Its Called an Urgent Care Emergency Center But Which Is It?

Published

4 days ago

June 24, 2024

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One evening last December, Tieqiao Zhang felt severe stomach pain.

This story also ran on NPR. It can be republished for free.

After it subsided later that night, he thought it might be food poisoning. When the pain returned the next morning, Zhang realized the source of his pain might not be as simple as bad food.

He didnt want to wait for an appointment with his regular doctor, but he also wasnt sure if the pain warranted emergency care, he said.

Zhang, 50, opted to visit Parkland Healths Urgent Care Emergency Center, a clinic near his home in Dallas where hed been treated in the past. Its on the campus of Parkland, the citys largest public hospital, which has a separate emergency room.

He believed the clinic was an urgent care center, he said.

A CT scan revealed that Zhang had a kidney stone. A physician told him it would pass naturally within a few days, and Zhang was sent home with a prescription for painkillers, he said.

Five days later, Zhangs stomach pain worsened. Worried and unable to get an immediate appointment with a urologist, Zhang once again visited the Urgent Care Emergency Center and again was advised to wait and see, he said.

Two weeks later, Zhang passed the kidney stone.

Then the bills came.

The Patient: Tieqiao Zhang, 50, who is insured by BlueCross and BlueShield of Texas through his employer.

Medical Services: Two diagnostic visits, including lab tests and CT scans.

Service Provider: Parkland Health & Hospital System. The hospital is part of the Dallas County Hospital District.

Total Bills: The in-network hospital charged $19,543 for the two visits. BlueCross and BlueShield of Texas paid $13,070.96. Zhang owed $1,000 to Parkland a $500 emergency room copay for each of his two visits.

What Gives: Parklands Urgent Care Emergency Center is whats called a freestanding emergency department.

The number of freestanding emergency rooms in the United States grew tenfold from 2001 to 2016, drawing attention for sending patients eye-popping bills. Most states allow them to operate, either by regulation or lack thereof. Some states, including Texas, have taken steps to regulate the centers, such as requiring posted notices identifying the facility as a freestanding emergency department.

Urgent care centers are a more familiar option for many patients. Research shows that, on average, urgent care visits can be about 10 times cheaper than a low-acuity or less severe visit to an ER.

But the difference between an urgent care clinic and a freestanding emergency room can be tough to discern. Email Sign-Up

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Generally, to bill as an emergency department, facilities must meet specific requirements, such as maintaining certain staff, not refusing patients, and remaining open around the clock.

The freestanding emergency department at Parkland is 40 yards away from its main emergency room and operates under the same license, according to Michael Malaise, the spokesperson for Parkland Health. It is closed on nights and Sundays.

(Parklands president and chief executive officer, Frederick Cerise, is a member of KFFs board of trustees. KFF Health News is an editorially independent program of KFF.) The hospital is very transparent about the centers status as an emergency room, Malaise told KFF Health News in a statement.

Malaise provided photographs of posted notices stating, This facility is a freestanding emergency medical care facility, and warning that patients would be charged emergency room fees and could also be charged a facility fee. He said the notices were posted in the exam rooms, lobby, and halls at the time of Zhangs visits.

Zhangs health plan required a $500 emergency room copay for each of the two visits for his kidney stone.

When Zhang visited the center in 2021 for a different health issue, he was charged only $30, his plans copay for urgent care, he said. (A review of his insurance documents showed Parkland also used emergency department billing codes then. BCBS of Texas did not respond to questions about that visit.)

One reason I went to the urgent care instead of emergency room, although they are just next door, is the copayment, he said.

The list of services that Parklands freestanding emergency room offers resembles that of urgent care centers including, for some centers, diagnosing a kidney stone, said Ateev Mehrotra, a health care policy professor at Harvard Medical School.

Having choices leaves patients on their own to decipher not only the severity of their ailment, but also what type of facility they are visiting all while dealing with a health concern. Self-triage is a very difficult thing, Mehrotra said.

