Primary Care, Urgent Care, ER – Which is Best?

by Linda Esterson

Garrett Greffe was warming up to pitch in a travel baseball game last fall. Light tosses graduated to powerful throws. As he delivered the heat, the 17-year-old felt something pop in his elbow. Standing on the mound for his Sykesville team that October afternoon in Howard County, he experienced significant pain.

“He was very distressed, and he couldn’t feel his arm,” says Philip Greffe, Garrett’s father. “I thought the situation was severe enough to warrant going to the emergency room.”

Philip drove his son to the ER at Carroll Hospital Center. Garrett was triaged quickly, had an X-ray and was examined. Before long, his arm was in a sling, he had medication, and Philip was provided a list of orthopedists for follow-up.

“It was a positive experience all the way around,” says Philip Greffe. “The [caregivers] were friendly and comforting. They set his mind at ease.”

Historically, a weekend injury meant a trip to the ER. But patients now have more options when deciding where to go for care. Outside of an emergency and a call to 911, many turn to their primary care physician or pediatrician during daytime hours, while others opt for urgent care centers, which offer mid-level care and an alternative to long waits at emergency rooms.

For years, the Greffe family has turned to ExpressCare, an urgent care center, for sore throats, ear aches and other problems that don’t require a high level of care. They also rely on their primary care providers and specialists, depending on the urgency of the medical issue.

Maurice Reid was an ER physician working as clinical director for a hospital in Baltimore when he realized that many of the patients didn’t need to be there.

“Twenty percent of patients who present in the ED [emergency department] don’t need emergency care,” says Reid. “But they don’t have anywhere else to go — they don’t have a primary care [physician] or can’t get an appointment.”

As a result, Reid developed the ExpressCare concept, which first opened in Bel Air in 2005, following in the footsteps of Patient First, an urgent care provider that opened its first center in 1981. Today, 34 ExpressCare centers operate in Delaware, Pennsylvania, Virginia and Maryland, including four in Carroll County — Eldersburg, Hampstead, Mt. Airy and Westminster.

Physicians, physician assistants and nurse practitioners provide nonemergency care, Reid says, including treatment of cough and cold symptoms, lacerations, minor breaks, flu symptoms and rashes. Patients with chest pain, severe abdominal pain, and neurologic symptoms should head to the ER, and chronic conditions like diabetes and high blood pressure should be treated and monitored by a primary care physician, he adds. If needs fall beyond ExpressCare’s scope of services, the patient is sent to the local ER. Following care, records are sent to the patient’s primary care physician.

“If you wake up in the morning with pink eye or a bad sinus infection, and you can’t get an appointment with your primary care physician or you don’t have a primary care physician, you should be using our facility,” Reid says.

ExpressCare offers advance appointments, and extended hours from 8 a.m.-9 p.m. seven days a week, providing coverage outside of primary care office hours.

In addition to extended availability, urgent care centers help patients and insurance companies save money. Depending on the type of health insurance and deductibles, out-of-pocket expenses are generally lower at urgent care facilities than at emergency rooms.

For example, through Aetna, the Greffes paid 20 percent of the fee for both urgent care and emergency visits, after their medical deductible was satisfied in 2018.

An urgent care visit, billed at $150, cost the family $30, while Garrett’s emergency room visit resulted in a copayment of $239.86, including X-ray. The family’s responsibility for the $498 physician fee is still to be determined. A $25 fee was also paid to the radiology provider.

Westminster resident Leslie Dovell has used ExpressCare in recent years, as has her daughter, Piper. The co-pay, through Aetna, was the same ($40) as a regular physician visit, compared to $400 for the ER. Aetna’s basic HMO plan stipulates $75 urgent care and $250 ER copays. Exact costs are dependent on the specific insurance plan.

Dovell took Piper to urgent care for an ear infection on a Saturday, when the pediatrician’s office was closed. And when she experienced a painful urinary infection on a weekday and could not get a gynecologist appointment at lunchtime, she turned to ExpressCare.

“You can just go and sign in and you’re going to be seen,” Dovell says. “There’s no worrying about when the doctor can see you and if they can squeeze you in.” She was back to work with a filled prescription and detailed paperwork in under two hours.

