Urgent Care vs. Emergency Room

Where to go, what to expect when you need immediate care

As the healthcare landscape continues to evolve, an ever-changing and improving environment of options becomes available to anyone in need of medical expertise.

When it comes time to seek out such care, there can be questions.

We reached out to a panel of experts to learn more about the differences between urgent care and emergency room settings, what patients can expect, what financial details to consider and what we can expect in the future.

Our experts:

Joseph Mangum, PA-C, Catholic Medical Center Urgent Care

Nicholas Larochelle, MD, Medical Director, Concord Hospital Emergency Department

Marcus Hampers, MD, CEO, ClearChoiceMD Urgent Care

William Brewster, MD, Regional Vice President, Harvard Pilgrim Health Care

Joseph Guarnaccia, MD, Medical Director of Emergency Services, Elliot Health Services, Elliot Hospital [Elliot has three Urgent Care Centers in Londonderry, in Manchester (at River’s Edge) and in Bedford.]

Nicole Lane, Chief Operating Officer, Member Medical

Dr. Lukas Kolm, Wentworth-Douglass Hospital

Q. What is the difference between an urgent care facility and an emergency room?

Kolm: “Urgent care facilities are focused on treating simpler, less severe medical conditions, whereas ERs are intended to treat more serious, life-threatening issues.”

Q. What should someone consider when they’re deciding whether to visit an emergency room or an urgent care/walk-in facility?

Brewster: “You should really ask yourself two questions — is this a serious or life-threatening medical emergency or a worsening condition that cannot wait to be addressed? Or is this a routine medical issue that can be treated by your primary doctor or an urgent care center? If you think you are having a medical emergency, you should always call 911 or go to the nearest emergency room. For other, more routine issues, calling your primary care provider, going to an urgent care in your area or using an in-network telemedicine option should be your first step.”

Kolm: “When trying to decide where to go, there are a number of factors you can consider, such as the severity of your symptoms, as well as your age and the number of symptoms you’re showing at once.

Go to the ER when emergency strikes — the below are some examples:

• Major trauma and or severe burns
• New onset chest pain or shortness of breath
• Pregnancy with vaginal bleeding
• Worsening of recent treatment for complex medical issues
• Opting for urgent care situations could include:
• Upper respiratory infection and/or flu-like symptoms without complicated medical history
• Pediatric illnesses e.g., ear infection, sore throat, rashes
• Minor traumatic injuries e.g., sprains, dislocations, contusions
• Skin-related conditions e.g., minor burns, allergic reactions

“When deciding where to go, always consider your medical history. If you’re experiencing recurring symptoms that have required higher levels of care in the past, you may want to visit an ER. You should also think about any recent treatments you may have received for complex medical issues and whether those issues are worsening.”

Q. How do your services differ from those of a walk-in clinic?

Mangum: “The care offered at CMC Urgent Care is connected to the entire Catholic Medical Center system. If you are already a CMC patient, your visit becomes part of your record. We’ll be able to see your medical history and report back to your primary care or specialty provider. If you are not already a CMC patient, that’s fine too! You will find care backed by CMC’s entire network of services and can expect easy referrals for follow up treatment, if necessary. The same holds true for our CMC—ClearChoiceMD Urgent Care sites. Patients who go to those locations can trust that a network of specialists are here and ready for follow-up care, if necessary.”

Larochelle: “Concord Hospital Walk-In Urgent Care at CH Medical Offices at Horseshoe Pond in Concord treats minor illnesses including sprains, minor fractures, lacerations, sore throat, cough and many other minor emergencies. We utilize imaging services that include X-ray, ultrasound and CT imaging. In Concord Hospital’s Emergency Department we are able to treat more complicated problems that include heart attack, stroke, sepsis and serious trauma.”

Q. We are seeing more freestanding emergency rooms open in the Seacoast region. What is the difference between a freestanding emergency room and a hospital ER?

Kolm: “Freestanding ERs are designed to offer a higher level of treatment than urgent care facilities, though they don’t offer the same breadth of services as hospitals. Because of this, freestanding ERs have been shown to be a potentially irrelevant middle-ground option, depending on where the facility is located in relation to a hospital ER.

