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Urgent care sites offer alternatives for ER visits

When Allie Van Deusen fell four years ago and broke her left arm, it didn’t occur to her mother to take her to the emergency room.

She took Allie to Excelsior Orthopaedics Express instead.

Several other parents whose kids took similar spills in the same Lancaster neighborhood, and had taken their loved ones to the orthopedic urgent care center in Amherst, recommended Danielle Van Deusen do the same if it became necessary.

“When we walked in, it wasn’t like a hospital or ER,” Van Deusen said. A specialist saw them within a few minutes, eased the fears of mother and daughter (in Allie’s case, a Teddy Bear helped) and got them quickly back to the Excelsior X-ray room. When the fracture was confirmed, Allie got to pick the color of her cast: hot pink.

“We were on our way in a couple hours start to finish,” her mother said. “It was wonderful.”

Excelsior Express is among several emergency room alternatives on the Western New York health care landscape, though many have yet to discover them. Roughly one in three visits to New York State hospital emergency rooms could be avoided or treated elsewhere, according to a Univera Healthcare report released this month.

The insurer analyzed “potentially preventable” ER visit data from the state health department and found that of 6.4 million visits to hospital ERs in 2013, more than 2 million were for common conditions that included ear infections, headaches, back and neck problems, abdominal pain, nausea, constipation and diarrhea, urinary tract infections, bumps and bruises, and joint and muscle aches, pains, strains and sprains.

Preventable emergency room visits in New York State

“Compared to treatment received in a primary care setting, a telemedicine visit, or an urgent care facility, the ER has the longest wait times and highest expenses, including out-of-pocket costs,” said Dr. Richard Vienne, Univera vice president and chief medical officer. “Emergency departments are vital community resources and should be reserved for patients with significant trauma and conditions that are potentially serious.”

An ER visit costs nearly eight times more than seeing a doctor, 3.5 times more than going to urgent care and about 15 times more than telemedicine, Vienne said.

Like it or hate it, the health care system emerging from the Affordable Care Act was designed to prevent and treat sickness, disease and trauma in ways that are effective, but least costly. Those who learn to move through the system best will save money, time and aggravation. Here’s how to do so in an emergency.

FIRST LINE OF DEFENSE

Those who suspect they have a condition that falls within a potentially preventable emergency room visit should generally look for medical advice from their primary care doctor.

“There’s always somebody on call and they can do some triage over the phone and determine whether it’s OK for you to be seen in the office or go to an emergency department or to an urgent care,” said Dr. Richard Elman, chairman of the Catholic Health Department of Emergency Medicine.“We don’t discourage anyone from coming to the emergency department. Our doors are always open. We will be happy to see, evaluate and treat anybody who crosses our threshold. That being said, there are people who come to the ER that probably could be managed in a doctor’s office or urgent care setting.”

Still, he stressed, “If somebody’s having chest pains or signs of a stroke, or if they’re acutely short of breath or having significant belly pain, those patients should come directly to the emergency department. Symptom complexes like that can often be very serious and they don’t belong in urgent care.”

TELEMEDICINE

Telemedicine has been used in Western New York for the last decade, but mostly to get patients with stroke symptoms in rural areas on screen and quickly in front of a neurologist, Elman said. Psychiatrists and other specialists also have used the technology for online mental health assessments.

A new state law requires insurers to cover the cost of a telemedicine visit, so Elman and other emergency medicine specialists expect the service to become a growing tool provided by primary care doctors, specialists, emergency rooms and urgent care centers.

Insurers already have entered the mix. Those covered by Univera have access to MD Live, a service that costs $49 to consult with a doctor by computer or smartphone. The arrangement can address many conditions identified in the Univera report that can be remedied with a prescription and sound medical advice, said Dr. Marybeth McCall, a medical director with the insurer in the Utica region and the insurer’s expert on telemedicine.

McCall talked about a pilot program that connected sick babies in Utica with a pediatric cardiologist in Syracuse. “He would see the baby and a pediatric echocardiogram via a webcam, and decide whether to put the baby in an ambulance or not. We reduced our transport of new babies from Utica to Syracuse by 80 percent.”

Dr. Mark Pundt is CEO of the Medical Division of MASH Care Network, which runs six urgent care centers in Erie County and one in Olean, and emergency departments at Gates Vascular Institute and Brooks Memorial Hospital.