Zhang said he did not recall seeing posted notices identifying the center as a freestanding emergency department during his visits, nor did the front desk staff mention a $500 copay. Plus, he knew Parkland also had an emergency room, and that was not the building he visited, he said.

The name is misleading, Zhang said. Its like being tricked. In severe pain and uncertain of its cause, Tieqiao Zhang of Dallas says he didnt want to wait for an appointment with his regular doctor, but he also wasnt sure if he needed emergency care. He visited a clinic on the campus of Dallas largest public hospital and was charged 10 times what he expected.(Laura Buckman for KFF Health News)

Parkland opened the center in 2015 to reduce the number of patients in its main emergency room, which is the busiest in the country, Malaise said. He added that the Urgent Care Emergency Center, which is staffed with emergency room providers, is an extension of our main emergency room and is clearly marked in multiple places as such.

Malaise first told KFF Health News that the facility isnt a freestanding ER, noting that it is located in a hospital building on the campus. Days later, he said the center is held out to the public as a freestanding emergency medical care facility within the definition provided by Texas law.

The Urgent Care Emergency Center name is intended to prevent first responders and others facing life-threatening emergencies from visiting the center rather than the main emergency room, Malaise said.

If you have ideas for a better name, certainly you can send that along for us to consider, he said.

Putting the term urgent in the clinics name while charging emergency room prices is disingenuous, said Benjamin Ukert, an assistant professor of health economics and policy at Texas A&M University.

When Ukert reviewed Zhangs bills at the request of KFF Health News, he said his first reaction was, Wow, I am glad that he only got charged $500; it could have been way worse for instance, if the facility had been out-of-network.

The Resolution: Zhang said he paid $400 of the $1,000 he owes in total to avoid collections while he continues to dispute the amount.

Zhang said he first reached out to his insurer, thinking his bills were wrong, before he reached out to Parkland several times by phone and email. He said customer service representatives told him that, for billing purposes, Parkland doesnt differentiate its Urgent Care Emergency Clinic from its emergency department. More from Bill of the Month He Fell Ill on a Cruise. Before He Boarded the Rescue Boat, They Handed Him the Bill. May 22, 2024 Sign Here? Financial Agreements May Leave Doctors in the Drivers Seat Apr 30, 2024 A Moms $97,000 Question: How Was Her Babys Air-Ambulance Ride Not Medically Necessary? Mar 25, 2024 More from the series

BlueCross and BlueShield of Texas did not respond to KFF Health News when asked for comment.

Zhag said he also reached out to a county commissioners office in Dallas, which never responded, and to the Texas Department of Health, which said it doesnt have jurisdiction over billing matters. He said the staff for his state representative, Morgan Meyer, contacted the hospital on his behalf, but later told him the hospital would not change his bill.

As of mid-May, his balance stood at $600, or $300 for each visit.

The Takeaway: Lawmakers in Texas and around the country have tried to increase price transparency at freestanding emergency rooms, including by requiring them to hand out disclosures about billing practices.

But experts said the burden still falls disproportionately on patients to navigate the growing menu of options for care.

Its up to the patient to walk into the right building, said Mehrotra, the Harvard professor. It doesnt help that most providers are opaque about their billing practices, he said.

Mehrotra said that some freestanding emergency departments in Texas use confusing names like complete care, which mask the facilities capabilities and billing structure.

Ukert said states could do more to untangle the confusion patients face at such centers, like banning the use of the term urgent care to describe facilities that bill like emergency departments.

Bill of the Month is a crowdsourced investigation by KFF Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

Emily Siner reported the audio story.

Renuka Rayasam: rrayasam@kff.org, @renurayasam Related Topics Health Care Costs States Bill Of The Month Hospitals Investigation Texas Contact Us Submit a Story Tip

World

‘Unmitigated disaster’ for Biden in TV debate with Trump – as he faces calls from Democrats to step aside

Published

31 mins ago

June 28, 2024

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'Unmitigated disaster' for Biden in TV debate with Trump - as he faces calls from Democrats to step aside

Joe Biden and Donald Trump have faced off in the first debate in the 2024 presidential election campaign.

