Freestanding urgent care and emergency care clinics are on the rise throughout the nation, and Frisco is no exception.

According to national health care organizations, the number of freestanding emergency rooms have doubled in the past decade to nearly 300, and urgent care centers number close to 1,000 throughout the U.S.

Frisco has about a dozen urgent care and emergency care clinics, including two emergency clinics that have opened in the past two months.

"Health care is transforming into a more retail-like environment where patients really want to be treated on their time schedule," said Dr. Kirk Mahon, one of the owners of Legacy ER & Urgent Care, a local clinic which offers urgent and emergency services. "As health care has changed, I think it's harder for many patients to get an appointment with their primary care physician when they are actually sick. Many times when you get sick [a primary care physician office] will say, 'We'll see you in three days,' and that doesn't really work if you're sick today. I think that's really been the push for the urgent

care side."

Dr. Carrie de Moor, CEO of Premier One Emergency Centers, which recently opened one clinic in Frisco and is planning a second clinic that will also incorporate urgent care services, said the popularity of freestanding ERs in Frisco is because of simple supply and demand. With Frisco expected to more than double in population by the time it is built out, facilities are getting established now as the demand grows.

While freestanding ER facilities are required by law to treat any person, regardless of their ability to pay, they are not allowed to accept Medicare and Medicaid, said de Moor, who is also the chairwoman-elect for the Collin-Fannin County Medical Society and a board member for state and national emergency physician organizations.

As a result, freestanding ERs often do well in affluent areas that generally have a highly insured population—a low-risk area such as Frisco, she said.

"Most people are insured, so the chance of getting reimbursed is high," de Moor said.

Tony Felker, Frisco Chamber of Commerce president, said based on the number of freestanding facilities in the Frisco area, it is clear there is some level of demand for the services.

"I believe the convenience of [urgent and emergency care centers] is a big factor in their popularity—the visibility is much better than a major hospital across town, and the single purpose for these locations is also likely a factor," Felker said. "However, I think there might also be confusion in the market in terms of what sort of services are offered—is it a true emergency center or not, et cetera, that will need to be communicated."

Dr. David Weitzman, who serves as chairman on the Council for the American Academy of Urgent Care Medicine, said urgent care clinics are capable of taking some of the burden off potentially crowded emergency rooms and busy primary

care physicians.

"In the U.S. [urgent care] is seen as a stopgap measure because primary care physicians are too overburdened to see patients who get sick," Weitzman said.

Different services

Urgent care clinics are generally used for providing care in certain situations and are not intended for the treatment of chronic illness or serious conditions such as a heart attack or stroke, said Joanna Ray, CEO of the Urgent Care Association of America.

"Urgent care is really intended more for episodic concerns, such as cold symptoms, sunburn, sprains and fractures," Ray said.

Urgent care clinics often have extended hours past normal doctor's office operating hours, although they are generally not open 24 hours a day, Weitzman said.

Walk-in appointments are available, and the wait time is usually short at urgent

care clinics.

Urgent care clinics are not required by law to be staffed by a doctor, and a physician's assistant or nurse practitioner may see patients instead, Weitzman said.

Freestanding emergency clinics by Texas law are required to be open 24 hours a day, be staffed by a physician and have on-site laboratory equipment and radiology services as well as X-ray, CT and ultrasound capabilities.

Mahon said a freestanding ER should be able to handle any initial emergency a hospital emergency room can, although patients with massive trauma such as a gunshot or knife to the chest would probably be better off at a hospital ER.

"Urgent care is family practice care that is unscheduled," Mahon said. "An emergency room or emergency center has the kind of doctors and training that are capable of handling life-threatening emergencies just like the hospital ER. The similarities [between urgent and emergency care] are that they are both unscheduled. The difference is the equipment and the training."

Different costs

Dr. Howard Mell, spokesman for the American College of Emergency Physicians, said sometimes people are not sure whether to go to an urgent or emergency care center, or do not differentiate between the services the two offer.

While a patient will receive treatment at an emergency care facility even if it is not an emergency, they will be charged an emergency care facility rate, which is significantly higher than urgent care or primary care rates, he said.

Mahon said freestanding emergency clinics generally charge similar rates to what a hospital emergency room

would charge.

In a true emergency, freestanding emergency rooms are required by law to treat any patient, regardless of ability to pay.

"What that means is that in an emergency in Texas, a patient shouldn't have to pull out their phonebook or go on the Web to figure out which hospital or which freestanding ER is in their [insurance] network or is not," Mahon said. "So if they present an emergency—abdominal pain or something they think is an emergency—their insurance should pay for the same type of copays, benefits, et cetera, as if they are

in network."

Urgent care facilities generally require payment at the time of service, although most accept insurance.

Unlike hospitals and freestanding emergency centers, urgent care facilities are not mandated by the state to treat patients regardless of their ability to pay.

Mahon said urgent care clinics charge similar to what a primary care physician would charge.

"However, urgent care patients tend to require slightly more services, so the bill may be slightly higher if they received more treatment," Mahon said. "For example, an urgent care patient might be sick enough to need some labs or a shot of antibiotics whereas a primary care patient might just be there for a wellness visit, a checkup."

Fragmentation of care

Urgent care is not intended to be a replacement for a primary care physician, Weitzman said.

Urgent care clinics should encourage the patient to set a follow-up appointment with his or her primary care physician within a few days of visiting an urgent care clinic,

he said.

The Texas Medical Association also stresses that having urgent care and emergency care options does not replace the need for a primary care physician.

"It all goes back to a society of convenience," said Dr. Gary Floyd, a board member for the TMA. "We have to plan for work; we don't want to have to plan for doctor's appointments. It's a shame really, because [a primary care physician] is where you get the most comprehensive care. It comes down to personal responsibility. We often know more about what we are putting in our cars than ourselves."

Not having a primary care physician in place can also lead to a lack in continuity of medical care, Floyd said.

With the use of urgent care and emergency clinics, medical care can become fragmented because of a lack of communication among different medical facilities, Floyd said.

That lack of communication could lead to duplication of tests or medication, or cause a misdiagnosis due to the new doctor not understanding previous medical conditions.