Who wins the race for patients—the ER or the urgent care center?
Tracy Hume, a freelance writer who lives in Greeley and a reader of Thinking About Health columns, recently sent along this provocative question. “Do ER-affiliated urgent care providers ever try to escalate patients to the ER when it is not medically necessary?” she asked. “Why? How should a consumer respond?”
She explained that over the July 4 weekend, her teenage son had complained of nausea, headache and abdominal pain and was throwing up. Alarmed, she took him to an urgent care center, which was in her insurance plan’s provider network.
A clerk at the clinic inquired about his symptoms and immediately said since he was having abdominal pains he needed a CT scan, and the urgent care center did not have the capability to do that test. He would have to go to the emergency room across the street, part of the same hospital system.
Hume thought twice. The copay at the urgent care center was $75; at the ER it was $250. Plus, she told me, no one at the center had bothered to examine her son to see if he even needed a CT scan, a procedure that researchers say is overused in the country’s emergency rooms.
Dr. Rita Redberg, a prominent cardiologist at the University of California, San Francisco Medical Center, has pointed out, “CTs, once rare, are now routine. One in l0 Americans undergo a CT scan every year, and many of them get more than one.” They are becoming common in emergency rooms, where patients are getting scans at rates five times higher than in the mid-1990s.
While some CT scans undoubtedly save lives, if you get one and don’t need it, you’re exposing yourself to needless radiation. Redberg said the use of medical imaging with high doses of radiation, particularly CT scans, has increased “more than six-fold between the 1980s and 2006.”
What’s behind the growing use? Fears of malpractice suits and patient demand for them “just to be sure,” as I reported in my last column, are partly to blame, but so is the presence of more of these machines along with the financial pressures on the hospitals to use them as revenue generators.
And that reason circles back to Hume. Was the hospital system sending patients to a place of higher-priced care to pad its bottom line? Hume did say that there are two “large, aggressively competitive health care systems competing for business” in Greeley, a city of almost 100,000 people, and “each built fancy, fully equipped new ERs on the affluent side of town within a two-mile radius of each other.”
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Holyoke Enterprise July 24, 2014