The format, with each taking turns to speak with their opponent’s microphone muted, was designed to prevent a shouting match with both candidates talking over each other.

In truth, it served to highlight the differences in the performances of the two men.

Mr Trump appeared confident, on the front foot and in command, even if his claims sometimes stretched the truth to breaking point.

Mr Biden on the other hand was hesitant, sometimes stumbling over his words and at one point appearing to freeze, less than 10 minutes into the debate.

The only time the US president appeared to land any blows was when he lost his temper and attacked Mr Trump and his “alley cat morals”.

After the debate, political figures and commentators broached the idea of replacing Mr Biden as the Democratic presidential nominee.

It’s “time to talk about an open convention and a new Democratic nominee,” one Democratic politician told Sky’s US partner network NBC News.

Another said: “This was like a champion boxer who gets in the ring past his prime and needs his corner to throw in the towel.” They added he meant Mr Biden should exit the race.

David Axelrod, a senior aide to former President Barack Obama, told CNN: “There is a sense of shock at how he came out at the beginning of this debate. How his voice sounded. He seemed a little disoriented.

“There are going to be discussions about whether he should continue. Only he can decide if he’s going to continue,” Mr Axelrod added.

Sky’s US correspondent Martha Kelner said some Democrats had described Biden’s debate performance as an “unmitigated disaster”, “a meltdown”, and “a slow-motion car crash”.

Changing candidates at this stage of the campaign would be difficult and unprecedented. Unless Mr Biden chooses to step aside, delegates at the Democratic National Convention would have to revolt – despite being elected on their pledge to nominate the president.

The debate mediators divided the time in to subjects, beginning with the economy.

Mr Trump claimed under his presidency the US had the “greatest economy in the history of our country”, only stalling when COVID struck.

Mr Biden hit back saying he inherited “an economy that was in freefall”.

“The pandemic was so badly handled… the economy collapsed,” he said.

“What we had to do is try to put things back together again. That’s exactly what we began to do.”

Early debate was a gamble Joe Biden may regret

This was an extraordinary evening.

Joe Biden’s debate performance was among the worst by any presidential candidate in history, if not the worst.

It was an “unmitigated disaster”, “a meltdown”, and “a slow-motion car crash”.

Those are not descriptors from Republican voters, they are the words of Democrats. Even former aides of President Biden admit it was a really horrible night for him.

I was literally gripping the sides of my seat at times it was so excruciating. Team Biden hoped to see State of the Union Joe on the stage, when the President gave a slick, impassioned and well-delivered speech.

Right from the start it became apparent this would be an entirely different version of him. His voice was hoarse, he was stumbling and there were long pregnant pauses.

I was struck by how much older he looked than the last time he was in the same room as Donald Trump four years ago.

“We finally beat Medicare,” he said with a misspeak that is sure to go viral, a sentence that does not make sense and was pounced upon by Donald Trump.

Biden was asked by the debate moderator about abortion, one of the strongest issues for the Democratic Party, a subject where he has the opportunity to really nail Donald Trump to the wall.

He somehow managed to ramble his way off-topic to talk about immigration, one of his biggest vulnerabilities. It was an open goal missed in spectacular style.

The debate descended near the end into a row between two senior citizens about who had a lower golf handicap and who could drive the ball further.

It summed up the quality, or lack thereof, of this debate. It might have been funny if it weren’t so depressing for American voters.

It is hard to believe that President Biden fought for this debate at this time, the earliest there has ever been.

His team calculated that, given he was trailing Trump in the polls and there were growing questions about his age and vitality, it was a risk worth taking.

But it was a huge gamble, given that this format is so exposing on the national stage. It could well be a gamble they come to regret.

Watch a special programme with reaction to the US presidential debate on The World with Yalda Hakim on Sky News from 6pm

For much of the debate, Mr Trump was forthright while President Biden, his voice hoarse, came across as hesitant.

On the issue of abortion, Mr Biden appeared to have slightly more success, describing the decision to overturn Roe v Wade as horrendous.

“It’s been a terrible thing what you’ve done,” he told Trump.

