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Annual, Urgent or Emergent? The Challenge of Directing Patients to the Most Appropriate Location for Care.

Julia (Hansch) Schultz

In a perfect world, everyone would visit their primary care provider annually to ensure all systems are working and receive due immunizations. As we (infrequently) encounter unexpected ailments, such as a throbbing earache or extremely sore throat, we would go to our neighborhood urgent care/walk-in facility. And, in the rare and unfortunate case that we experience life-threatening stroke or heart attack symptoms, we would be rushed to the Emergency Department.

Are you rolling your eyes or thinking, “Right. In a perfect world, Julia ….”

As I reread the preceding paragraph, I did the same. I’m as guilty as anyone of receiving my healthcare primary through urgent care visits during cold and flu season (with a quick stop at a “flu shot clinic” in the fall) – although my 7-year-old son has never missed a wellness exam nor an immunization – and know that I don’t always appropriately use the preventive healthcare services available to me.

On the other side of the spectrum, we’ve all heard stories (or perhaps experienced, firsthand) when patients abuse the ER simply because their insurance covers it, or they don’t want to wait until the urgent care center opens the next day. Conversations with colleagues and friends remind me I’m not alone in my approach to “as I need it (and can fit it into my schedule)” healthcare, and apparently it’s a growing nationwide trend.

Patients are going to urgent care centers for a variety of reasons. The American Academy of Urgent Care Medicine suggests evening and weekend hours increase urgent care’s appeal, because less than one-third of primary care providers offer after-hour appointments. When compared to another alternate option – a visit to the ER – urgent care also comes out ahead regarding cost. Becker’s Hospital Review found the average urgent care visit costs less than $150, compared to the average ER visit of $1,354.

Those of us in the healthcare industry understand (but may not always practice … see example, above) the appropriate use for primary care appointments, urgent care visits and trips to the ER. And now, with the financial consideration in mind, commercial insurance providers are developing policies that require patients take a closer look at how they use these three healthcare services.

Recently, Anthem BlueCross BlueShield placed restrictions on the types of care they will pay for in the ER. For instance, if a patient with Anthem insurance goes to the ER with a sore throat (something more appropriately handled in urgent care), Anthem may not cover the cost of that ER visit. This is understandable, considering the much higher cost of an ER visit versus an urgent care visit, and is now something about which patients must be mindful. Anthem has been proactive about educating policyholders about this change and how to best use urgent care versus the ER, offering online tools that help patients determine appropriate locations in which to receive care.

Healthcare providers are also assisting in spreading the word to their patients. Their goal is (at least) three part: to help protect patients from receiving rejected charges from their insurance provider; to reduce crowded ER waiting rooms for cases better handled in urgent care; and to encourage patients to sustain a regular relationship with their primary care providers, to best prevent or mitigate more serious healthcare issues in the future. It can be a challenge to ensure the hospital isn’t suggesting it won’t care for a patient in need who comes to the ER (no one likes an EMTALA violation compliant), but instead is assisting the patient choose the best location to treat his or her ailment.

We’ve worked with clients to help craft communication plans to educate patients about the best way to make healthcare location decisions. With the rise of population health, we’ve also developed strategic marketing plans (and eye-catching creative campaigns) to drive patient volume to primary care providers, and have marketed multiple urgent care launches across the country.

If you’re wondering how to best educate your patients about where in your organization they should receive care – or would like to ramp up marketing efforts in one of these areas – leave a comment or send me an email and we can discuss strategies around these poignant topics and how to best communicate with your patients to help drive them to the most appropriate location for care – something that’s best for everyone.

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