“We are considering becoming involved in telemedicine,” Pundt said. “We feel it’s part of the continuum of episodic care.”

Pundt said he also sees a day when state lawmakers will approve a “limited services clinic” model, used in grocery and drugstores in other states, which allows physician assistants and nurse practitioners to diagnose minor ailments and handle treatment.

URGENT CARE

ER wait times for hospitals

Meanwhile, urgent care settings gain in popularity. Co-pays at these sites can cost as little as $20 but run up to $100, depending on your health insurance, and often cost about one-third of emergency department care. In some cases, you can see a specialist.

Excelsior Express is one of at least three medical practice-based clinics that handle emergency orthopedic cases that include strains, sprains, minor dislocations and closed fractures. Its staff advises emergency room visits for those with potentially life-threatening injuries, head trauma or fractures in which a bone breaks the skin.

“It’s not a back door into the office for someone who’s had knee pain for a few weeks; it’s designed for acute injuries – the slips and falls, athletic injuries, work injuries,” said Dr. Lisa Daye, the orthopedic surgeon who oversees Excelsior Express.

Walk-ins are welcome, but those who use its services are encouraged to call ahead at 250-9999. Emergency patients can see a physician assistant or doctor from 8 a.m. to 9 p.m. Monday to Friday and 2 to 7 p.m. Saturday and often are in and out in an hour, Daye said.

MASH operates the Roswell Park Cancer Institute Extended Hours Clinic on hospital grounds from 5 p.m. to 1 a.m. weekdays and, starting this weekend, 8 a.m. to 4 p.m. Saturdays and Sundays.

And in 2010, Dr. Kathy Lillis, a pediatrician who worked in the Women & Children’s Emergency Department for 18 years – half that time as director – launched Pediatric & Adolescent Urgent Care of WNY.

A fireplace, cushioned chairs and a Keurig coffee maker set the scene in the waiting room of the company’s location at Maple and Ayer roads in Amherst. The treatment area includes eight rooms with twin beds, pillows, blankets and toys. Staff can do lab work and X-rays not far from a closet packed with crutches, nebulizers and kids T-shirts that read, “They’re the reason I stopped wheezin’.” The place is decorated in a jungle theme. A second location, which opened two years ago in Orchard Park, has a similar layout, with a beachfront ocean feel.

“We’ve tried to focus on the little things,” Lillis said. “It’s a very homelike setting. The staff all wears street clothes to make the kids comfortable. We try to put stuff on the ceiling when we know the kids are going to be laying there. We have therapy dogs that come through often. Sometimes we have volunteers who do story time. We have an iPad kids get to use during procedures.”

The staff of four doctors and eight nurse practitioners – all with at least three years experience in pediatric emergency settings – treat children and young adults up to age 21 mostly for respiratory illnesses, dehydration and gastrointestinal problems in winter and falls and other mishaps in summer. Stitches and antibiotics can be given to patients.

Pediatricians in the region first looked at her venture with caution, Lillis said, but have since begun to see the company as an important cog in the regional child health care mix. The centers are open from 4 p.m. until late evening on weekdays and 10 a.m. to 10 p.m. Saturdays and Sundays, which allows pediatricians to recommend complementary care after their business hours, should they see fit.

MASH Urgent Care is among companies that offer similar services to those of all ages. The company’s urgent care business started in 2004 at the Dent Tower, across Sheridan Drive from Excelsior. It served 69,000 patients in 2013 and expects to tend to 114,000 this year, Pundt said. During the same time, hospital emergency departments have developed “fast track” models that combine less serious cases into a separate flow category, with separate staff, to better address wait times.

Upper respiratory infections, sinus infections and sore throats are most commonly treated at MASH. So too are lacerations, fractures sprains, rashes, insect bites and urinary tract infections. Pundt said MASH doctors and other providers – many of whom also work part time in regional ERs – also work with primary care doctors to prevent ER visits for patients with chronic conditions that include asthma, dehydration, migraine headaches and COPD.

Not every hospital administrator is thrilled with the trends in emergency care, but Elman, who has been in the field since 1979, understands the inevitabilities.

“Medicine has progressed to such a point that we can keep patients alive much longer and we see a lot more chronic conditions in the emergency department than when I first started out,” the Catholic Health Emergency Medicine chairman said. “Our volume continues to go up. The first quarter has gone up significantly – and we didn’t even have a bad flu season.”

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