what is acute visit

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Acute and Sick Visits

Even if you live a healthy lifestyle and practice preventive healthcare, you can still suffer injuries or become ill. Whether you’re battling a bug during flu season or dealing with a sudden injury, you may need medical care to address the issue. At Healthcare Associates of Texas, our compassionate acute care specialists can help you recover and get your health back on track.

What Is Acute Care?

Acute care involves active, short-term medical treatment for a specific illness or injury. Generally, this type of non-emergent care is provided in hospitals or medical clinics to address urgent needs. In contrast, long-term care assists patients who need daily medical treatment or supervision to function normally.

What Types of Injuries or Illnesses Require an Acute Care or Sick Visit?

Acute illnesses develop suddenly and typically run their course in a few days to a few weeks. Acute injuries also happen without warning and usually resolve relatively quickly. With appropriate treatment, the likelihood of recovering from these types of injuries or illnesses is high.

Patients frequently seek acute care for the following situations:

• Sudden, unexplained aches and pains
• Minor fractures and broken bones
• Wounds that may need stitches
• Falls and other forms of sudden physical trauma
• Sprains and strains
• Allergic reactions
• Bronchitis, pneumonia, and other respiratory infections
• Severe sore throat or persistent coughing
• Sinus infections
• Abdominal pain or vomiting
• Flu or other stomach viruses
• Severe and persistent diarrhea
• Persistent fever
• Urinary tract infections
• Breathing difficulties caused by asthma, allergies, or illness

Sudden, severe headaches, trouble breathing, severe abdominal pain, and some infections may also be signs of an underlying condition. If you or a loved one has any of these symptoms, prompt medical evaluation is recommended.

When Should I Schedule a Sick or Acute Care Visit?

If you have an acute illness that has lasted longer than it should have, consider scheduling a sick visit. You should also visit a doctor if you have unexplained, severe headaches or stomach pain.

If you’re over 50, have underlying health conditions, or are in a high-risk health bracket, you should also schedule a sick visit when you’re ill. Aging and pre-existing medical conditions can increase the risk of health problems associated with illnesses and injuries. It’s important to see a doctor for acute care to help prevent chronic conditions from developing or worsening.

If you suffer an acute injury, such as a sprain, strain, or wound, you should schedule an acute care visit. But if your injury requires immediate medical attention, it may be in your best interest to visit an emergency room instead.

What Happens at a Sick Visit or Acute Care Visit?

When you see a doctor for acute care or a sick visit, your provider will take your vitals and then talk with you about what you’re experiencing. You’ll discuss how long you’ve had symptoms, what they feel like, and what makes them better or worse.

If your injury or illness needs more in-depth diagnostic testing than your doctor can provide, you may get a referral to a specialist.

After making a diagnosis, your physician will provide medical treatment or advice to help you guide your body back to health. Treatment may include prescription medications or antibiotics, as well as at-home care recommendations.

At your visit, be sure to tell your doctor about all the medications and supplements you take. If you need new medicines to treat your injury or illness, your doctor must make sure they won’t interact negatively. If possible, make a list before your visit, so you don’t forget anything.

Will I Need a Follow-Up Visit After My Sick or Acute Care Visit?

It’s a good idea to follow up with your primary care provider after a sick or acute care visit, but it’s not always necessary. If, however, you received treatment for a problem that may require ongoing medical attention, it’s in your best interest to schedule a follow-up appointment.

At Healthcare Associates of Texas, our compassionate acute care providers are committed to providing you and your family members with personalized and effective medical treatment. Whether you’re experiencing an injury or acute illness, please call your local clinic or schedule an appointment online to discuss your needs and start your journey back to health.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3646345/

https://www.nia.nih.gov/health/how-prepare-doctors-appointment

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Acute Care: What Is It and How Does It Work?

June 19, 2023

If you find yourself in need of emergency or urgent medical attention, the decision between which healthcare setting you go to may seem daunting, especially when you are already in distress.

When you seek this kind of medical care, or even when you are just not feeling well, the type of care you need is called “acute care.”

What exactly is acute care, and how can it address your needs? Let’s start with some of the basics.

What Is Acute Care?

Acute care can be defined as the active treatment of sudden onset, short-term, and/or life-threatening injury or illness.

