Patti Neighmond, NPR News, Author at �鶹Ů�� Health News

Can’t Get In To See Your Doctor? Many Patients Turn To Urgent Care

Patti Neighmond, NPR News — Tue, 08 Mar 2016 10:00:59 +0000

Though the majority of Americans have a primary care doctor, a large number also seek treatment at urgent care centers, statistics show. For many people, the centers have become a bridge between the primary care doctor’s office and the hospital emergency room.

Urgent care is not meant for life-threatening emergencies, such as a heart attack, stroke or major trauma, doctors say. But it is to treat problems considered serious enough to be seen that day — conditions like a cut finger, a sprained ankle, severe sore throat, or the sort of infection 25-year-old Dominique Page recently experienced.

Page, who lives in Los Angeles, suspected she had a bladder infection when she woke up that morning. Instead of calling her primary care doctor, she headed straight to the nearest urgent care clinic.

“I knew if I made an appointment at my doctor’s office, it wouldn’t be for today,” she explains. “Their appointments are usually booked.”

Page’s decision seems pretty typical. In a conducted by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health, most people reported going to urgent care because they believe it is more convenient and takes less time than going to their regular doctor. One in 5 said that at least once in the past two years, they were unable to see their regular doctor when they needed medical care, mostly because the doctor didn’t have any available appointments, the office was closed or the doctor was out of the office.

Page went to Reliant Immediate Care, adjacent to Los Angeles International Airport. Walk-in patients are welcome, and the clinic is open 24/7.

“We don’t even know where the key to the front door is,” says the clinic’s medical director, , “because at least in the 10 years that I’ve been here, we’ve never closed the front door.”

For years, Lebow says, he worked in a hospital emergency room, where he saw lots of people who “never should have been in the ER in the first place.” In his experience, he says, maybe 20 percent of the ER patients are admitted to the hospital, which means that about 80 percent are sent home.

National suggest an even higher percentage tend to leave the ER without needing a hospital stay. Of those patients, Lebow says, probably 75 percent could be seen in a less intensive setting — like an urgent care center.

After tests, Lebow confirmed that Page had a bladder infection and prescribed antibiotics. Page was relieved to have a diagnosis and treatment. She was in and out in less than an hour, she says, and — even better — her visit cost far less than going to a hospital ER, which charges a “facility fee” just to walk in the door.

That fee — which typically ranges from $300 to $500 — helps cover the cost of having on hand, 24/7, all the equipment and staff needed to treat even the most extreme emergencies, explains , an emergency medicine doctor on the governing board of the Urgent Care Association of America.

According to a recent from the National Center for Health Statistics, visits to the ER can easily run more than $1,000 for adults. The average visit to an urgent care center, in contrast, hovers around $150.

Nationwide there are now more than 7,000 urgent care centers across the country, and Hicks calls the industry’s growth in the past couple of decades “explosive.” He says patients tell him they appreciate the cost savings and convenience — most urgent care centers are open in the evenings and on weekends and holidays. In large, urban areas, many are open around the clock.

Most centers take private insurance and Medicare, although some don’t take Medicaid; Hicks says Medicaid reimbursement doesn’t cover the cost of providing care. Uninsured patients have to pay cash.

In our poll, most patients said they found the cost of their visits “reasonable.” And the majority — 75 percent — rated the care they received as “excellent” or “good.”

But 25 percent of those polled described their care at an urgent care center as just “fair” or even “poor.”

One of those poll respondents was 31-year-old Syntyche Toniy, who lives in Orlando, Fla. Toniy went to her local urgent care center after cutting her hand while gardening, and says she found the process there “disorganized.”

After registering at the front desk, she waited another two hours before seeing a doctor, who then sent her to the hospital emergency room anyway — for stitches.

Another woman who responded to the NPR poll — 69–year-old Carole Lamb in Ashland, Ore. — recalls a frustrating experience during her visit to an urgent care center for symptoms of bronchitis. Lamb told the doctor that she’d previously been prescribed a medication for her infection, but it hadn’t worked very well.

As she was explaining the situation, the doctor got up, walked out of the room and sent in an assistant who gave her a prescription for the very same medicine.

“I thought, really?” Lamb says. Fortunately, she adds, she was able to get an appointment within a few days with a new primary care provider — who successfully treated her infection.

Hicks says his association continues to work hard to improve quality and maintain high standards in urgent care centers nationwide. While most centers are standalone facilities, some are embedded in large, integrated hospital systems.

At the UCLA Urgent Care facility in Santa Monica, , the medical director, says the beauty of a large integrated system is that primary care, urgent care and hospital care are all connected, so medical records are shared. Not only is that sort of system more efficient, he says, but patient care is improved, too.

