Tonawanda News

July 14, 2013

Urgent care facilities popping up to bridge gap between primary physicians, ERs

By Danielle Haynes danielle.haynes@tonawanda-news.com
The Tonawanda News

Tonawanda News — Every day, people in Western New York face the challenge of just what to do about that possible broken bone or cut that needs stitches at 8 p.m. on a Thursday. Or perhaps a fever that just won’t go away Saturday morning.

Do you wait it out until you can see your doctor the next weekday morning? Or do you sit in a waiting room — perhaps for hours — and pay a large bill at an emergency room for a medical concern that’s maybe not that serious?

Urgent care centers have been popping up across the region the last several years to bridge that gap in medical care, providing a lower-cost, efficient alternative to primary care physicians and busy emergency departments, something that may become even more necessary when the Affordable Care Act goes into full effect. But some doctors worry patients may not be using urgent care facilities for their intended purpose.

Not all urgent care centers are created equal

There’s one thing many urgent care workers, emergency room doctors and family physicians can agree on, it’s that urgent care centers are often a quicker alternative to a visit to a doctor’s office or emergency room.

Of the four urgent care centers interviewed for this article — Express Medical Care of WNY, Pediatric & Adolescent Urgent Care of Western New York, MASH Urgent Care and WNY Immediate Care — all accept walk-in appointments and are open for hours beyond traditional family doctors’ practices.

It may be difficult to get a last-minute appointment with a primary care physician on the same day, and patients may sometimes have to see another doctor or physician’s assistant at the same practice instead of their regular doctor. Emergency room waits can draw on for hours, especially if a patient’s injury or illness is less serious than those who come in with life-threatening problems.

Mark Pundt, the CEO of MASH Urgent Care said that timely convenience is part of the driving force behind the urgent care business model.

“People of today want what we want in all aspects of life and that’s access to care when they want it, and convenient location and appropriate cost,” he said. 

Salvatore Durante, manager of urgent care operations at WNY Immediate Care, called his facilities “the fastest emergency room alternative.”

“One of our pride and joys is that we get a vast majority of patients in and out in an hour,” he said.

Most of the urgent care centers we talked to offer similar services: treatment for cuts and abrasions; sprains, fractures and brakes; insect bites; burns; cold and flu symptoms; asthma; urinary tract infections; ear infections; allergies; vomiting; diarrhea; gynecologic problems; headaches; backaches; abdominal pain; nosebleeds; minor eye problems. 

Many also offer a variety of vaccinations, physicals, drug testing, pregnancy tests, EKGs, X-rays, STD testing, and screening for mono, flu and strep, among other things.

But some provide more specialized care, like Pediatric & Adolescent Urgent Care of Western New York, where younger patients are treated.

Michael Lillis, the chief operating officer of the facility, said they treat patients with more serious illnesses and injuries than even most other urgent care centers in an effort to keep children out of hospitals.

His wife, medical director, Dr. Kathleen A. Lillis, has 20 years of pediatric emergency experience and previously worked at Women and Children’s Hospital in Buffalo.

A good percentage of their business comes from pediatricians who refer their patients to the facility during non-traditional doctor’s office hours.

“We’re supplementing what pediatricians provide rather than competing,” Michael said, adding that the urgent care center will keep certain sick children overnight for observation if need be.

For adults, there is some more specialized care offered at WNY Immediate Care, for instance, where some of their facilities offer even more advanced diagnostics like a CT scan, something most urgent cares don’t have.

Some have special partnership with doctors, like MASH Urgent Care, which collaborates with, among others, the 900 or so physicians with Catholic Medical Partners, like Dr. Edward Stehlik.

Ultimately, it all comes down to what your primary care physician suggests is the best urgent care facility for your particular illness or injury.

Urgent cares don’t replace your doctor

Every doctor we interviewed for this article said the first thing to do when considering visiting an urgent care facility is to call your primary care physician if you have one.

The biggest concern Stehlik, whose practice, Northtowns Medical Group, is located in the Town of Tonawanda, has with urgent care centers is that people are using them when they should be going to their doctor instead.

“Some people perceived (urgent cares) would solve an issue to deal with missed patients, those not sick enough to go to the emergency room but needed some type of care that was more than a medical office could provide or during hours when one isn’t opened,” he said.

Some of the patients going to urgent cares aren’t fitting that model, though, he said.

“Many people going to urgent care centers are people who are best cared for in their doctor’s office because for the types of issues they have or times they’re going in they can also be seen in physicians’ offices,” Stehlik said.

All four urgent care facilities interviewed for this story said they transfer medical records from all visits to a patients’ primary care doctor, but Stehlik said patients should always try contacting their own doctor first, even if it’s during late hours or on weekends.

“Every physician has someone on call, either himself or a covering physician,” he said. “Have your primary care physician work with you and triage your needs ... a doctor knowing your past history is good.”

The primary care doctor can then refer you to the right urgent care center for a patient’s needs, or suggest coming in to the office instead.

Ultimately, urgent care centers work best as an extension of a primary care doctor during times when he or she is not available, or to provide services not given in their office. Even more importantly, a doctor can better tell their patients when urgent care isn’t enough and it’s time to head to the emergency room.