For his part the former president said it was right for individual states to decide policy on abortion.

Next came immigration, previously something of a “trump” card for the former president.

Mr Biden was asked about his record.

“The Border Patrol endorsed me, endorsed my position,” he said, before turning on Mr Trump.

“He was separating babies from mothers, putting them in cages, making sure that the families are separated [when he was in office],” he said.

Mr Trump responded: “We have the largest number of terrorists coming into our country right now.”

“That’s simply not true,” Mr Biden said.

“There’s no data to support what he said, once again, he’s exaggerating. He’s lying.”

Asked what he will do to address the crisis, Mr Trump said “we have to get them out” but didn’t specify any particular policy.

On Ukraine, Mr Trump was the first to answer, taking aim at Mr Biden’s handling of it.

“As far as Russia and Ukraine, if we have a real president, a president that was respected by Putin, then he would have never invaded Ukraine.”

Asked what he thought of Mr Trump’s comments, Mr Biden replied: “I’ve never heard so much malarkey in my whole life.”

He warned that if Mr Putin wins the war there is a risk he will go after other countries like Poland and Belarus. However, the strength of his argument was undermined by appearing to confuse Mr Trump and President Putin at one point.

The Middle East was next, with Mr Biden saying the US had “saved Israel”, referencing the ongoing support from his government and the organised defence against a massive Iranian air attack.

Trump however slammed his opponent’s handling of the crisis in the Middle East.

“He’s become like a Palestinian, but they don’t like him because he’s a very bad Palestinian. He’s a weak one,” he said.

Next came topics where Mr Biden genuinely had the chance to land some heavy blows: the Capitol riots and the litany of criminal cases facing Trump.

The odd punch did hit home but – as throughout the debate – Mr Trump appeared in charge, confident in his own version of the truth. He repeatedly said he did nothing wrong, claiming any action he encouraged was to be carried out “peacefully and patriotically”.

Mr Biden retorted: “He encouraged his folks up on Capitol Hill.

“Now he says if he loses again, [he’s] such a whiner, it is basically [going to be] a bloodbath.”

The only time Mr Trump appeared even slightly uncomfortable was when Mr Biden pointed out his recent criminal charges and called him a convicted felon.

“The only person on this stage that is a convicted felon is this man I’m looking at right now,” he said of the former president.

In one of his most forceful moments of the debate, Mr Biden referred to Mr Trump’s alleged sexual relationship with porn star Stormy Daniels, telling him: “You have the morals of an alley cat.”

The debate continued, covering racial inequality, climate change and the US opioid crisis, but in truth the optics varied little.

Mr Trump – a chin-jutting picture of arrogance and self belief. Mr Biden – often seeming to feel his age, only coming into his own when he lost his temper over what he clearly regarded as his opponent’s lies.

The debate revealed little of substance with regard to policy, with podcaster and analyst Tim Miller tweeting that it was “the worst debate in history”.

The level of the debate was put into sharp relief with the two candidates defending their mental capabilities and squabbling about golf.

Taking a shot at Mr Biden, Mr Trump said the US president “can’t hit a ball 50 yards”.

Mr Biden replied, saying: “I’d be happy to have a driving contest with him.”

The hour and a half of to-and-fro is unlikely to have done Mr Trump any harm, but it may well have damaged President Biden.

As one observer pointed out, the problem for Joe Biden and the Democratic Party is “that Trump lies so well and Biden tells the truth so badly”.

World

Donald Trump and Joe Biden: The key moments in the first US presidential election debate

Published

31 mins ago

June 28, 2024

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Donald Trump and Joe Biden: The key moments in the first US presidential election debate

Joe Biden and Donald Trump have held the first presidential debate, where the president struggled to speak and the Republican was dogged by his criminal trials.

Held in Atlanta, Georgia, the CNN-hosted debate marked a rematch four years in the making.

With one candidate’s microphone turned off while the other was speaking, Mr Trump and Mr Biden slugged at each other’s record in office for 90 minutes.

Read the Trump v Biden debate as it happened live here

The mediators divided the debate in to subjects, but both candidates evaded questions and stuck to their favoured topics.