The opposite of acute care is ambulatory care, which provides long-term care and chronic care to treat medical disorders that may develop slowly and worsen over time, affecting a patient’s everyday life. While acute care is reactive, ambulatory care can help promote and maintain a healthier lifestyle by providing preventative measures, tests, and treatments.

Common examples of ambulatory care include:

• Appointments with Primary care physicians (PCP)
• Tele-Medicine
• Rehab Facilities

A significant component differentiating acute care from ambulatory care is the time pressure healthcare professionals face to prevent disability or death.

How Does Acute Care Work?

If you were to think of this as a sports analogy, ambulatory care provides outpatient services to support the long game. In contrast, acute care addresses immediate issues during inpatient assistance to get you back on the field as soon as possible.

Acute Care Has Levels

Acute care is an umbrella term for multiple tiers of medical care. There are different levels of treatment based on the severity of the acute medical conditions, ranging from minor cuts and burns to heart attacks.

Each of these requires specialized, immediate responses, and below, we highlight the different types of acute care.

Four common options for the treatment of acute medical conditions are:

• Intensive Critical Care
• Emergency Care
• Urgent Care
• Walk-in or Retail Clinics

When deciding which setting will provide you with the care you require, you want to make an informed decision. Let’s expand on what each of these healthcare facilities does and compare the pros and cons of each to help you conclude where to go.

What Is Intensive Critical Care and When Should You Go?

Intensive care units, more commonly known as the ICU, provide care for those who are experiencing severe, life-threatening medical conditions such as:

• Cardiopulmonary arrest
• Severe trauma
• Respiratory failure

Pros of Intensive Critical Care

Often patients are referred to the ICU after being seen in the emergency department. A physician has likely determined the patient requires a healthcare facility stocked with specialized equipment and specialized staff able to provide 24/7 monitoring and support.

This equipment comes from medical technology companies, who use sales reps to help ensure that medical facilities are outfitted with the most up-to-date equipment.

These healthcare providers must also be able to respond quickly, as many of these patients are at risk for severe side effects or even organ failure. This level of attention is often required over a long period, sometimes weeks at a time.

Cons of Intensive Critical Care

Intensive care units are uniquely positioned to treat various emergencies and can accommodate long-term hospital stays. As a result, ICUs are often located in larger healthcare facilities in more populated areas.

Therefore, if you seek the health services provided by intensive care units, you will likely be expected to travel to urban settings.

This may be a challenge for many individuals from rural communities whose condition risks permanent disability or even death the longer it goes untreated.

What Is Emergency Care and When Should You Go?

The emergency care provided by hospital emergency departments is usually reserved for limb-or-life-threatening injuries or illnesses that require immediate attention, but the treatment or recovery is short. These facilities are available seven days a week, 24 hours a day.

You should consider a trip to the emergency department if you are experiencing symptoms such as:

• Difficulty breathing
• Compound or severe fractures
• Most seizures

Pros of Emergency Care

Healthcare professionals in the emergency department have experience providing immediate and critical care. Emergency departments provide acute care services based on an outpatient, short-term treatment model.

These environments played a critical role in the treatment of COVID-19 due to their advanced equipment, stock of medical supplies, and staff of qualified healthcare professionals.

Cons of Emergency Care

Healthcare professionals who work in critical care need to attend to patients based on the severity of their condition and the level of medical intervention required. If you go to an emergency room, you may sit in the waiting room for hours before being seen.

For many, affordability is critical when deciding where to seek medical attention. In 2022, the average out-of-pocket price for an emergency room visit for those with insurance was $526 and $2,188 for those uninsured.

However, don’t let these numbers scare you from seeking the required treatment. Trust your instincts. You are the most in-tune with your body, and if something feels seriously wrong, don’t hesitate to seek emergency care.

What Is Urgent Care and When Should You Go?

Urgent care centers are available for patients who require medical attention within 24 hours but are not in critical condition. The treatment and recovery for these conditions are often short, unlike chronic care, which can be required for weeks or even months.

Medical ailments that are commonly seen in urgent care settings are:

• Strep throat
• Animal bites or scratches
• Strains and sprains
• Rashes and hives

Pros of Urgent Care

In urgent care facilities, you can walk in without an appointment and be seen by a qualified healthcare professional that same day.

These offices often have flexible schedules, including evenings and weekends, making this an excellent option for working professionals and those seeking care for children or other family members.

