When the St. Andrews Hospital emergency room was converted to an urgent care center, Lincoln County Healthcare said patients would see reduced costs. Although urgent care costs are lower than emergency department costs, some patients have been upset that costs are still relatively high.

Table 1 shows facility and physician costs for Miles emergency department, and for first-time patients at St. Andrews Urgent Care, Lincoln Medical Partners’ primary care physician offices and Mid Coast Hospital’s Walk-in Clinic in Brunswick. 

Basic visit costs vary from $212 to $1,465 at Miles emergency department, from $135 to $889 at the St. Andrews Urgent Care, from $66 to $318 at Lincoln County physician’s offices, and from $72 to $175 at Mid Coast’s Walk-In Clinic. These costs do not include treatment, tests or medication costs.

Urgent care, walk-in clinics and physicians’ offices bill new and established patients differently.

“Medicare and others recognize a difference between a patient that has been seen by the provider in the past and one that has never been seen before,“ LCH Chief Financial Officer Wayne Printy explained in an email. “This difference is recognized in urgent care and physician office visits, not in emergency rooms. It assumes that a first time patient will take longer to treat than one already known by the provider.”

Although not provided here, Printy said costs for established patients would be lower at the urgent care and a physician’s offices than shown in Table 1. Mid Coast Walk-in Clinic’s established patient base costs range from $39 to $121.

Lincoln County Healthcare’s fees are broken down into five different levels of care, whereas Mid Coast provided only a high and low end. Levels between facilities are not directly comparable, since the level is facility-specific, Printy said.

“These five levels are relative to the amounts of resources ‘consumed’ in the provision of care, essentially the severity of the patient encounter,” Printy wrote. “There are two components of a bill for the emergency room and for urgent care. There is the professional fee that is for the doctor's services and the facility fee, which is for everything else.”

Emergency departments are able to offer a level of care not provided in urgent cares, walk-in clinics or physician offices. Both St. Andrews Urgent Care and Mid Coast Walk-in provide care for non-emergent conditions; their list of non-emergent conditions suitable for each facility is similar.

However, Mid Coast is staffed by physician assistants, nurses and medical assistants, whereas St. Andrews Urgent Care is staffed by emergency physicians, supported by emergency trained nurses and technicians. Brittany Sciricka, Mid Coast Walk-In Clinic, said the walk-in clinic’s staff also work shifts at Mid Coast Hospital emergency room.

LCH CEO Jim Donovan said the choice of the urgent care model for St. Andrews, although more expensive, was intentional. “We specifically decided to go the urgent care center route as our physicians felt it was a higher level of care the community needed,” Donovan said. “This mostly encompassed staffing by emergency trained physicians and nurses along with the 7 day/week service. There was much discussion at the time about a walk-in or ‘quick care’ facility staffed much like a primary care physician's office but we ultimately went the direction we chose.”

LCH Chief Medical Officer Dr. Mark Fourre said the choice was intended to foster community trust in the facility and to provide a high level of care during the transition period.

“We felt it important that the community have a high sense of trust for the care delivered at the urgent care center from the beginning,” Fourre said. “Our urgent care center is currently staffed with the same personnel and equipment as the prior St. Andrews ED so that we will be able to handle a patient who may present to the urgent care center with a true emergency.”

Both Donovan and Fourre said the staffing model at the urgent care will be reevaluated over time.