Rethinking urgent care after vehicle wrecks (and one simple way to stay safe on a bicycle)

ERsign-173x300With U.S. road deaths spiking  20-year highs, everyone who travels in any fashion on the country’s roads must be as savvy as possible about staying safe, including by thinking twice about where to go to receive medical checks and treatment after any seemingly minor vehicle wrecks and by  forgoing bike riding while high on drugs or booze.

In recent times, patients have found urgent care centers to be a handy alternative as compared with big hospital emergency rooms for getting fast, less costly care for less complicated but still relatively serious illnesses and injuries (including for sports mishaps, cuts, and broken bones). Why not turn to such facilities after a vehicle crash, if not otherwise taken to a jammed, expensive hospital ER for major treatment? As NPR reported, such patients with lower medical demands still have been surprised that urgent care centers have turned them around and sent them to nearby ERs.

This happened to a young Georgia driver named Frankie Cook, who with her dad also then was shocked at the $17,000 cost of the ER care for scans and exam to determine if she suffered a concussion in a wreck that seemed to have left her with no visible injuries and a headache. As NPR explained:

“Frankie, then a high school junior, worried that she might have a concussion that could affect her performance on an upcoming Advanced Placement exam, so she and her father decided to stop by an urgent care center near their house to get her checked out. They didn’t make it past the front desk. ‘We don’t take third-party insurance,’ [her dad] Russell says the receptionist at Atrium Health Floyd Urgent Care Rome [Ga.] told him, though he wasn’t sure what she meant. ‘She told me, like, three times.’ The problem didn’t seem to be that the clinic lacked the medical expertise to evaluate Frankie, and the family does have good health insurance. But, when injuries are the result of accidents, another insurer, such as auto or home, may be primarily responsible for the medical bills. Health insurance, if it’s on the hook at all, may kick in after the other insurer pays. The Cooks seemed to be confronting a reimbursement policy that is often used by urgent care centers to avoid waiting for payments from car insurance settlements. Russell was told to take Frankie to an emergency room, which by law must see all patients regardless of such issues. The nearest one, at Atrium Health Floyd Medical Center, was about a mile down the road and was owned by the same hospital system as the urgent care center.”

The news article further explained:

“Lou Ellen Horwitz, CEO of the Urgent Care Association, says it’s a pretty standard policy for urgent care centers not to treat injuries that result from car crashes, even minor ones. ‘Generally, as a rule, they do not take care of car accident victims regardless of the extent of their injuries, because it is going to go through that auto insurance claims process before the provider gets paid,’ she says. Horwitz says urgent care centers — even ones owned by big health systems — often operate on thin margins and can’t wait months and months for an auto insurance company to pay out a claim. She says ‘unfortunately’ people tend to learn about such policies when they show up expecting care.’

NPR quoted experts as saying that free-standing urgent care centers often are located near ERs because many are owned by the same hospital. This lessens potential risks to vehicle wreck patients who may be swiftly referred to the bigger, more costly facility. ERs, just to remind, provide some of the costliest of all hospital medical services because they must treat patients and must keep talented staff and expensive resources at the ready 24/7 for a huge array of conditions. That’s not true with urgent care centers, NPR noted, quoting Dr. Ateev Mehrotra, a professor of health care policy at Harvard Medical School:

“Mehrotra … says urgent care centers are not bound by the Emergency Medical Treatment and Labor Act, a federal law known as EMTALA that requires hospitals to stabilize patients regardless of their ability to pay.”

NPR reported that crash patients may face further aggravation by visiting an urgent care center and then getting sent to an ER, because both facilities may bill them. This will take time to sort out, as Frankie Cook and her dad discovered. By the way, they did what savvy consumers should, scrutinizing their big ER bill and contesting it with the hospital and their insurance company. They ended up paying not $17,000 but $1,042 — more affordable but still much more than the $200 Frankie’s dad hoped to be billed for a quick exam at urgent care

Stoner cycling can be really risky

Here is one common sense way to avoid urgent care and ERs: Don’t ride that bike while stoned.

Alas, this is a too-frequent problem, according to a study newly published in a medical journal and reported on by the HealthDay news service, which wrote:

“Between 2019 and 2020 alone, more than 11,000 people were treated in U.S. emergency rooms for injuries that happened as they rode a bicycle while high on methamphetamine, marijuana or opioids, ‘The people affected by these injuries likely have substance use disorder, may be more likely to be homeless. and may not have access to other types of transportation,’ explained lead researcher Bart Hammig, a professor of public health at the University of Arkansas in Fayetteville. ‘This is an often overlooked and ignored population when addressing serious injuries related to bicycle crashes.’”

He and his colleagues said their work emphasizes the importance of ERs also having social service referral capacities, so injured bikers can get appropriate help, too, for drug abuse problems. The experts said their study also points out that this country needs more and better transportation options to get poor, intoxicated people off bikes and roads where their injuries can be serious:

“Hammig and his University of Arkansas colleague Robert Davis, an assistant professor of public health, found that bicyclists who crashed while high often had more serious injuries than those who weren’t using drugs. Most of those injured were men (86%), according to the study. Of those, 22% had broken bones; 19% injured internal organs; and almost 33% had to be hospitalized … Some [wrecks] likely resulted in deaths, but because the data came from emergency room records, researchers couldn’t report on fatalities. The most common drugs found were methamphetamine (36%); marijuana (32%); and opioids (19%). Nearly a quarter of injured bikers had also been drinking alcohol, the study found.”

Not good. In my practice, I and my colleagues see not only the harms that patients suffer while seeking medical services, but also the damage inflicted on pedestrians, bicyclists, and drivers by motorcycle, vehicle, and truck wrecks. The country had made significant progress in reducing road harms but the positive trends reversed in recent years and went off the rails during the pandemic.

We have an individual responsibility to right this wrong. We can ensure we do our own part to ensure we don’t drive while distracted — especially while texting or using electronic devices — drunk, drugged (with recreational or prescription drugs), or otherwise impaired, especially by sleepiness. We can return to the fundamental idea of reciprocal altruism by restoring basic courtesy, consideration, and concern for others. This means we take to heart the idea that we won’t, and neither will others, engage in reckless, aggressive conduct behind the wheel — flouting common sense laws, speeding, and ignoring stop and other signs.

Please pay attention when you’re behind the wheel, and slow down. Buckle up. If you have the misfortune of getting involved in a bad vehicle crash, you and your loved ones may wish not only to call in your insurer early but also experienced and expert lawyers to deal with the extensive legal issues that may ensue. Your auto agent represents the insurer, remember, and these individuals, kindly and conscientious as they may seem, may not be trained to deal with complex legal and medical issues.

We have lots of work to do to keep ourselves and our roads as safe as possible.

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