For example, Manuel says, if someone with asthma shows up at the urgent care center two or three times for difficulty breathing, Manuel will reach out to the primary care provider and let them know the patient’s asthma is not under control.

He sees his center’s job, in part, as helping each patient establish a better continuity of care, so those sorts of medical emergencies arise less frequently. And if patients don’t have a primary care provider, Manuel helps them find one within the system of UCLA Health.

One thing is for sure, says Hicks: Until the of primary care doctors eases nationally, the number of urgent care centers — and their use — will continue to climb.

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Katrina Shut Down Charity Hospital But Led To More Primary Care

Patti Neighmond, NPR News — Wed, 26 Aug 2015 09:00:50 +0000

Five years ago, New Orleans attorney Ermence Parent was struggling to find out what was wrong with her leg. She was 58 years old, and her right leg hurt so much that she needed a cane. That was not only painful, but frustrating for a woman who routinely exercised and enjoyed it. Parent sought advice from several doctors and a chiropractor, but got no diagnosis.

Then she made an appointment at the newly renovated , a primary care clinic dedicated to providing quality care for people regardless of insurance status. Most patients, including Parent, are on Medicaid or Medicare. Some pay on a sliding scale. Parent saw internist , who is now medical director of the clinic.

Abell took a careful medical history, looked at Parent’s X-rays and watched as she walked up and down the hallway

“‘Baby, your hips are going,’ ” the doctor told Parent. The attorney had “bone-on-bone” arthritis. Without surgery, the doctor said, “‘in about six months you’re going to be in a wheelchair.’ “

Instead, about a month later, Parent received her first hip replacement, and nine months later, her second.

Today, she’s back to exercising, has lost weight and sleeps more soundly. “You know, changing those two hips just rejuvenated me; it gave me years back on my life,” Parent says.

When Katrina hit in 2005, many health facilities were destroyed or otherwise shut down, including urgent care centers, nursing homes, pharmacies and hospitals. The renowned and beloved Charity Hospital, a public facility that had served the city’s poor for centuries, was forced to close.

Many said the loss of the hospital was devastating. Charity represented a precious connection to health from childhood through old age.

But the attachment people felt to the old institution may have been based more in sentiment than fact, says Abell, especially when it came to primary care. She says patients had to rely on a trip to the emergency room if they didn’t have health insurance and had ongoing chronic problems.

“Before Katrina, there was no primary care or preventive medicine — really, truthfully — for patients,” Abell says. “None. Zero.”

Back then, a patient with a medical problem that wasn’t acute often had to wait months to schedule an appointment, she says. And once they showed up for the appointment, they might have to wait all day — or even end up with the wrong clinic or with the wrong physician. Abell says the situation was “very disrespectful” to patients.

Today is a “different day,” Abell says. In recent years, a network of renovated and newly built primary care health clinics has opened, which she and New Orleans residents hope will bring a new degree of stability to the health care that the city’s low-income residents get.

Katrina was devastating, Abell says, but after its ruin, New Orleans received a dramatic infusion of cash from the state and federal governments, and from private foundations. The funds resulted in new hospitals, new clinics and an enormous state-of-the-art facility that replaced the old Charity Hospital.

, which opened this month, is just a few blocks from the shuttered hospital. The new facility’s gleaming buildings, hundreds of patient beds and high-tech specialty care, stand in startling contrast to the old institution.

The old New Orleans Charity Hospital (L) and a makeshift emergency room (R) in the hospital in 2005 after Hurricane Katrina. Katrina forced the hospital to close in 2005. (Photos by Mario Tama/Getty Photos)

Abell has high hopes the new medical center will provide timely, excellent care for both acute and chronic needs. And her biggest praise is for the new network of primary care clinics.

“Today, a patient can call and get same-day primary care,” Abell says, an improvement that Ermence Parent attests to, as well. A few months ago, when Parent’s leg became swollen, she called the clinic and was seen right away.

In a of New Orleans residents by NPR and the Kaiser Family Foundation, 72 percent of adults agreed that progress has been made in the availability of medical facilities and services in the city. But the majority of residents — 64 percent — also said more needs to be done to provide care for people who are uninsured and have low incomes.

And among African-Americans, nearly half said they’re very worried that health care services may not be available when they need them. Only 13 percent of white adults said they are very worried in that way.

According to Abell, one of the biggest remaining weaknesses in the current system in New Orleans is timely access to specialty care like orthopedics, neurology and cardiology.

It’s a problem, she says, “when you can’t get your patient in to be seen for an issue that’s evolving, and you know that some specialty advice would be helpful.” She says she’s had to rely on personal connections — and 30-plus years of experience working in the city — to help her poorer patients gain timely access to specialty care. She’s anticipating that the new University Medical Center will help remedy that.

