What Separates Urgent Care And The ER? Your Bill. : Planet Money Urgent care centers look a lot like emergency rooms. But they're a lot cheaper, both for patients and operators.
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What Separates Urgent Care And The ER? Your Bill.

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What Separates Urgent Care And The ER? Your Bill.

What Separates Urgent Care And The ER? Your Bill.

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SALLY HERSHIPS, HOST:

There are currently about 10 1/2 thousand urgent care centers in the U.S., and that number is about to grow by 10% over the next few years. That number comes from Kalorama, a market research firm that looks at the medical industry.

DARIUS RAFIEYAN, HOST:

And I'm a big fan of urgent cares because I go to the doctor way too much and they're very convenient.

But in case you don't know, urgent care centers live in this kind of gray area. They fall somewhere between your doctor's office and an emergency room. Oftentimes, they're in, like, storefronts, like, next to a Starbucks or a pet store. They've often got longer hours than your regular doctor, open earlier. They stay open later. And unlike at your doctor, you don't need an appointment. You can just walk in.

HERSHIPS: I mean, that is huge.

RAFIEYAN: Yes.

HERSHIPS: According to a recent study from Zocdoc, more than 70% of Americans think it's easier to go to the ER than to get a doctor's appointment.

Urgent care centers have been around since the '70s. The last time we saw this much growth was after the Affordable Care Act was passed and more people had insurance and they could pay for health care, so all these new urgent care centers started opening.

RAFIEYAN: But here is the mysterious thing about urgent care. They offer some of the very same services you get at an ER, but they're cheaper - like, so much cheaper.

HERSHIPS: Yeah, that is one of the reasons why a couple of years ago, when I had a nasty incident with a bike - I wanted to ride the bike; the bike did not want to be ridden - I ended up with a broken wrist, and when I was deciding where to go, I went to an urgent care center, not the emergency room. There was a doctor there. She examined me. She took an X-ray. And my bill was only $75. And you do not need a medical degree to know that is so much cheaper than if I'd gone to the ER.

RAFIEYAN: Yeah. And compare that to the average emergency room visit, which is - and get ready for this - more than $2,200 per visit. That is 1,300% more than the average urgent care visit. That data, by the way, comes from Kalorama. And that is today's indicator, 1,300.

HERSHIPS: How? How is it possible that an X-ray can be so much cheaper, or a doctor? A doctor is a doctor, right?

RAFIEYAN: An X-ray by any other price, you know?

I'm Darius Rafieyan.

HERSHIPS: I'm Sally Herships in for Stacey Vanek Smith. Today on THE INDICATOR, why are all these urgent care centers opening? And how is the treatment at an urgent care so much cheaper than at an emergency room?

(SOUNDBITE OF DROP ELECTRIC SONG, "WAKING UP TO THE FIRE")

HERSHIPS: OK, in order to answer our questions - why are so many urgent care centers opening and how are they so much cheaper than at the ER? - we need to look at what urgent care centers are. They're this weird hybrid of a doctor's office and an emergency room, but they are neither. Instead, they are their own distinct thing.

BRUCE CARLSON: An urgent care - despite the name, you're not coming in on a stretcher.

RAFIEYAN: Bruce Carlson is with Kalorama. He's the lead author on a study about the urgent care industry. And he says urgent care is there for weird rashes, the flu, broken wrists. And he says there's an important distinction between urgent care centers and emergency rooms.

CARLSON: So the first thing you're going to do when you walk into an urgent care is arrange the business portion - is arrange the payment.

HERSHIPS: This comes down to a federal law called EMTALA, the Emergency Medical Treatment And Labor Act. It was enacted in 1986, and it mandates that any entity or any emergency department that takes Medicare or Medicaid is required to see patients regardless of their ability to pay. But a lot of urgent care centers don't have to follow this mandate. That means they can turn patients away.

RAFIEYAN: And patient access to health care - that's a big reason that urgent care centers are becoming so popular. Often, patients, even when they have health insurance and can pay for medical care, are still not able to get care when they need it. That's because we have a shortage of doctors and nurses.

Alexei Wagner teaches emergency medicine at Stanford Medical School, and he knows a thing or two about this. He is an emergency room doctor himself.

ALEXEI WAGNER: Most regular doctors aren't set up to take patients for same-day appointments. They have long wait times. They have large panels of patients that they need to see. So you might have to wait one, three, five, two weeks to get an appointment for the ear infection or the sore throat. And patients just aren't willing to wait that long.

