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Urgent care is one of those scams so brazen that they can do it out in the open and get away with it. They bounce almost everything to the ER and essentially c

by treis 3y ago

Urgent care is one of those scams so brazen that they can do it out in the open and get away with it. They bounce almost everything to the ER and essentially charge twice for the same work. Once at the Urgent Care and once at the ER. It's such a fantastic business model and essentially is doubling their profits. It's not just private equity pulling these shenanigans. Our local Children's chain is a non-profit and they pull some real shady shit.

giantg2 3y ago
I wouldn't doubt that some urgent cares do shady stuff. The ones I've dealt with were great. Knowledgeable doctors (not just NPs or PAs), decent facilities, variety of common services like x-ray, blood draws, etc. One upfront fee for the visit and additional services are cheap ($30 xray, $10 blood tests). Really not bad.
tptacek 3y ago
Like a lot of people, I exclusively go to urgent care for routine stuff, and for the first line of care for anything more serious, and I have never once had the experience of being bounced to an ER. They share records with my PCP but can see me at the drop of a hat on no notice. People overuse doctors. Most of what younger people (under, say, 50) go to the doctor for, a good NP can do just as well or better. One of my weird hobbyhorses is how dumb the name "nurse practitioner" is; they should just call them "associate physicians". (Note here that we're talking about "urgent care", which are clinics run by health chains, staffed with a doctor or two, a couple NPs, and a bunch of nurses; "urgent care" is not the ER, which is a thing people gotten hung up on HN about before, because I guess every country calls their ER something different. Going to the ER for routine care is insane.)
- TylerE 3y ago
  I've been "bounced to the ER" once, but that's because the x-rays showed pneumonia, and my vitals were... not in a great spot. Even then it was phrased as more "If it were me, and I had similar comorbidities, I'd get that looked at ASAP" Ended up hospitalized for 4 days.
- QuarterReptile 3y ago
  >One of my weird hobbyhorses is how dumb the name "nurse practitioner" is; they should just call them "associate physicians". Well, there are "physician assistants", PAs, which are the same rung of the ladder as NP but via different path. Areas tend to somehow converge either on NPs or PAs, but not both so often.
- maxerickson 3y ago
  It is maybe a little bit crazy to design a system that charges people based partly on how well they are able to self-assess their need for care. The ER and urgent care at my local hospital are next door to each other. Until the last year or so, it was the only urgent care in the area (and is the only ER).
  - tptacek 3y ago
    The system I'm describing does no such thing. Urgent care is the doctor's office. It takes less self-assessment, not more, to go to urgent care, because you can go inexpensively and with no notice or appointment. Got a weird itchy bump? Stop in on your way back from work. If it's a rash, they'll tell you take Benadryl. If it's Fatal Familial Itchy-Bump-Itis, they'll square things away with your PCP and get serious diagnosis and care expedited. It works extremely well with my doctor's health system, and I'll add that my doctor's health system is notorious in the area for sucking to work with, so if I switched to, like, Rush or Northwestern, presumably it'd be even better.
    - maxerickson 3y ago
      Why should that stop cost more of you walk in the other door? One argument could be that treating non emergency cases would ruin availability or increase costs, both of which seems like big assumptions at a system design level (vs the actual constraints and incentives that have lead to the existing service configuration).
      - tptacek 3y ago
        At the point where you're noticing that Urgent Care costs less than a primary care appointment and find that problematic, it really starts to feel like you're just searching for things to disagree about. It's OK if we run out of things to dispute!
        maxerickson 3y ago
        I'm talking about the ER not having a triage level that is equivalent to urgent care, not comparing urgent care to primary care.
- rexf 3y ago
  Your experience and my experience vary a lot. My background is CA & NYC. I am able to get same day or same week (if less urgent) appts by calling my primary (PCP). In the event that my PCP has no availability or it's late in the day, I'll consider going to urgent care since it's the only thing open. I can understand other people posting how hard it is to find a good PCP (or even dentist frankly). I got lucky and found a good, local PCP that I've been seeing for years.
- singleshot_ 3y ago
  Associate physician would be a great term, but taking the analogy to the legal profession, wouldn’t we expect an associate doctor to become a doctor someday? Isn’t an associate doctor actually a resident or intern? Agree NP is a poor term.
candiddevmike 3y ago
I'm sure the executives, admins, and board members of your Children's chain are paid quite well! Administrative bloat is killing these places
- Tao3300 3y ago
  Married to a pediatric physician whose practice changed hands a few times and wound up in one the big local children's NPOs. The administrators are fucking vipers. These orgs are rotted at the heart. They do everything they can to stretch the staff thin while shifting their targets and gaslighting them into thinking they're underperforming. Execs are doing great, but in the meantime they're hemorrhaging docs, nurses, and office staff because the conditions suck.
Spooky23 3y ago
Urgent care is just a doctors office. I had to go for some stupid thing and the person at the front door would not let you enter if you had anything like chest pain.

