Health News
Health News
November 1, 2017
Getting the Right Care at the Right Time & Place

The doctor’s office.  Urgent care clinics.  Store-based clinics.  Free-standing emergency rooms.  Hospitals.  Patients have a lot of options when it comes to health care these days.  Choices are good, of course, but it’s important to know a little about each one so you know the right time to use them.  Just like you wouldn’t call for an appointment with your primary care doctor if you thought you were having a heart attack, you probably don’t need to check into a trauma center if you think you have a sinus infection.  Knowing where to go and when can keep you healthier, as well as save time and money. 

The Medical Home

Have you ever wondered what the term “medical home” means?  It’s an increasingly common term used in the world of health care and in very broad terms, speaks to the importance of everyone having a health care provider they see on a regular basis for checkups and most health care needs.  Many patients would consider their primary care provider (PCP) to be their medical home.  There are a number of factors that go into the establishment of a medical home, or as it’s formally known, a Patient Centered Medical Home (PCMH). 

The Agency for Healthcare Research and Quality at the U.S. Department of Health and Human Services defines a PCMH as one that includes five functions and characteristics:

  • Comprehensive Care: A PCMH can deliver the majority of a patient’s health care needs through a team of providers, which could include physicians, advanced practice nurses, physician assistants, nurses, pharmacists, social workers and nutritionists.  Comprehensive care includes physical and mental health and focuses not only on “sick care,” but also on prevention and wellness. 

  • Patient-Centered: Essentially, this means health care should be about the patient, not the provider.  Patient care should be individualized, with an emphasis on communicating in a way the patient is comfortable and with sensitivity to the patient’s values and unique needs. 

  • Coordinated Care: The PCMH is able to coordinate all health care services for the patient, including specialty care, hospitalization and home health.  There is also an emphasis on communications between patients and their families. 

  • Accessible Services:  A PCMH strives to make health care services accessible and convenient for patients.  This could include extended office hours in the evenings or on weekends, around-the-clock telephone or online access and short wait times for urgent needs. 

  • Quality and Safety:  Patient safety and high-quality care are core focuses for a PCMH.  The practice of evidence-based medicine and a focus on population health by tracking and analyzing patient data are essential.   

Many of the key attributes of a PCMH can be found in the practices of Texas Health Care/Privia North Texas providers.  “One of the reasons Texas Health Care partnered with Privia Health in 2016 was because both organizations believe in value-based care, focusing not only on solving a patient’s short-term illness or injury, but on long-term wellness and health,” says Dr. Lynne Tilkin, a primary care physician.    

“We pride ourselves on tailoring care to each patient, because we understand no two individuals are the same,” Dr. Tilkin continues.  “And we want to make sure that individualized care is available when the patient can access it, which is why many of our providers offer extended hours and are available for questions at any time.” 

Primary Care Providers

Most of your health care needs can be met through your PCP – usually a family doctor, internal medicine doctor, pediatric doctor or obstetrician/gynecologist – and those providers will fulfill many of the functions of a medical home.  You see that provider for health care needs such as:

  • Most illnesses

  • Regular checkups and screenings, such as cholesterol screenings and mammograms

  • Preventative medicine, such as an annual flu vaccine

  • Referral to a specialist

  • General questions about your health

“Utilizing your relationship with your primary care provider for most health care needs makes sense for a couple of reasons,” explains Dr. Tilkin.  “They’ll be able to treat you for common illnesses, such as a sinus infection or stomach bug and make sure you’re up-to-date on recommended health screenings and preventative measures.  That helps keep you healthy, but it’s also going to save you money – for example, a checkup and flu vaccine will cost you a small co-pay, whereas skipping the vaccine could land you in the emergency room.  Not only are you feeling miserable with a serious illness, you’ll be paying a lot more out-of-pocket for visiting the ER.” 

Of course, sometimes it’s just not possible to get the treatment you need when you need it at your primary care provider. To follow are some of the other common options people can turn to, including urgent care clinics and free-standing emergency rooms.  But first, it’s important to understand what constitutes a medical emergency.