“Freestanding ERs are also limited in their ability to provide broad diagnostic capabilities and acute interventions in the most timely manner. This can result in delays of diagnosis or treatment and can even add additional costs that could have been avoided altogether by going directly to a hospital ER.”

Q. What services or treatment can someone get at an emergency room that can’t be administered at a walk-in/urgent care facility?

Mangum: “There are many things an emergency department can do that an urgent care cannot. Broadly, a patient should go immediately to the ED if they have an acute, life-threatening conditions (heart attack, stroke, significant injury, etc.) or need emergency imaging (CT scan, MRI, ultrasound), specialist consultation, or treatment for a complicated infection or injury.

“Urgent care/walk-in facilities should be used for minor illnesses and injuries which can typically be evaluated and treated in less than an hour (colds, flu, UTI’s, minor cuts, sprains, fractures, rashes).  Many of these facilities have on-site imaging and laboratory capabilities to handle these basic conditions.

“Symptoms of a life-threatening condition or injury such as heart attack, stroke, severe allergic reaction, trouble breathing, etc., should be evaluated in an emergency department. An urgent care is not equipped to fully deal with these things.”

Brewster: “The emergency room should really only be used for life-threatening medical emergencies or a worsening illness/condition that needs to be addressed immediately. Other, less severe issues can typically be taken care of at a local walk-in or urgent care center, however it’s a good idea to know about your local non-ER options ahead of time and what conditions they treat by checking their website or by calling them directly.”

Hampers: “Urgent care is the treatment of episodic non-life-threatening illness and injury in patients of all ages. Almost all of us will have some type of unexpected minor illness or injury over the course of a year, whether it’s cutting your finger while slicing cucumbers, twisting your ankle while playing basketball or waking up with a bad sore throat. These are just three examples of the many conditions that urgent care centers can safely treat. Well-equipped urgent care centers can also conduct laboratory testing, administer intravenous fluids, take X-rays and perform several minor surgical procedures. Emergency departments treat life-threatening illnesses or limb-threatening injuries. A few examples of these conditions would be having a stroke, heart attack or a major automobile accident with multiple injuries and life-threatening bleeding.”

Kolm: “There are various circumstances in which you should bypass urgent care and go straight to the ER. For example, if you suddenly experience chest pain or shortness of breath, or if you’re pregnant and start to experience abdominal pain, vaginal bleeding or other new medical concerns. Major traumas and severe burns are also reasons to go straight to the ER.

“Urgent care facilities are intended for less serious concerns, such as upper respiratory infections or flu symptoms; pediatric illnesses such as ear infections, sore throats or rashes; minor injuries; or skin-related conditions. If you’re experiencing anything more serious, you should go to the ER.”

Q. Will you get the same level of care at any urgent care facility, or are there differences?

Kolm: “Not all urgent care facilities are the same. The scope of services offered is often based around their business model, the competency level of their staffing providers, and how the site is licensed to operate. That’s why it’s important to get to know your local urgent care facility and visit providers you trust.”

Q. Aside from treating unexpected minor illnesses and injuries, are there other services that urgent care centers provide?

Hampers: “Yes, there are many. Urgent care centers will often provide what are called employer health services. These services include performing routine drug screens for the employees, conducting pre-employment physicals and also evaluating a worker who may be injured on the job. Most urgent care centers also offer school, camp and sports physicals. ClearChoiceMD is proud to be one of only a few urgent care centers in the entire country that is now offering treatment for opioid addiction.”

Guarnaccia: “Elliot Urgent Care centers are staffed with board-certified emergency medicine physicians and advance care providers with emergency department experience. We offer point of care testing for flu, strep, UTI, and we have on-site X-ray and ultrasound (daytime hours only) and CT scanning. There are times when we send patients to the Elliot emergency department for CT scanning because the work-up is more extensive and needs more intensive resources such as surgery and admission. In our urgent care centers, we do perform many procedures such as foreign body removal, incision and drainage of abscesses, laceration repairs and splinting. Elliot Urgent Care is also connected to an extensive subspecialty network of Elliot physicians, so patients treated at our Urgent Care centers, who need subspecialty follow-up can get it within our network and we make that transition or hand-off care as seamless as possible.”