Not the same as an emergency room

Dr. Raquel Martin, the medical director at Kenmore Mercy Hospital’s emergency department, has worked in some capacity at a variety of urgent care centers for about 20 years. She has about the same number of years of experience working as the director of emergency departments, most recently at Kenmore Mercy and previously at Millard Fillmore Suburban Hospital.

When she walks in to one of her urgent care shifts, her co-workers know they’ll have more emergency room transfers than most nights.

“An urgent care center is not an emergency department,” she said, adding that she’s surprised how many time she’s seen patients at an urgent care exhibiting symptoms of life-threatening problems like heart attacks and strokes.

People often don’t triage themselves properly, which is where calling a primary care physician is helpful, she said.

While there are no hard-and-fast rules as to what constitutes an emergency room visit versus an urgent care visit, Martin has some guidelines to use. 

“If you don’t have a primary care physician (to help triage), I would say go to emergency room if you have belly pain, head pain or injury, think you’re having a stroke, you have deep, long lacerations or abscesses, if there’s any pediatric shortness of breath, or chest pain,” she said.

Go to the emergency room for abdominal pain as well, unless someone else in your household has had the flu, because it could be appendicitis, she added.

Still, Martin said urgent care centers can be useful in helping to take the workload off of emergency rooms by handling the less life-threatening cases.

“If you have (a small problem) that you would go to your doctor for and you can’t see your doctor, go to an urgent care center,” she said. “Don’t come to an emergency room because there are so many sick people and we’re not going to be as quick as an urgent care center cause we have so many sicker people.”

And in the near future, emergency rooms may find themselves even more overloaded than they are currently.

The future of urgent care 

On Jan. 1, 2014, Americans who are not covered by an acceptable health insurance plan will have to pay a fine under the Affordable Care Act, which was signed into law March 2010.

Millions of Americans who don’t currently have health insurance will starting next year, meaning that many more people may be looking for health care, warned Pundt.

“As we move forward into the days of the Affordable Care Act there will be a large number of people who will have health insurance and will be looking for medical care. We already have a shortage of primary care physicians, so it will be very difficult for those people to find healthcare on a regular basis,” he said.

People will have two options, he said, “one is to go to the emergency room, which is already overwhelmed ... it could sink the ship.

“The other safety net will be urgent care. I see the market growing over the next decade and I think the goal of the medical community, including those who lead urgent care, is to work collaboratively to educate patients as to the best location of medical treatment for their injury or illness.”

Martin said she anticipates that if there is a rise in urgent care usage due to the Affordable Care Act, it will happen because perhaps more doctors, like Stehlik, will start working in conjunction with the facilities, using them as extension of their own practices.

“Ideally the Affordable Care Act should give everybody a primary care physician, and then the hopes would be that if everybody has a doctor and they don’t have ability to see you in timely manner, they can offload you at urgent care if they’re inundated,” Martin said.

The act is aimed, she said, at providing more people with preventative health care and primary care doctors.

“I suppose urgent care centers could into (preventative medicine) in areas where there aren’t enough primary care doctors,” she added. “I don’t know which way it will shake out.”

Pundt anticipates the prevalence of urgent care centers to grow in Western New York — and indeed the rest of the country — as more and more people find themselves seeking medical care.

Is it affordable?

It’s one question that doesn’t have a simple answer. It all comes down to your insurance provider and what plan you have with said provider, said Julie Snyder, director of corporate relations at BlueCross BlueShield of Western New York.

“You really should check with your health plan to make sure that you understand the coverage,” she said, adding that high-deductible plans may require a higher payment at time of service until you meet your deductible. 

This is why Snyder emphasizes the need to contact your primary care physician before dropping in on an urgent care facility. If an illness is something a primary care physician can handle in office, a patient only has to pay their typical office visit co-pay. An urgent care visit could count against a deducible and cost more.

Still, it’s less than the cost of an emergency visit the majority of the time, Michael Lillis said.

He said a most of their patients end up paying something between a doctor’s co-pay and emergency room fees. Though it’s not a hard-and-fast rule, he says most pay about $50 depending on insurance plans.

MASH Urgent Care offers a flat-fee payment plan, in which patients will pay to be evaluated and treated by a doctor — there are no extra fees for shots, stitches or X-rays, for example.

“If you have a choice between a hospital emergency room or an urgent care center, many times an urgent care center is more cost effective and is a better time-saver for you,” Snyder said. “If it’s a sore throat or an ear ache or a small cut, you probably will get your issue addressed in less time and at a lower cost both to you and to the health plan.”

Ultimately, know before you go. Call your doctor to make sure urgent care is right for you, and call your health insurance company to double check what you’ll be expected to pay out of pocket.

MORE INFORMATION • Express Medical Care of WNY -- 876-4362 or visit www.expressmedicalcareofwny.com. • Pediatric & Adolescent Urgent Care of Western New York in Amherst -- Call 636-5437 or visit www.pedsurgentcare.com • MASH Urgent Care -- Call 701-6331 or visit www.mashurgentcare.com. • WNY Immediate Care -- Visit www.wnyimmediatecare.com to find contact details for the location nearest you.

Contact Sunday Lifestyle editor Danielle Haynes at 693-1000, ext. 4116 or follow her on Twitter at @DanielleHaynes1.