. Where to Go? • Urgent care: Urgent care centers such as Concentra and CityMD offer walk-in care for illnesses and injuries that are not life threatening. Charges for simple complaints, such as sore throats, run $150 or more. Urgent care centers may be staffed by a physician assistant, a nurse practitioner or a physician. • Emergency rooms: There are now three types of emergency departments: stand-alone E.D.s, mini-hospital E.D.s and traditional hospital E.D.s. All are staffed 24/7 by board-certified emergency physicians. All are able to deliver lifesaving care. And all are similarly expensive. Stand-alone E.D.s are usually the quickest and most convenient. Traditional hospital E.D.s are best equipped to handle severe emergencies, such as major trauma.

4. Where to Seek Acute Care Rule-of-thumb suggestions for the most common symptoms seen in emergency rooms. Source: Richard Klasco and Richard Zane, adapted from the National Hospital Ambulatory Medical Care Survey

5. Considerations? • Using sore throat as an example, health insurers reimburse emergency departments at an average of $956 for a sore throat, compared with $131 at an urgent care center. While the patient’s financial responsibility varies from insurer to insurer, emergency room co-payments are generally higher than they are for urgent care, and the bill will be higher than it would be at a retail clinic or urgent care center. • But cost cannot be the sole concern. Potentially serious problems require a visit to the emergency room. For example, adults with chest pain — particularly those with a history of cigarette smoking, diabetes or other cardiac risk factors — should be evaluated in an emergency room. Visiting one of the other venues risks turning one bill into two, as a referral to an emergency room is likely. It also risks a delay in receiving potentially lifesaving care.

6. The Economics MB3 $ Emergency • (Almost) pure case of MB, MC. • MC? • There is some issue of information. • Do you know how sick you are? • If you pick the wrong one, you may have to pay for two. MB1 Urgent Retail MB2 Virtual Type of Visit