Lane: “The urgent cares that we align ourselves with also provide X-ray and lab services on-site. They also do a great job assisting with care coordination should their patients need services outside of the urgent care, like physical therapy, advanced diagnostics or a referral to a specialist.”

Q. How do patients benefit from having both urgent care and emergency room services in close proximity?

Larochelle: “Our Walk-In Urgent Care Center allows us to treat minor illnesses in a more timely fashion and in a more cost effective manner for our patients. We understand that time is valuable to our patients and commit to treating our patients with minor illnesses at our Walk-In Urgent Care Center in one hour or less. At Walk-In Urgent Care, there is an emergency medicine residency trained physician and emergency medicine physician assistant at all times who also work in the Emergency Department at Concord Hospital. If the patient requires additional emergency testing or treatment, we are able to easily transition their care to Concord Hospital’s Emergency Department due to our electronic health record system. The electronic health record system also helps us to communicate effectively with our outpatient primary care colleagues.”

Q. Is going to an urgent care center better than going to see my primary care provider?

Hampers: “It’s better in the sense that it’s significantly more convenient for the patient to be seen in a timely manner for the evaluation of an unexpected minor illness or injury. Urgent care is very different than primary care. Primary care focuses on the treatment and prevention of chronic illnesses like diabetes, emphysema and high blood pressure, just to name a few.  When primary care offices receive morning phone calls from patients with unexpected illnesses and injuries requesting to be seen that same day, it diminishes the amount of time the primary care provider (PCP) can dedicate to their schedule patients who may have chronic illnesses. As a result, if they add on too many patients with minor illnesses and injuries, the PCP may not be able to spend as much time counseling a patient about, for example, managing their blood sugars or helping them quit smoking. These are interventions which we know lead to a better and longer life for the patients. Urgent care and primary care can coexist harmoniously when information is shared in nearly real time. For example, if the urgent care center sees a patient with a sore throat, the results will be sent to the primary care provider so that that provider is in the loop regarding the diagnosis and treatment in the urgent care center.”

Q. Is there a price difference between visiting urgent care over (or instead of) an emergency room?

Mangum: “Yes there is a difference, but cost should only be a consideration if someone is deciding to use an ED vs. an urgent care for a minor illness or injury. In this case, an urgent care would be more appropriate and cost effective. Urgent cares are equipped to treat a minor illness or injury at a lower cost than an ED, which has to be prepared to treat the most severe, life-threatening situations. Cost should not prohibit a patient with a serious medical condition or symptom from seeking medical attention in an emergency department.”

Q. How does Member Medical change the approach to ER and urgent care facilities?

Lane: “Member Medical’s mission is to make health care more accessible and more affordable for everyone – regardless of their insurance situation. We provide our members with access to a network of Urgent Cares throughout Northern New England for just a $10 visit fee at the time of service. Should they need any additional services during their visit, they are provided with a transparent list of prices of those services so they know the cost up front. There is no balanced billing and no unexpected costs.”

Q. What documentation/paperwork/information should someone have with them (if possible) when they go to an emergency room or urgent care facility?

Brewster: “You should always have a copy of your insurance card, whether it’s the physical card or an electronic version, a list of any significant medical conditions like allergies, heart conditions, etc., as well as any recent or current medications. Medications could have caused or added to a condition you are seeking medical attention for, so it is important that medical staff are as informed as possible. It’s always a good idea to have them written down and kept in your wallet or purse as staff may look for it if you are unable to speak for yourself and accessing a list on your cell phone could be difficult if it is password protected. You can also let family members know you have one and where it is in case they are asked.”