Cons of Urgent Care

It has been argued that what makes urgent care attractive can also be a deterrent. Because of the quick in-and-out business model, the quality of care a patient receives is perceived to be lower than if they were to go to their primary physician.

Urgent care offices likely do not have your medical files on hand; therefore, they will likely be unaware of your medical history. Additionally, you cannot choose which doctor you see and will often see a different doctor between visits.

Based on a study by NPR, the quality of patient care is rated lower at urgent care centers than at primary care facilities. However, the cost value of each is almost identical.

What Are Walk-In Clinics and When Should You Go?

If you don’t feel very good or require testing for school or work, walk-in clinics will likely provide you the care you need without subjecting you to lengthy waits or expensive procedures and tests that may not be necessary. Healthcare providers at walk-in clinics often try to focus solely on the patient's current complaint.

Standard procedures and illnesses treated at walk-in clinics include:

• Immunizations
• Flu, Common Colds, and Covid-19

Pros of Walk-In Clinics

Walk-in clinics, sometimes called “retail clinics,” provide a more cost-efficient option for medical treatments than emergency rooms.

Although they are very similar to urgent care offices in that they provide guaranteed appointments, they often have less access to specialized equipment and therefore have limited capabilities.

While there is room for technological improvement at these facilities, this is often limited by financial restrictions and poor sales-rep-to-healthcare-professional relationships.

Cons of Walk-In Clinics

Unfortunately, because walk-in clinics have limited resources and equipment and are usually staffed with only nurse practitioners and physician assistants, they may be unable to provide more complicated or involved care.

If you are experiencing an injury or illness that requires a more specialized treatment plan, walk-in clinics may ultimately defer you to a hospital for a more thorough exam. This creates an extra step between you and the care you need.

This may be frustrating if you initially select a walk-in clinic because of its accessibility and affordability compared to an emergency room.

How To Choose the Right Acute Care Setting for You

When suddenly faced with a medical emergency, you may be overwhelmed and scared, which impairs your judgment and leads to self-doubt and confusion. Often, patients are presented with the choice to seek treatment at either an urgent care center or the emergency room.

When deciding between the two, you should ask yourself how immediately you need care or if you can afford to wait. The best advice we can offer is to slow down and ask the following questions before deciding what acute care setting will take the best care of you or your loved ones.

• How suddenly and severely impacted are you by the illness or injury?
• How immediately does your treatment need to happen to prevent disability and death?
• How accessible is the care facility?
• How affordable is the care provided?

Ultimately, your quick thinking and responsiveness will help with the outcome of your emergency medical situation. Those trained to provide acute care services can only do their job if you seek out their skills first.

Determining where to go is the first step in providing the care you need and getting you or your loved one on the road to recovery.

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What Is Acute Care and When Do I Need It?

To put it in layman’s terms, acute care is inpatient care, in contrast to ambulatory care, or outpatient care. In an acute care setting, you remain under constant, round-the-clock care. 

You generally need acute care when it comes to minor to major traumatic injuries, care for chronic disease, and recovery from life-threatening illnesses. Acute care intervention is incredibly important, as it’s often life-saving and performed within the first 24 hours following an emergency.     

At Sulkowski Family Medicine, Dr. Thomas Sulkowski and his team are here to provide you with a comprehensive explanation of the different kinds of acute care and the type that we provide. This guide will better help you to understand when you need to seek out acute care.  

The different types of acute care

Acute care can take place in emergency or non-emergency medical facilities, including hospitals, nursing homes, and clinics. The types of care that are included in acute care include:

• Emergency care - emergency department treatment in limb- or life-threatening situations
• Trauma care and acute care surgery - treatment involving acute surgical intervention 
• Urgent care - immediate care outside of an emergency department, usually on a walk-in basis, like the kind of acute care that we provide here at Sulkowski Family Medicine
• Short-term stabilization - treatment that precedes definite acute care, like receiving IV fluids before surgery
• Prehospital care - care administered before arrival at a facility, such as intervention from paramedics in an ambulance
• Critical care - care for those with life-threatening conditions who require constant monitoring, like those in intensive care units

Now that we’ve covered what acute care is, it’s important to know when you need it. This is particularly true when you take into consideration that in the U.S., one-third of all health services account for acute care. 