HERSHIPS: So urgent care centers can be a popular option. According to the Urgent Care Association, 70% of patients wait less than 20 minutes at urgent care. I mean, come on. That sounds amazing.

RAFIEYAN: Heavenly.

HERSHIPS: And doctors can be fans of urgent care, too. The pay can be lower than, say, at an emergency room, but there are some real perks. Residents who need a side hustle to pay their bills from medical school can pick up extra work on evenings and weekends.

RAFIEYAN: And ERs are notorious for crazy, long hours, so doctors who want to have, you know, lives, families or just not work in a nightmarish hellscape of sleep deprivation and caffeine might opt to work at an urgent care instead.

Urgent care centers are also popular with hospitals. They can open them offsite so that when patients get sick and are deciding where to go, they have other options before they resort to the ER. And Alexei says hospitals - they want the very sickest patients to go to the ER, obviously. But often, that's not what really happens.

WAGNER: So you have patients who have a complaint. They have pain in their throat, and they think - some of them, very naturally - that this is the scariest thing that's ever happened to them, that I'm going to die, this is cancer. My friend of a friend had the same complaint, and I think I have the same thing.

HERSHIPS: But they don't have cancer. They are not dying, but they do go to the emergency room. And that is not what hospitals want. So by opening urgent care centers, hospitals are creating an alternative - somewhere they can steer those patients to get the care they need but, at the same time, keep the wrong patients from cluttering up emergency rooms.

WAGNER: There's always a disconnect between the patient's understanding of the concern for how sick they actually are and then actually how sick they actually are to the doctor. And that disconnect can sometimes make patients go to the wrong place to get care.

HERSHIPS: Are you saying that we are not as sick as we think we are (laughter)?

RAFIEYAN: Alexei says, let's face it; sometimes we're not.

HERSHIPS: Maybe you're not. I am.

RAFIEYAN: And if we're not, when we're deciding where to go, we should know that we have the option to go to urgent care instead of the emergency room because it'll probably save us a lot of money.

Big, fat caveat here. Sally, you and I, obviously, are not doctors. We're not trying to tell you not to go to the hospital. If you are experiencing a medical emergency and are in distress, dial 911, go to the emergency room. Don't take medical advice from podcasters.

HERSHIPS: So let's get back to economics, where we are on firmer ground. The same services, like an X-ray or a blood test, could cost you more at the ER than at urgent care. And this is a weird concept - right? - because, usually, scale means efficiency, lower costs. Why would an X-ray at the ER cost more than the same X-ray a few miles away at an urgent care center?

Alexei says large medical systems - they may have signed a contract with a nurses union, so they may be paying higher salaries. They may have to meet certain staffing ratios or have rates that have been pre-negotiated with labs, which are charging them more.

RAFIEYAN: Bruce from Kalorama says there's another reason that hospitals are more expensive.

CARLSON: Some of it is just basically that emergency rooms and hospital systems are charging more for the service, but they actually provide and have at the ready a much higher level of staff and a higher level of service.

HERSHIPS: Can we just back up one second?

CARLSON: Sure.

HERSHIPS: You mentioned - wait; did you just say that one of the reasons ERs charge more is because they can?

CARLSON: Well, I think that that is some factor in there. In other words, there's limited competition for - the only competition they have is with other emergency rooms.

HERSHIPS: So going to the ER can be more expensive. And as a patient, it's important to keep this in mind because if you make what your health insurance company decides is the wrong decision, you could get slapped with a giant bill. Alexei says there is a new trend in health insurance - insurers refusing to cover bills for emergency room visits they decide are unnecessary.

RAFIEYAN: And Alexei says more people have been signing up for high-deductible health insurance plans. That means they're paying more out of pocket, so there's an incentive to shop around for the lowest-cost option. They don't want to get stuck with giant bills, so urgent cares might be a good option. And we may see more of them opening up in the future.

HERSHIPS: So how are you feeling?

RAFIEYAN: I'm feeling, like, a little under the weather.

HERSHIPS: Well, I'm feeling great, and I'm not going to the doctor, the ER or urgent care anytime soon.

RAFIEYAN: I think I might go to the ER and the urgent care, just to be safe.

HERSHIPS: Hedge your bets.

(SOUNDBITE OF DROP ELECTRIC SONG, "WAKING UP TO THE FIRE")

RAFIEYAN: This episode was produced by Rachel Cohn, edited by Paddy Hirsch. Nadia Lewis (ph) is our intern and fact-checker. And THE INDICATOR is a production of NPR.

(SOUNDBITE OF DROP ELECTRIC SONG, "WAKING UP TO THE FIRE")

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