Getting the Right Care, at the Right Time, at the Right Cost

Wednesday, December 04, 2019

The United States spends a staggering amount on healthcare each year and costs continue to rise at an unsustainable rate. A host of factors play a role in this trend including our growing and aging population and the prevalence of uncontrolled chronic conditions.

However, unnecessary utilization of healthcare services is also a driving factor. Specifically, the inappropriate use of emergency room services for non-life-threatening medical treatment.

According to U.S News, many of these visits are generated by those who are underinsured or un-insured, nearly two-thirds, or 27 million ER visits, were by those who have some form of private health insurance. Collectively, if those “avoidable” visits were rerouted to the appropriate care setting, such as an urgent or primary care setting, this would translate into an estimated savings of $18 billion annually. So, how can we, as smart consumers, make a positive impact on healthcare spending?

We can do this by knowing where to get the Right Care, at the Right Time, and at the Right Cost.

The Right Care

While the principal decision of whether to visit the emergency room should rest on the severity of symptoms or condition, the decision is often made from convenience. Knowing your options can help you make the best decision for you and your family and lessen the tension on healthcare resources.

Primary Care – considered the first point of entry into the healthcare system and focal point for continuous care. Usually requires an appointment on a Monday-Friday 8 a.m. – 5 p.m. schedule, but most have same-day availability for acute illnesses.

Urgent Care – the bridge between primary care and the emergency room, created because of the severe shortage of primary care physicians and access issues. No appointment necessary, usually open 7 days a week until 9 p.m. or later and only closed on major holidays.

Emergency Room – for emergent, life-threatening conditions with additional treatment resources available such as an operating room. Open 24/7, 365 days a year.

The Right Time

What are “avoidable” visits? “Avoidable” visits are considered preventable visits to the emergency room for reasons such as poorly managed conditions, lack of access to appropriate care, or poor judgement on the part of the patient.

Overuse of the emergency department can cause overcrowding, gaps in care coordination, and a strain on resources, so knowing where to go for your condition is imperative!

The general rule is that if the condition is NOT life threatening but requires attention today, head to an urgent care facility.

Did you know the cost difference of a common condition treated at an emergency room  versus a primary care setting is typically 12 times greater? Services in the hospital, including labs and imaging services, typically cost more because of additional facility charges. Along with the strain that over-utilization causes the healthcare industry, emergency room overuse and over-utilization of hospital services often cause a monetary burden for the patient and their family. In fact, medical bills are the #1 cause of bankruptcy in the United States!

The following is the average out-of-pocket cost of treating a common primary care condition at the different care settings:
Primary Care              $167
Urgent Care                $211
Emergency Room        $2,800

To read the article by U.S. News visit:

Diagnosis and treatment of acute illness
Flu, fever or cold symptoms
Severe chest pain
Diagnosis and treatment of
chronic conditions
Animal/insect bites
Severe abdominal pain
Prescription refills
Disease management
Sprains/broken bones
High fever/ rash in children
Cuts that require stitches
Vaginal bleeding with pregnancy
Preventative services
Vomiting/ Diarrhea
Health maintenance and prevention
Back pain
Severe head/eye injuries
Health promotion
X-rays/ lab tests
Allergic reactions