Guarnaccia: “It is always good to have a list of your medications, allergies and medical history/problems. If you are an Elliot Health System patient, we have a single electronic medical record that allows us to review your medical history, medications, allergies, labs, radiology tests, Elliot doctor visits and admissions to Elliot Hospital. This gives us verified and helpful information about your full medical history and allows us to engage other doctors you may be seeing, if necessary.”

Lane: “They should always have a valid photo ID (preferably a driver’s license) and their insurance care (if applicable).”

Q. Is insurance handled different in an emergency room than it is at a walk-in/urgent care facility?

Mangum: “Every insurance plan is different, and urgent care centers may have different pricing structures. Typically, however, urgent care centers bill just like a patient’s primary care physician’s office would bill. Cost to the patient varies depending on their insurance, especially as it relates to co-pays. Some insurances view urgent care visits as a specialty co-pay, while others view the co-pay as being similar to a PCP office visit. Emergency department costs will have their own pricing structure, higher co-pays, and will often include separate physician fees on top of a facility charge.”

Brewster: “The specific details will depend on the health plan they have, but typically there are different copays and co-insurance that the patient would be responsible for depending on the type of facility they go to. The more complex the condition, the more expensive the care and, possibly, a higher cost for the patient.”

Q. What is the No. 1 thing someone going to an emergency room or urgent care facility needs to know?

Brewster: “Know your history and medications and have them written down. You should also include a list of people with their contact information who could help answer questions and your PCP’s name with phone number. The more information you can provide to the medical staff, the more informed treatment decisions they can make, no matter what type of facility you end up going to for treatment.

“I would also suggest having a durable medical power of attorney filled out and established before you are sick, as it allows someone you trust to know what you would want done if you are unable to speak for yourself.”

Guarnaccia: “You can help by choosing where to go wisely. Emergency departments are over-utilized for illnesses and injuries that can be treated in the urgent care setting. The wait times are much shorter in urgent care and in our facilities at River’s Edge and Bedford, if you need a prescription, the Elliot Pharmacy is on-campus so you can leave with prescriptions in hand. Our Londonderry Urgent Care does not have this feature. The Elliot Urgent Care website offers a list of medical problems we treat to help patients choose more effectively when deciding between urgent care or emergency department care.”

Lane: “Knowing your medical history is always helpful, but it’s also important to understand why you should seek care at an urgent care versus an emergency room. Emergency rooms should be used for life-threatening emergencies. Non-life threatening things, minor orthopedic injuries, X-rays, minor cuts and scrapes, ear infections — those things should all be directed to urgent care centers. You’ll save yourself a lot of time and money when you choose the appropriate setting for your care.”

Q. What do you see as the future of the emergency room/urgent care industry going forward?

Larochelle: “In the future, we expect to see a continued need for both urgent care and emergency services. There will certainly be an increased demand for both types of services. We will continue to create a patient-centered care model where we are able to direct our patients to high quality, cost effective and evidence-based care at the right time and place. The integration of both urgent and emergency care is essential to meet these demands.”

Lane: “Telemedicine is the future. Our partners at ExpressMED/BOAC in Manchester and Salem just launched Telemedicine for urgent care and it’s being operated by the medical providers that serve the clinics in Manchester and Salem. That means that any time someone accesses their telemedicine platform, they are interacting with local, licensed providers and have direct access to the clinic should they need follow-up care.”

Q. What makes ClearChoiceMD unique compared to other urgent care centers?

Hampers: “Our most prominent distinction is that we are a physician-led and owned organization. We have the deepest understanding of what quality care is. Also, being physician-led, we have credibility with the local medical practices and hospitals. Because of our credibility, we have developed partnerships with several of our local hospitals. We are proud to be the only New Hampshire urgent care company to have formed a 50-50 joint venture with a healthcare system, Catholic Medical Center (CMC) to co-own two urgent care centers. CMC and many of our other hospital affiliates have realized that their communities are demanding additional access points for high-quality, convenient and affordable care. ClearChoiceMD was founded by forward-thinking community-minded local physicians. We are committed to optimizing healthcare access to all our communities while preserving the viability of the local healthcare systems through meaningful partnerships.”