by treis 3y ago

giantg2 3y ago

I wouldn't doubt that some urgent cares do shady stuff. The ones I've dealt with were great. Knowledgeable doctors (not just NPs or PAs), decent facilities, variety of common services like x-ray, blood draws, etc. One upfront fee for the visit and additional services are cheap ($30 xray, $10 blood tests). Really not bad.

tptacek 3y ago

Like a lot of people, I exclusively go to urgent care for routine stuff, and for the first line of care for anything more serious, and I have never once had the experience of being bounced to an ER. They share records with my PCP but can see me at the drop of a hat on no notice. People overuse doctors. Most of what younger people (under, say, 50) go to the doctor for, a good NP can do just as well or better. One of my weird hobbyhorses is how dumb the name "nurse practitioner" is; they should just call them "associate physicians". (Note here that we're talking about "urgent care", which are clinics run by health chains, staffed with a doctor or two, a couple NPs, and a bunch of nurses; "urgent care" is not the ER, which is a thing people gotten hung up on HN about before, because I guess every country calls their ER something different. Going to the ER for routine care is insane.)

TylerE 3y ago
I've been "bounced to the ER" once, but that's because the x-rays showed pneumonia, and my vitals were... not in a great spot. Even then it was phrased as more "If it were me, and I had similar comorbidities, I'd get that looked at ASAP" Ended up hospitalized for 4 days.
QuarterReptile 3y ago
>One of my weird hobbyhorses is how dumb the name "nurse practitioner" is; they should just call them "associate physicians". Well, there are "physician assistants", PAs, which are the same rung of the ladder as NP but via different path. Areas tend to somehow converge either on NPs or PAs, but not both so often.
maxerickson 3y ago
It is maybe a little bit crazy to design a system that charges people based partly on how well they are able to self-assess their need for care. The ER and urgent care at my local hospital are next door to each other. Until the last year or so, it was the only urgent care in the area (and is the only ER).
- tptacek 3y ago
  The system I'm describing does no such thing. Urgent care is the doctor's office. It takes less self-assessment, not more, to go to urgent care, because you can go inexpensively and with no notice or appointment. Got a weird itchy bump? Stop in on your way back from work. If it's a rash, they'll tell you take Benadryl. If it's Fatal Familial Itchy-Bump-Itis, they'll square things away with your PCP and get serious diagnosis and care expedited. It works extremely well with my doctor's health system, and I'll add that my doctor's health system is notorious in the area for sucking to work with, so if I switched to, like, Rush or Northwestern, presumably it'd be even better.
  - maxerickson 3y ago
    Why should that stop cost more of you walk in the other door? One argument could be that treating non emergency cases would ruin availability or increase costs, both of which seems like big assumptions at a system design level (vs the actual constraints and incentives that have lead to the existing service configuration).
    - tptacek 3y ago
      At the point where you're noticing that Urgent Care costs less than a primary care appointment and find that problematic, it really starts to feel like you're just searching for things to disagree about. It's OK if we run out of things to dispute!
      - maxerickson 3y ago
        I'm talking about the ER not having a triage level that is equivalent to urgent care, not comparing urgent care to primary care.
rexf 3y ago
Your experience and my experience vary a lot. My background is CA & NYC. I am able to get same day or same week (if less urgent) appts by calling my primary (PCP). In the event that my PCP has no availability or it's late in the day, I'll consider going to urgent care since it's the only thing open. I can understand other people posting how hard it is to find a good PCP (or even dentist frankly). I got lucky and found a good, local PCP that I've been seeing for years.
singleshot_ 3y ago
Associate physician would be a great term, but taking the analogy to the legal profession, wouldn’t we expect an associate doctor to become a doctor someday? Isn’t an associate doctor actually a resident or intern? Agree NP is a poor term.

candiddevmike 3y ago

I'm sure the executives, admins, and board members of your Children's chain are paid quite well! Administrative bloat is killing these places

Tao3300 3y ago
Married to a pediatric physician whose practice changed hands a few times and wound up in one the big local children's NPOs. The administrators are fucking vipers. These orgs are rotted at the heart. They do everything they can to stretch the staff thin while shifting their targets and gaslighting them into thinking they're underperforming. Execs are doing great, but in the meantime they're hemorrhaging docs, nurses, and office staff because the conditions suck.

Spooky23 3y ago

Urgent care is just a doctors office. I had to go for some stupid thing and the person at the front door would not let you enter if you had anything like chest pain.