Oct 2, 2017

Where to go for Care: Decoding Your Medical Provider Options

By: Dr. S. George Kipa, MD, deputy chief medical officer at Blue Cross Blue Shield of Michigan 


Recent studies indicate that nearly half of the 500,000 Blue Cross Blue Shield of Michigan member visits to the emergency room (ER) in 2015 were inappropriate or potentially avoidable. The average cost of a non-emergency ER room visit is $750, but can cost health plan members anywhere from $50 to $150 or more per visit, depending on their plan. Alternatively, other quality care choices typically fall under $200 per visit with member costs starting as low as free, such as with the use of a 24-hour nurse line. Not only do unnecessary ER visits cost members more in out-of-pocket costs and time waiting for medical attention, they also contribute to the rising costs of health care overall. For patients to receive the most cost-friendly, accessible care possible, it’s crucial to understand which facilities and resources are appropriate when care is needed. 

·         Primary Care Physician (PCP): Average time for care: 60 minutes
       If an individual is not in need of serious or immediate medical attention, it is recommended that he/she first call their primary care physician with questions or concerns. A sore throat, cough, low-grade fever, earache, cold and flu symptoms are a few examples of when a trip to the doctor’s office would be appropriate. Health care providers can offer wellness guidance tailored to the patient, especially if the two share a long-standing history. 

·        24/7 Nurse Lines: Average time for care: 12 minutes
Many patients are unaware that health questions and concerns can be addressed 24 hours a day, seven days a week over the phone. As the name implies, nurse lines offer free, convenient medical advice from registered nurses who can provide tips and advice for any health issue and in some cases, a treatment plan. Patients can use nurse lines to assess a health condition, receive general wellness guidance or tips on preventive care. The nurse line is especially helpful for families with small children. Information on nurse lines can be found through insurance and/or health care providers. 

·        Online Tools: Average time for care: 10 minutes
Digital tools are making their mark in the health care space by offering patients low-to-no cost medical guidance from board-certified health care providers. Patients can see a doctor face-to-face through their computer at home or on-the-go using mobile apps and online tools. Many of these resources also offer the ability to fill necessary prescriptions and/or help those without a primary care provider, find a doctor nearby. 

·         Retail Clinics: Average time for care: 30-45 minutes
Non-emergency conditions can be treated by physician assistants and nurse practitioners operating retail clinics in select pharmacies. These facilities are low-cost and convenient for patients looking to treat minor illnesses and injuries or fill medications without a wait. Depending on the location, these walk-in clinics are often open on evenings and weekends. 

·         Emergency Room (ER): Average time for care: 4 hours  
Patients experiencing a serious or life-threatening health emergency are advised to call 911 or go to the nearest emergency room. If the health risk is unclear, primary care physicians and nurse lines can help determine whether an individual should make the trip to an ER. Those with pre-existing conditions should keep in mind signs and symptoms specific to their health history and risk level. 

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