My daughter injured her wrist playing soccer a week ago. Another player launched the ball upward into her extended wrist. She had immediate pain. Tears flowed. I shifted from Dad to doctor mode and assessed her wrist on the sideline. I had low suspicion for a fracture or severe injury. She was able to continue playing.
The wrist hurt more later that day. She iced, and we applied a wrist brace we had at home. I counseled her that it was likely a bad sprain and should get better over the next few days. I asked her to let me know each day how she was recovering.
She improved wearing the brace. Then the pain came back as she used the wrist more writing at school. After a week of persistent symptoms, I decided an X-ray made sense to rule out a fracture.
Our busy family schedule didn’t easily allow for a trip to a radiology center during regular Monday through Friday business hours (of course I have the latitude to order the test myself) so I decided that I would take her in for the X-ray on Saturday morning.
I phoned the free-standing radiology group I normally patronize and learned that while they’re open for MRIs on the weekend (both Saturday and Sunday) they do not offer the more simple X-ray service on the weekend — the lion-share of their income is from MRI reimbursements so it likely does not make financial sense to pay an X-ray technician on the weekend. So I had to find another option.
I thought next about taking my daughter to an urgent care clinic for an X-ray. I have Kaiser Permanente (formerly Group Health) insurance that promises more cost effective care when using Kaiser providers, and so looked up the Kaiser Urgent Care in Bellevue, open 24 hours. And off we went.
I’d never been to Kaiser’s Bellevue facilities though I work across the street. Looks beautiful from the outside. It’s even nicer on the inside. As a small business owner who has hired contractors to remodel my office space, I stood in awe of the elegant atrium with warm accents like a gas fireplace with couch-like seats that had nearly the feel of a ski chalet. My daughter said, “Dad, this looks like an airport.” And I thought, she’s right, this is kind of like the beautiful new atrium at Sea-Tac Airport…but the airport is used 24/7 — I wondered what the foot traffic looks like here on any given week.
And sure enough it was a ghost town. We walked right up to the Urgent Care reception desk and checked in. Two kind women were there to serve. One seemed to be mentoring the other.
We were taken back within minutes — no sooner had I taken my daughter’s homework out of my backpack when we were brought back by a nurse for vital signs. The nurse then had us go back to the waiting area. One minute later we were greeted by an upbeat male technician who identified himself as an ER Tech, and taken back into what I expected would be a typical Urgent Care medical office facility.
To my surprise, the facility was a high tech and fully equipped emergency room. The young man, the tech, told me that this was a fully functioning ER but due to contractual issues with Overlake Hospital (that has another fully functioning and state-of-the-art ER literally across the street), they must call it an Urgent Care.
My daughter and I sat idle in a room that could accommodate a full Code Blue with oxygen lines and monitors adorning the wall. We were right across the way from the nurses station (actually all rooms look out towards the nurses station as a deliberate and modern wheel-and-spoke ER design element). We observed at one point approximately 10 people casually standing around chatting at the nurses station. There were perhaps two other persons being attended to for what appeared to be reasonable urgent care type issues like cough/flu or nausea/vomiting.
The ER tech was kind, and after I told him our story, and that I’m a sports medicine physician, he said he’d facilitate the X-ray even before we were to be seen by the physician assistant. After about 15 minutes an X-ray technician brought us back for my daughter’s wrist X-ray. Then we met the physician assistant, who performed a very brief history and a nominal examination. The radiologist had concern for a buckle type fracture of the distal radius (forearm bone), and so the physician assistant got on the phone with a Kaiser orthopedic surgeon on-call. The orthopedic surgeon kindly spoke with me over the phone and after reviewing the images and the clinical history, he did not think there was a fracture. Ultimately we decided that bracing her for several weeks makes sense and we were discharged.
Our experience at the Kaiser "Urgent Care” (in quotes because this is really a fully functional and state-of-the-art ER) was very positive in that we received prompt attention from a number of very friendly staff members and we met my goal of obtaining an X-ray to assess for fracture. In fact, we surpassed my expectations as I was able to speak with an orthopedic surgeon about my daughter’s case.
My level of worry going in was very low. My daughter was quite functional, and I deemed her at low risk for a significant injury. I got more excited about adjacent observations during the visit that might impact cost — both my direct and indirect costs of an “urgent care” visit to an actual emergency room, and the cost to my larger community.
An article (http://www.crainscleveland.com/article/20150708/NEWS/150709836/akron-general-to-build-new-emergency-department-cost-expected-at-35) from 2015 describes a cost of ~$35 million to build a new emergency room in Akron, Ohio. So I wouldn’t be surprised if that approximates the cost of the Kaiser “Urgent Care” here in Bellevue…again, this facility is literally the neighbor to the adjacent building of Overlake Hospital with a level 3 trauma center ER.
Aside from this being an example of overbuilding and an outrageous, and costly, redundancy in community resources, I find it remarkable that I didn’t even know that such a facility exists given that I work across the street AND I myself have Kaiser Permanente insurance. As one of Kaiser’s insured, clearly it may benefit me and my family to know about the resources at our disposal. As one of Kaiser’s neighbors and a community physician who treats others having Kaiser insurance, clearly it may benefit my patients to know about this extraordinarily equipped “urgent care” facility.
So what are the take home messages? The high and growing cost of your healthcare insurance premiums relates to many things, and one of my concerns is that inter-system competition (i.e. locally, Swedish vs UW vs Overlake vs Virginia Mason) is a consequence of the consolidation of healthcare providers/systems and competing systems often compete on resources. These resources are costly. And that cost is passed on to you.
We all want answers now. Not only for emergent care, which is a bit easier to define (perhaps by my definition, care that might help you prevent loss of life or limb), but for issues that we know are not emergent but trigger enough concern or anxiety to warrant a visit right now (i.e. is it broken or just a sprain, or will my infection need an antibiotic?). Let’s face it. We’re all looking to escape from our anxious thoughts. One way to do so for a health related concern is to seek attention immediately. Escalate our urgency to a "fever pitch” (pun intended) and drive to some 24 hour clinic. Why lie awake all night with anxiety when you can go see someone tonight? At least this is some of the psychology that underlies patient behavior, and perhaps the more irrational behavior of health systems that more and more are squandering our money!
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