Know Before You Go

While many rural Texas towns struggle with access to quality healthcare services, Matagorda County is blessed with a wide range of primary, specialty, walk-in, and emergency care services. But when it comes to cost, there are often major differences between each of these services.

People often ask why the cost of delivering care can vary so much by setting. While there are many reasons ranging from reimbursement rates from insurance agencies and government programs to the overall increasing costs of supplies and labor, there are also many structural reasons why this can occur. Here are just a few things to consider:

Your Doctor ($)

Your primary care provider’s office is generally optimized to treat illnesses, and routinely maintains the staff, supplies, and relationships with other providers to deliver care at the lowest cost. By utilizing your primary care provider for non-emergency care, follow up, and preventive services, most patients can expect to receive the services they need at the lowest possible cost.

Walk-In Primary Care ($$)

While most walk-in services are hosted by clinics and have many of the same benefits as a visit to your regular provider’s office, additional wait times or a lack of immediate availability during the busiest times of the day may increase the cost of your visit due to unplanned time off work. Though a great option for those who need non-emergency care and who cannot get an appointment with their regular provider, a lack of immediate availability may be a financial factor for some.

Weekend Urgent Care ($$$)

As the name suggests, MRMC’s Weekend Urgent Care service is a clinic set up on Saturdays and Sundays in the Doman Freeman Phillips Medical Office Building next door to the hospital. The cost of delivering care in a special setting like this is often much higher due to the number of contracted medical providers and support staff needed to provide these extended hours. Each weekend, the clinic has to be set up and removed in order for other services to function during the week. The Weekend Urgent Care service, though convenient and accessible, is a premium service provided to our community. Those with non-emergency healthcare needs who can wait until the weekdays to see their primary care provider or visit a walk-in service often choose to do so. Those who do not need emergency care and who cannot wait or who prefer the convenience of a weekend visit are encouraged to visit the Weekend Urgent Care clinic.

Emergency Room ($$$$)

MRMC’s Level III Emergency Room with Level IV Trauma designation remains in a state of “constant ready” to treat emergency illnesses. From emergency physicians and Advanced Practice Providers to lab, radiology, pharmacy, telemedicine consults, on-call medical experts and emergency transport services, the costs associated with providing access to emergency care 24 hours per day 7 days per week can be staggering.

All patients who need emergency care services are encouraged to dial 911 immediately, as all patients are treated regardless of their ability to pay. But for those needing non-emergency care, any emergency room visit to any hospital is likely to be the most expensive option.

From a recent Becker’s Hospital Review article:

Each time a patient enters the emergency department [ED for short] with a condition that can be treated in a primary care setting, it comes at an average cost of $2,032 to the healthcare system, according to an analysis published by UnitedHealth Group.

UnitedHealth said the average cost is 12 times higher than visiting a physician office, which costs an average of $167. It also said the $2,032 price tag is 10 times higher than an urgent care visit, which costs an average of $193.

UnitedHealth said the 10 most common conditions treated in the ED that could be treated in a primary care setting are bronchitis, cough, dizziness, f­lu, headache, low back pain, nausea, sore throat, strep throat and upper respiratory infection. UnitedHealth projects 18 million of the 27 million ED visits made by privately insured Americans each year are avoidable.

While this information may not be comforting, we hope you’ll find it useful in planning health services for yourself and your loved ones. Everyone wants to stay physically and financially healthy, and this “Know Before You Go” message is one of the ways we help our community identify and access the best care in the most affordable setting possible.

Sources: MRMC’s internal data, United Health Group Analysis, and Becker’s Hospital Review.