Here’s the key topics Mr Biden and Mr Trump clashed on….

Economy

With a hoarse voice – which his aides later briefed was because of a cold – Mr Biden started the debate by blaming Mr Trump for the state he left the economy in when he left office.

Mr Trump, however, praised his own record, saying: “We have the greatest economy in the history of our country, and we have never done so well.”

He claimed he ran a higher deficit to stop another Great Depression during the COVID pandemic, before accusing Mr Biden of doing a “poor job,” saying inflation is “killing” the country, and adding: “It’s probably the worst administration in history.”

Moderators noted Mr Trump’s administration approved $8.4tn in new debt, while so far Mr Biden has approved $4.3 trillion in new debt.

When asked about tax cuts he passed that are set to expire in 2025, Mr Trump said they “spurred the greatest economy we’ve ever seen just prior to COVID,” and added: “The country was going like never before, and we were ready to start paying down debt”.

Mr Biden then attacked Mr Trump over having the largest national debt of any president and insisted he would fix the tax system. But while saying his administration was “making sure that we’re able to make every single solitary person eligible for what I was able to do with the COVID,” Mr Biden stumbled.

He continued to say “excuse me – with dealing with everything we have to do with – look – if we finally beat Medicare,” before pausing until the end of his allotted time.

Mr Trump picked right up on it and fired back: “That’s right, he did beat Medicaid, he beat it to death. And he’s destroying Medicare.”

Abortion & Roe v Wade

Mr Trump has taken credit for appointing Supreme Court judges who revoked the Roe v Wade ruling in 2022. It underpinned federal protections for the rights to abortions, and has been a fixture of Mr Biden’s re-election campaign.

When asked about a recent Supreme Court ruling decision to approve abortion medication despite state bans, Mr Trump supported it and insisted returning power on abortion to state governments was what “everyone wanted”.

After discussing how “the states are working it out”, Mr Trump added: “I believe in the exceptions. I am a person that believes, and frankly, I think it’s important to believe in the exceptions.”

Mr Biden then told Mr Trump “it’s been a terrible thing what you’ve done” in overturning Roe v Wade, and said he was making it harder for women in large swathes of the country to get access to basic health care.

The president also said he supported abortions in the third trimester of pregnancy and that “no politician should be making that decision” on when one should take place.

“A doctor should be making those decisions,” he added. “That’s how it should be run. That’s what you’re going to do. And if I’m elected, I’m going to restore Roe v Wade.”

Watch a special programme with reaction to the US presidential debate on The World with Yalda Hakim on Sky News from 6pm

Immigration

While time was allotted for immigration as a topic on its own, Mr Trump hammered Mr Biden on the issue throughout the debate, including after the Democrat’s first answer on abortion.

“There have been many young women murdered by the same people,” the former president said. “He allows to come across our border.”

Later on, Mr Biden was asked why he should be trusted on immigration after a record number of illegal migrants have crossed the border from Mexico under his current administration.

He pointed to how he brought in “significant increased number of asylum officers”, and attacked Mr Trump’s record in office

After another rambling answer, Mr Trump said: “I really don’t know what he said at the end of that sentence. I don’t think he knows what he said either.”

He then claimed that under his administration, the US “had the safest border in the history of our country.” In a terse moment, Mr Biden spoke about Mr Trump’s previous comments on veterans, where he was alleged to have called those who died in war “suckers and losers”.

The president got personal in evoking his son, Beau Biden, who served in Iraq before dying of brain cancer, and told Mr Trump: “My son was not a loser, was not a sucker. You’re the sucker. You’re the loser.”

Foreign policy

Another topic Mr Trump returned to often was the US withdrawal from Afghanistan in 2021.

After 20 years in the Middle Eastern country, the Taliban seized control almost immediately after American troops withdrew.

Near the start of the debate, he said: “It was the most embarrassing day in the history of this country’s life.”

Later, Mr Trump attempted to link Russia’s invasion of Ukraine to the fall of Kabul, claiming that Vladimir Putin “watched” the US withdrawal.