What is a Medical Emergency? 

The following is the American College of Emergency Physicians’ list of medical emergency warning signs, as cited by the U.S. National Library of Medicine: 

  • Bleeding that will not stop
  • Breathing problems (difficulty breathing, shortness of breath)
  • Change in mental status (such as unusual behavior, confusion, difficulty arousing)
  • Chest pain
  • Choking
  • Coughing up or vomiting blood
  • Fainting or loss of consciousness
  • Feeling of committing suicide or murder
  • Head or spine injury
  • Severe or persistent vomiting
  • Sudden injury due to a motor vehicle accident, burns or smoke inhalation, near drowning, deep or large wound, or other injuries
  • Sudden, severe pain anywhere in the body
  • Sudden dizziness, weakness, or change in vision
  • Swallowing a poisonous substance
  • Severe abdominal pain or pressure

“If you or someone you are with experiences any of these symptoms, call 911 immediately or go to the nearest emergency room,” says Dr. Tilkin.      

Urgent Care Clinics

If your symptoms don’t include anything on the above list, an urgent care clinic can be a convenient option for care.  They are generally open well into the evenings and on weekends.  Usually, you don’t have to have an appointment, although some clinics allow you to get on a waiting list over the phone or online. The clinic will notify you when they can see you, reducing the time you spend in the waiting room. 

If you find yourself looking for an urgent care clinic, it’s very important to know the difference between it and a free-standing emergency room.  

Free-standing Emergency Rooms

It’s hard not to notice that there has been a proliferation of free-standing ERs in North Texas over the last few years.  They’re called “free-standing” because they are not attached to a hospital, although they may be affiliated with a hospital system.  Free-standing ERs are open 24/7 and can treat anything you would visit a hospital ER for, from a broken bone to a heart attack.  The only exception to this is that they are not equipped to treat trauma patients.  Medical trauma is defined as a serious and sudden injury that requires immediate attention. 

Given the number of free-standing ERs in North Texas, you can often get to one faster than you can a hospital and may have less of a wait time once you arrive.  On the other hand, if you’re experiencing an event that may require surgery – such as a heart attack that leads to emergency bypass surgery – the free-standing ER can get you stabilized, but then you’ll have to be transported to a hospital anyway.  In that kind of emergency, it’s best to call 911 so that paramedics can begin treating you immediately and they can transport you to the closest, most appropriate place for care. 

There have been instances of people confusing free-standing ERs with urgent care clinics and visiting these facilities for illnesses such as a cold or stomach virus.  This can be a costly mistake.  Insurance companies will charge a significantly higher co-pay for an ER visit than for an urgent care visit (usually an urgent care co-pay is higher than the co-pay for your primary care provider, but far less than for an ER or free-standing ER).  Additionally, you may receive a separate bill from a provider you saw in the ER, a practice referred to as “balanced billing.”

Bottom line – if you have a medical emergency, call 911 or go an emergency room immediately.  But if it’s not an emergency, take a few minutes to think through your options – it could save you hundreds, or even thousands, of dollars. 

Hospital Emergency Rooms

Just like free-standing emergency rooms, a hospital emergency room should be utilized in cases of medical emergency.  An emergency room in a hospital will have surgeons on hand in the event surgery is needed and of course, they can admit patients whose illness requires an overnight stay. 

Most major hospitals in North Texas will be in most major insurance plans’ networks.  It’s a good idea to review your insurance plan and make sure the hospitals closest to your home and workplace are in your network in case you ever need to visit one.  But if it’s a medical emergency, don’t worry about any of that – get to the closest facility you can, as quickly as possible. 

Take Charge of Your Health Care

By understanding both the various health care options out there today and your health insurance policy, you can take charge of your care and use these resources to keep yourself healthy, as well as be prepared in the event of an emergency.  It all starts with a relationship with a primary care provider and establishing a medical home.  If you’re looking for a doctor, take a look at the Texas Health Care/Privia North Texas list of providers and find one near you.  

This article contains information sourced from:

Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services

U.S. National Library of Medicine, National Institutes of Health