Save Me Steve: Urgent Care vs. Freestanding ERs

They're popping up on every corner. But do you really know the difference between an urgent care facility and a freestanding emergency room? Consumer reporter Steve Noviello explains the differences and helps you make decisions that will save you time and money.

The number of licensed freestanding ERs has exploded in Texas. There were 19 of them in 2010 compared to 210 now. And more are being built every day.

First, emergency room is not just a clever marketing name for an urgent care clinic. If you see ER, understand that you’re walking into one even if it’s not attached to a hospital. They have equipment like ERs, board certified physicians like ERs and they can admit you to a hospital like an ER.

In fact, Texas law requires these medical centers to use the words emergency room in their name so consumers understand what they’re getting into.

Still, as many as 65 percent of people are choosing wrong. That’s how many cases are being treated at freestanding ERs that are not life-threatening.

You go in. You think you’re walking in to an urgent care clinic. You accept treatment and then you get the bill charged at the emergency room rate when you didn’t have an emergency situation.

By comparison, the treatment for strep throat at both types of centers is the same but there are two very different prices. It costs a couple hundred dollars at an urgent care clinic and several thousand dollars at a freestanding ER.

How does that happen? Freestanding ERs charge a facility free and professional office visit fee, which can be 80 percent of the massive difference in the bill. Labs and medicines at ERs also generally cost more.

It’s okay to ask at the front counter. Will this be a $20 or $30 co-pay or will this be $100 co-pay for an ER visit?

Freestanding ERs or ER departments can charge urgent care rates if it’s determined that a patient didn’t need the ER, but that almost never happens.

There’s also a lot of variety when it comes to walk-in urgent care facilities. In general, these are walk-in clinics that focus on treating non-life-threatening illnesses that require immediate attention but are not serious enough for an ER.

Most, but not all, are staffed by a physician, physician assistants, advanced practice clinicians and nurse practitioners. These clinics are not required to have a licensed physician on staff. And their normal office co-pays are designated by the insurance provider at a non-ER rate.

There are also some new hybrid centers like Legacy ER and Urgent Care. They are supposed to completely remove the guess work from the equation because patients can show up to one place and the doctors will direction their care as urgent or emergency based on their evaluation.

It may seem like doctors would always direct people to the ER so they could make more money, but the folks at Legacy claim more than 80 percent of patients who walk in the door are treated as urgent care patients.

Last, there are some important details to remember about Medicare and Medicaid. In general, Medicare doesn’t recognize these freestanding ERs and will not reimburse them for ER services. The exception is a freestanding ER which is a satellite of a hospital.

But just like a hospital ER, anyone with an acute problem will be cared for when they walk in the door.