In a sprawling answer, he claimed: “When Putin saw that, he said: ‘You know what? I think we’re going to go in and maybe take my’ – this was his dream. I talked to him about it, his dream.

“The difference is he never would have invaded Ukraine. Never. Just like Israel would have never been invaded in a million years by Hamas.”

Mr Biden said, “I never heard so much malarkey in my whole life” before defending his record on foreign policy, pointing to how “we got over 100,000 Americans and others out” of Afghanistan and to Mr Trump’s comments on NATO.

On Israel, both candidates vowed support. Mr Biden touted his May ceasefire offer, while Mr Trump said of the president: “He’s become like a Palestinian, but they don’t like him because he’s a very bad Palestinian.”

Democracy and January 6

When asked about what he would say to voters who were concerned about a possible second term for Mr Trump after the January 6th riots, the former president again touted his economic and immigration records.

When asked the question again by the moderators, Mr Trump then made false claims about former House speaker Nancy Pelosi and about an offer of sending the National Guard.

Mr Biden said Mr Trump “didn’t do a damn thing” to stop his supporters marching on Capitol Hill while the 2020 election results were being certified, saying the rioters “should be in jail… and he wants to let them all out”.

He then called Mr Trump a “convicted felon” over being found guilty on 34 counts of falsifying business records to cover up hush money payments to adult film star Stormy Daniels.

Mr Biden added: “Think of all the civil penalties you have. How many billions of dollars do you own civil penalties for? For molesting a woman in public?

“For doing a whole range of things, of having sex with a porn star on the night and while your wife is pregnant? I mean, what are you talking about? You have the morals of an alley cat.”

Mr Trump repeated false claims the 2020 election was “rigged and disgusting” and added: “I did not have sex with a porn star.”

Moderators directly asked the former president towards the end of the debate whether he would condemn any form of political violence and whether he would accept the result of the upcoming election.

“The answer is, if the election is fair, free… and I want that more than anybody,” he said, before changing the subject mid-sentence – stopping just short of saying outright that he would accept the result.

World

Excruciating Biden debate performance against Trump was among worst in presidential history – if not the worst

Published

31 mins ago

June 28, 2024

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Excruciating Biden debate performance against Trump was among worst in presidential history - if not the worst

This was an extraordinary evening.

Joe Biden‘s debate performance was among the worst by any presidential candidate in history, if not the worst.

It was an “unmitigated disaster”, “a meltdown”, and “a slow-motion car crash”.

Those are not descriptors from Republican voters, they are the words of Democrats. Even former aides of President Biden admit it was a really horrible night for him.

I was literally gripping the sides of my seat at times it was so excruciating.

Watch a special programme with reaction to the US presidential debate on The World with Yalda Hakim on Sky News from 6pm

Team Biden hoped to see State of the Union Joe on the stage, when the president gave a slick, impassioned and well-delivered speech.

Right from the start it became apparent this would be an entirely different version of him. His voice was hoarse, he was stumbling and there were long pregnant pauses.

I was struck by how much older he looked than the last time he was in the same room as Donald Trump four years ago.

“We finally beat Medicare,” he said with a misspeak that is sure to go viral, a sentence that does not make sense and was pounced upon by Donald Trump.

Biden was asked by the debate moderator about abortion, one of the strongest issues for the Democratic Party, a subject where he has the opportunity to really nail Donald Trump to the wall.

He somehow managed to ramble his way off-topic to talk about immigration, one of his biggest vulnerabilities. It was an open goal missed in spectacular style.

The debate descended near the end into a row between two senior citizens about who had a lower golf handicap and who could drive the ball further.

It summed up the quality, or lack thereof, of this debate. It might have been funny if it weren’t so depressing for American voters.

It is hard to believe that President Biden fought for this debate at this time, the earliest there has ever been.

His team calculated that, given he was trailing Trump in the polls and there were growing questions about his age and vitality, it was a risk worth taking.

But it was a huge gamble, given that this format is so exposing on the national stage. It could well be a gamble they come to regret.