How we do acute care

At Sulkowski Family Medicine, we’re here to provide you acute care in the form of immediate care, non-emergency intervention in a clinic setting. Some of the acute issues that we treat include:

• Sore throat
• Sinus infection
• Ear infection

If you have one or more of the following symptoms, you should make an appointment with us, as they are symptoms of the above conditions:

• Swollen glands

If you have severe symptoms, like a traumatic break or serious bleeding, go to the emergency room immediately, as you need more care than we can provide.

If you do have an immediate care need, call us or schedule an appointment right on our website today. 

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Emergency vs. Urgent Care: What's the difference?

• Emergency Medicine

It's Saturday morning and your child fell while playing in the backyard. He can't put any weight on his rapidly swelling ankle, and he is sweating and crying in pain. Should you head to the Emergency Department or Urgent Care?

If you have been in a similar situation and wondered which option is better, you are not alone. Although Mayo Clinic Health System has offered Urgent Care for more than 20 years, many people are confused about when to use it.

Here are a few differences between Emergency Departments and Urgent Care clinics:

Severity of health problems.

An Emergency Department treats life- or limb-threatening health conditions in people of all ages. It is the best option when you require immediate medical attention.

Urgent Care is the middle ground between your primary care provider and the Emergency Department. If you have a minor illness or injury that can't wait until tomorrow, Urgent Care is the way to go. Also, it is a good option if you have illnesses or injuries without other symptoms, or if you do not have other underlying health conditions. For example, an earache can easily be treated in Urgent Care. However, if it is accompanied by a high fever (104 F or higher), or you have a history of cancer or are on immune-suppressing medication, it is important to have it checked out in the Emergency Department.

Hours and staff

Emergency Departments are staffed 24/7 with physicians, physician assistants, nurse practitioners and nurses trained in delivering emergency care. The team has quick access to expert providers in advanced specialties such as Cardiology, Neurology and Orthopedics. Emergency Departments also have the imaging and laboratory resources needed to diagnose and deliver care for severe and life-threatening situations.

Typically, Urgent Care clinics are staffed with physician assistants, nurse practitioners and nurses. Although, some Urgent Care clinics have physicians on staff as well. Urgent Care providers can order basic labs and imaging tests, such as X-rays, to help them provide diagnoses and develop treatment plans. Urgent Care clinics have set hours and an established list of conditions treated. As a result, Urgent Care clinics often are less expensive and have shorter wait times than Emergency Departments.

Here are examples of types of conditions treated in Urgent Care clinics and Emergency Departments:

Urgent care clinic:.

• Back or muscle pain
• Cuts and minor burns
• Skin conditions
• Sprains or joint pain
• Upper respiratory infection
• Urinary tract infections

Emergency Department:

• Chest pain or pressure
• Compound fracture (bone that protrudes through the skin)
• Head injuries
• Severe abdominal pain
• Shortness of breath
• Sudden, severe headache, or paralysis or weakness
• Uncontrolled bleeding

Always call 911 and don't drive yourself to the Emergency Department if you are having difficulty breathing, shortness of breath, a life or limb injury, or signs of stroke or heart attack.

Learn about your options for same-day care .

Graham King, M.D. , is a  Family Medicine  physician in  Mankato , Minnesota.

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Acute and Short-Term Care

Acute care is short-term health care that involves treatment and care that are active but not over a long period of time. This type of care is typically used for injuries, illnesses, urgent and emergency needs, and for recovery or rehabilitation after surgery. Acute care is in contrast to long-term care, sometimes called chronic care, for recurring illnesses and progressive or terminal conditions.

There are many types of acute care, from emergency to pre-hospital care to urgent care. Regardless of the type, you or your loved one has a right to receive care that meets certain standards. Your caregivers are responsible for doing all that is reasonably possible to help you and to inform you of your condition and your options for treatment so that you can give informed consent for any procedures or before being discharged or transferred to another type of care.

What is Acute Care?

Acute care is a type of secondary health care. Secondary care describes care that is not received from a person’s primary caregiver, or doctor. It is more specialized than primary care. Acute care is treatment that is necessary but only for a short period of time. It is more specialized than primary care because it may involve emergency health care workers, urgent care specialists, trauma specialists, and other health care provides that are not primary care physicians.