Choosing the provider depends on the nature of the emergency. Shortness of breath, coughing and not being able to catch a breath, and chest pain all are scary situations and absolutely warrant an emergency room visit, says Karen Lee, executive director of medical and emergency services at Carroll Hospital Center.

“The biggest thing to keep in mind is to make the right decision when you’re feeling your worst,” says Lee. “Always start with your family physician — they know you, know your background, know your meds.”

Westminster Internal Medicine Associates is one practice that encourages patients to call when they feel ill instead of immediately heading to an urgent care center or the ER. According to Denise Freiji, a registered nurse who runs the practice with her husband, Dr. Khalil Freiji, nurse practitioners and physician assistants joined the practice to accommodate growth but also provide same-day appointments for illness and injury. The practice is an approved Accountable Care Organization (ACO), which is geared to the Medicare population and works to contain costs and limit overutilization. To this end, the practice has a working relationship with LabCorp, Carroll Hospital and Advanced Radiology to provide timely laboratory and radiology services for Medicare patients needing more urgent care.

Freiji suggests patients feeling ill or experiencing abnormal issues should start with their primary care provider. Calls to the practice nurse or a provider can assist in determining the right care avenue and avoid unnecessary expenses for the patient and insurance company.

“We make sure it is safe for the patient to come to the office,” she says. “They have to listen to a trained individual to make sure it is appropriate to [come to the office or] go to urgent care.”

Generally, upper respiratory infections, bronchitis, lacerations, pulled muscles, sports injuries are referred to urgent care if the office is closed. Issues that are more critical, like severe abdominal pain, symptoms of heart attack, stroke signs, passing out, or severe lacerations or trauma, are referred to the ER. But patients should call their primary physician first, unless the situation is life-threatening.

“Everybody has a different perception of their feeling,” Freiji says. “We never want to deny they are feeling that badly. If you feel that badly, you need to come in and be seen. It’s never a wrong decision to be seen.”

Lee, of Carroll Hospital Center, says ER volumes have decreased somewhat over the past several years with the advent of the urgent care centers. ER clinicians see fewer sprains, strains and suturing. Much of the volume, she says, is very sick patients.

Wait times, historically high in emergency rooms across the country, depend on the day and the seriousness of the condition. At Carroll, the average wait for triage, registration and initial intake, is four minutes, Lee says, and door-to-clinician is less than 28 minutes, on average. Usually, the visit extends four to five hours from walk-in to discharge. Lee stresses the need for patience as more seriously ill patients are seen faster than those with less emergent conditions.

With a 44-bed ER, there could be as many as 60-70 patients in the department at a time. In an attempt to alleviate the wait, some patients are triaged in the waiting area. They may receive medications or nebulizer treatments “so they start to feel better as quickly as possible.” Some are even discharged from the waiting room, Lee says.

 

Primary Care vs. Urgent Care vs. Emergency Room

It’s important to know where to go for illness or injury.

PRIMARY CARE


Your primary care physician is the best option for routine care as your doctor helps manage your health over the long term. Make appointments for:

  • Routine physical exams
  • Allergies
  • Sprains and strains
  • Prescriptions
  • Screenings (blood pressure, cholesterol)
  • Chronic disease management (diabetes, asthma, etc.)
  • Common sickness (cold, sore throat, fever, etc.)

 

 

URGENT/EXPRESS CARE


Urgent or Express Care is your best option when your doctor is not available and you need immediate care and your injury/illness is not life-threatening. Appointments not necessary.

  • Minor burns
  • Injuries requiring stitches
  • Flu, sinus infection, ear infection, cold
  • Fractures and sprains
  • Nausea, vomiting, diarrhea
  • Rashes and hives
  • Work-related injuries
  • Anything on the primary care list that cannot wait for an available doctor appointment

 

 

EMERGENCY CARE

The ER should be used for life- or limb-threatening injuries. This is not the place to go for minor injuries or illnesses.
If you experience these symptoms, go the ER or call 911.

  • Chest pain or difficulty breathing
  • Head or spinal injuries
  • Uncontrolled bleeding
  • Coughing or vomiting blood
  • Severe burns, cuts or puncture wounds
  • Poisoning
  • Broken bones protruding from the skin
  • Loss of consciousness
  • Seizures
  • Stroke or heart attack symptoms

 

*This list is not comprehensive and includes general guidelines. Contact a professional for medical advice.