For minor illnesses and injuries, urgent care may provide quicker, more affordable alternative to emergency rooms

Humana KenMalcolmson1

Humana green logoBy Ken Malcolmson
Regional CEO of the Employer Group Business Segment, Humana’s West Region

When people are sick or injured – whether bogged down by the flu or dealing with a sprained ankle – the last thing they want to do is wait to get better. Not realizing that there are other options, however, many patients go straight to hospital emergency rooms (ER), where the average wait time is nearly an hour and average visit time is more than four hours. [i]

Wait times are likely to get worse, due to about seven percent of ERs nationwide being forced to close in the past 10 years and about 90 percent of the rooms either at or over capacity.[ii]  ER visits have increased by 32 percent over the past decade, according to statistics from the Urgent Care Association of America (UCAOA).[iii] And, the number of people seeking care will only increase due to an influx in individuals expected to enter the health care system over the next few years.

Depending on the health condition and situation, patients should consider going to one of the many urgent care centers located in San Antonio, which are often faster, less expensive and more accessible, while providing personalized care.

At urgent care centers, which increased in number nationwide by more than 16 percent from 2008 to 2012, wait times are usually less than 20 minutes, no appointments are necessary and parking is convenient. [iv], [v] Most offer extended weekend and evening hours and some, like Humana’s Concentra, can connect with a patient’s primary physician to share information about the visit and create a greater continuum of care.

Going to the ER – or calling 911 – is the right course of action for life-threatening situations where patients exhibit severe symptoms or have a serious injury or illnesses, including head trauma, chest pain, loss of consciousness and severe burns. However, research shows up to half of ER visits usually don’t require an ER.[vi] Fortunately, urgent care centers provide quality service for common injuries and illnesses, such as ear infections, strep throat, cuts requiring stitches, minor burns and most other non-life-threatening problems. Additionally, urgent care centers are increasingly offering diagnostic testing and flu immunizations.

Urgent care centers, which accept most insurance, Medicare and cash payments, can also provide a considerable service to patients’ wallets. The cost for medical care at these centers is, on average, six times less than receiving the same care at an ER, according to the UCAOA.[vii] Insured patients often have lower co-pays and out-of-pocket costs, and non-insured patients who choose urgent care over ERs can also see about 80 percent in cost savings. For example, treatment for an ear infection typically costs about $60 at an urgent care facility, while the same service costs about $320 at an ER.

In all, San Antonio residents are encouraged to visit urgent care centers for timely and affordable care. Anybody interested in guidelines on when it is best to go to an urgent care center and when an emergency room is recommended can visit Understanding the differences will help you make the right decision for you and your family.

Ken Malcolmson is the chief executive officer of Humana’s West Region, where he is responsible for the overall management and strategic planning for the company’s Employer Group benefit products in a 14-state region.

[i]  CDC: Wait Time for Treatment in Hospital Emergency Departments –

[ii]  American College of Emergency Physicians –

[iii]  Urgent Care Association of America –

[iv]  Kaiser Health News –

[vii]  Urgent Care Association of America – 2010 Urgent Care Benchmarking Survey Results (no link available)

Employer penalty for “Pay or Play” rule on the Affordable Care Act postponed

Padgett Stratemann & Co.On July 3, 2013, the Obama administration postponed mandatory employer and insurer reporting requirements that are part of the Affordable Care Act (ACA). Large employers, subject to the “pay or play” mandate will not be penalized in 2014 for not offering health insurance to their workforce.  The one-year delay will allow large employers time to prepare for the reporting and penalty consequences of the requirement. Under the law, businesses with 50 or more employees would have had to provide affordable healthcare to their full-time employees or pay a penalty of $2,000 for each uninsured employee effective January 1, 2014.

Employer’s confusion and lack of clarity on cost obligations of benefit implementation strategy, as well as a need for more time to carry out implementation, all seem to be suspect for the delay.  Employers have stated they need more time to comply with the obligations of the law.

Other Significant Mandates of the Affordable Care Act Not Affected? The health marketplace exchange and individual mandate to purchase insurance are still in effect for January 1, 2014. Individuals must carry insurance in 2014 or pay a penalty. Further guidance is coming to comply with a voluntary information reporting system in 2014.

What should employers do? The delay is an obvious benefit for employers to now prepare to review cost of offering affordable healthcare or paying a penalty. Employers should review their responsibilities under the ACA to understand the definition of affordable coverage and minimum essential coverage requirements. Employers should evaluate healthcare coverage extension and employee qualification for subsidies. Employers should use this time to reassess their strategy or start by creating one.

How can we help? Padgett, Stratemann & Co., L.L.P. has a Human Resources Consulting (HRC) team that can provide benefits support to assist employers in evaluating their healthcare reform strategy. Now is the best time to learn about the impact associated with this delay! Contact us today for more information!