That hope extends to mental health care, as well. Rashain Carriere-Williams, who directs program operations at , a community organization that helps troubled families and children, says the need for mental health treatment in the city is huge.

After Katrina, psychiatrists fled New Orleans, along with many other people. Unfortunately, Carriere-Williams says, most psychiatrists never came back. In the entire city, there are now only two or three psychiatrists who accept Medicaid and are willing to see her patients and their families, Carriere-Williams says.

“A lot of times it’s easier to get them in to see a psychologist, because there are more of those,” she says. But psychologists can’t prescribe the medication some patients need.

Although the new hospital has some beds dedicated to patients in need of mental health treatment, the number of beds isn’t nearly high enough, she says.

She’s been faced with heartbreaking situations — including one New Orleans boy who recently threatened suicide and had to be placed on suicide watch. The only facility with an inpatient bed was a six-hour drive from the city. The family drove their child there for a 72-hour hold, and the child temporarily got the needed care, says Carriere-Williams. But the experience was grueling, at a time when the family was extremely fragile.

Carriere-Williams says she’s hopeful the new clinics and hospitals will begin to fill the big gaps in the community’s mental health needs. But, based on Louisiana’s and New Orleans’ history in that regard, she says, she’s skeptical.

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Despite Progress, African Americans Still Hard Hit By Medical Bills

Patti Neighmond, NPR News — Mon, 10 Jun 2013 13:51:19 +0000

This story comes from our partner

‘s Shots blog.

For many years, high medical bills have been a leading cause of financial distress and bankruptcy in America. That pressure , according to a released last week by the Centers for Disease Control and Prevention.

But one in five Americans still face hardships due to medical costs — and African Americans continue to be the hardest hit.

by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health found that 24 percent of African American families said they had problems paying for needed prescription drugs. The poll is part of NPR’s ongoing series, the .

Mike Jackson is one of those people. Jackson, 52, lives in Oklahoma City and works for a major insurance company. He has high blood pressure and hypertension, and has been diabetic for 15 years.

Treating these chronic health problems isn’t cheap. Jackson’s medical bills add up to nearly $500 a month. Jackson says: “Diabetes alone — just the two medications alone for diabetes would have run $325 a month.”

That’s “would have”, because Jackson couldn’t pay. This time last year, he was laid off, got divorced and lost his health benefits.

He worried that he wouldn’t be able to afford the insulin he needs to control his diabetes. So he started cutting back.

“Instead of taking 60 units twice a day I was taking 30 units twice a day,” Jackson told NPR. “The idea behind that was if I watched what I would eat and then stay with the 30 units — I would keep my blood sugar down enough that hopefully it would not be much of a problem.”

But cutting back on insulin for eight months did cause problems. Jackson developed numbness in his foot and toes, and nerve damage in his eye – all complications of uncontrolled diabetes. “My left eye actually shut; wouldn’t open,” Jackson says. “The muscle for my eyelid won’t open.”

An ophthalmologist gave Jackson a discount. But Jackson is still struggling to make payments.

In response to an NPR Facebook call out, 30-year-old Ashley Liggins of Fort Worth, Texas, wrote that she’ll never forget being without health insurance and having to decide between medication for high blood pressure, gas for her car, or food for the week.

Like Jackson, Liggins also tried to stretch out the medication she had by reducing the dose and even borrowing pills from her mother. “I was really worried,” says Liggins, who now works in the financial services industry. “High blood pressure runs in my family.”

A single mother of two wrote to us about being sued for unpaid medical bills totaling nearly $5,000. She has no idea how she’ll pay. She, too, has high blood pressure, a common worry among African Americans in our poll.

One in three African Americans surveyed said they, too, had serious problems paying bills from doctors or hospitals in the past year.

“We specifically asked African-American families what were the top concerns they had for health in their own families,” says Robert Blendon, a professor of health policy at the Harvard School of Public Health, who partnered with NPR for this survey. “And we ended up with high blood pressure, stroke and diabetes as being the top.”

That’s in contrast to other national surveys, where cancer and other type of illnesses are often raised as the biggest concerns.

And even though most of the people in this poll did have health insurance, nearly half still worried that if they suffered a major illness in the future they wouldn’t be able to pay for medical care.

“We found general economic insecurity among families who generally were doing well,” Blendon says, “And this fear of paying a larger medical bill was just one of the top problems they had.”

For Mike Jackson, covering the cost of caring for a chronic health problem became impossible. He’s now working, but it’s a temporary job that doesn’t offer health benefits. And Jackson worries every day about the future.

“It’s one of those things where, if something happens to my car or to me health wise, I’m in trouble. If anything goes wrong, I’m one step away from disaster.”

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