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A Navigation Tool for the Emergency and Acute Care System

Author: Brendan Carr, M.D., director, ASPR Emergency Care Coordination Center
Published Date: 6/15/2017 10:08:00 AM
Category: Public Health Preparedness;

In a Midwestern town, Sherri’s son injured himself with a chain saw cleaning up debris after a tornado; Sherri was gripped by fear, which quickly gave way to frustration and confusion. A thousand miles away, on the East Coast, hours after a hurricane blasted Tom’s hometown, his mother suddenly had chest pain. He thought she should see a doctor but he wasn’t sure where to take her post-storm. All Sherri and Tom wanted to do was take care of their loved ones, but they were confronted with a healthcare system that they did not fully understand, and they had no idea where to get the right information.

Should they go to the emergency department? Or would a retail clinic or urgent care center be better? And would that place have the right equipment and capabilities necessary for care? After a natural disaster, which of these places was even open and were the roads there clear enough to reach them?

Twenty years ago, navigating the emergency and acute care system, which includes any unplanned illness or injury from a head cold to trauma from an accident or disaster to cardiac chest pain, was easier because options were limited. The traditional approach was to call your primary care doctor for a walk-in appointment or go to the emergency department.

Since then, the number and diversity of options has exploded. The private sector has invested heavily in new care options, including retail clinics, urgent care centers, community paramedicine programs, telemedicine, and healthcare apps. In addition to the 5,025 emergency departments in the U.S., there are 1,900 retail clinics and 6,400 urgent care centers, and those numbers are rapidly rising. The American Telemedicine Association reports there are about 200 telemedicine networks nationwide.

The proliferation of options better match patients’ unique care needs, but also means that patients must learn to find their way through a more complex system.

To navigate that system, it is easiest to think of the different options for emergency and acute care on a spectrum. On one end, convenience and low cost are prioritized. As you move to the other end, the care options gain capabilities, lose convenience, and cost increases.

Telemedicine represents the most convenient and lowest cost end of the spectrum but has limited capabilities. A health system or private sector entity (e.g. Doctor on Demand, American Well, Teladoc, and others) offers telemedicine services through a phone, tablet, or computer. The patient enters their symptoms or medical questions and then video-conferences with a medical provider, who assesses the situation, performs a limited examination over video, and can diagnose a number of medical conditions, recommend treatment, and write prescriptions. This service can be covered by an insurer or is available for a flat fee.

Next, new medical care start-ups and concierge medical practices offer hands on-visits wherever is convenient for you. For $99, one sends a doctor to your house in less than an hour. Another charges $150 and sends a nurse to your home, who can then video chat with a physician. Similarly, community paramedicine is sometimes available, for which a paramedic will come to your house, assess the situation, and either treat you or transport you to the hospital if necessary. These options are limited to larger cities in the U.S. but are rapidly expanding.

Retail clinics often are located in pharmacies or supermarkets. Physician assistants or nurse practitioners provide immunizations and low-severity and preventive care, often offering extended hours. According to Consumer Reports, retail clinics average $110 per visit, but that may be covered by your insurer with a copay.

Urgent care centers are staffed by family medicine or emergency medicine physicians. They treat conditions that need to be seen expediently, but not serious emergency medical conditions. They also offer extended hours but are typically not open 24/7. Most urgent care sites will offer X-ray capabilities and many can perform basic labs, but you should call before going to see what capabilities the site offers. Urgent care centers average $156 per visit, and some are covered by your insurer.

Finally, emergency departments (including free standing emergency departments) offer the largest number of facilities, but can have longer wait times and be the most expensive. They are always open and provide a comprehensive suite of services, including “fast track” care for minor injuries or illnesses, full laboratory and imaging capabilities, and a safety net for patients without insurance or other care options. Emergency departments are usually staffed by emergency medicine experts and have the hospital’s full complement of medical and surgical specialties available. On average, an emergency department visit costs $570, and this amount may be covered partly or fully by your insurer.

More healthcare options can mean more confusion, especially when it comes to a stressful event like an unplanned injury or illness, or a larger-scale event like a hurricane, but it can also mean the opportunity to optimize cost, convenience, and capabilities for your loved one’s health. Empower yourself as a patient and know your options for acute and emergency care, because when you need it, there’s no time to lose.


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