Types of Acute Care

Acute care is a diverse group of medical specialties, but it can be organized into a few different types:

• Emergency care. Emergency care is any acute treatment that is administered for a life-threatening illness or injury. It may also be used to treat illnesses or injuries that are causing severe pain or may lead to serious consequences if not addressed immediately.
• Urgent care. This is a type of outpatient, or ambulatory care that is administered from a clinic rather than an emergency room and that typically does not require an appointment. Urgent care is used for pressing, but not emergency, health care needs.
• Trauma and acute surgery. Acute surgery is used to treat patients with immediate needs, such as the removal of the appendix before it bursts. It may also be used for treating traumatic injuries, like internal bleeding after a car accident.
• Prehospital care. This is care provided for a patient before they arrive at the hospital. It may be emergency care administered by paramedics or EMT, or it may be evaluation by an urgent care or other doctor who then decides to transfer the patient to the hospital.
• Critical and intensive care. Intensive or critical care units are typically found in hospitals and are used to treat and monitor patients who have life-threatening conditions but do not require emergency treatment. Patients are often transitioned from emergency to critical care after emergency treatment.
• Short-term stabilization. This is a type of care that is used to stabilize a patient ahead of the actual treatment. For example, a patient may need to be stabilized and hydrated with

The Importance of Acute Care

This kind of care provided in an acute setting is important to individuals and to the community at large. Acute care facilities, such as hospitals, have a responsibility to be prepared for any eventuality, including natural disasters, widespread illness or epidemics, and accidents involving a lot of people. Acute care plays an important role in saving lives and preventing disability in patients. When practiced with high standards of care, acute care is a valuable part of medicine.

Responsibilities of Health Care Facilities in Providing Acute Care

As with all types of care, professionals who provide acute care must adhere to certain standards of care and quality of care. The facility, the nurses, the doctors, and other professionals have a responsibility to give you quality care to the best of their abilities and training, doing all that is reasonable to assess, diagnose and treat your condition, and to advise you if there are choices to be made.

Informed consent is an important part of many instances of acute care. This means that you have a right to have the information necessary in order to make a choice about your care. For example, if you have a choice between undergoing surgery for an injury or waiting to see what happens, your caregiver should give you the most expert advice so that you can make a decision that is informed. Even if your decision goes against what the doctor advises, it was informed.

After Receiving Acute Care

Many types of acute care require some type of follow up, to evaluate the condition or injury or to determine if further treatment is needed. Being discharged from acute care may also require that you make an important decision. For some situations, simply going home is the best option. A child with a broken arm that has been casted or family member with an infection and a prescription for antibiotics are likely to be able to go home to recover with follow ups with doctors later.

Other situations may be more complicated. Depending on the injury or illness and the overall stability and health of the patient, he or she may need to be transferred to a rehabilitation facility, intensive care, or home but with skilled nursing support. Your medical team should explain your options to you and answer any questions you have before you make a decision. This planning for discharge and post-acute treatment is an important part of the standard of care because it allows patients and their caregivers to make informed decisions. And, follow up after acute care is an important part of good quality health care.

Most people will require some type of acute care during their lives, often many times. Getting sick, suffering an injury, having a heart attack, and other health issues are what leads people to seek out acute care. This is a very important part of health care because it saves lives and prevents or minimizes disabilities patients might otherwise suffer. You have a right to good care when you seek out acute care from health professionals. Know what to expect and be informed so that you can demand and ensure you get the best possible care.

• http://www.who.int/bulletin/volumes/91/5/12-112664/en/
• https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-13-20.pdf
• https://uihc.org/health-library/what-happens-after-acute-care
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Emergency Room, Urgent Care or Primary Care Physician?

When is it appropriate to visit each of these care providers?

It's 2 a.m., and you wake up with a terrible pain in your lower back. It's 5 p.m. on a Sunday afternoon and you suddenly feel extremely nauseous. It's 9 a.m. on a Wednesday morning and that cough that's been bothering you for a couple days suddenly seems to take a turn for the worse. What should you do in any and all of these situations? Should you visit the emergency room? Can you get an appointment with your primary care doctor ? What about those urgent care centers that are popping up all over the place? Where can you be seen in the most timely manner and get the most appropriate care for whichever health issue you're facing?

It can be a tricky question to answer, especially when you're making it under duress and without the benefit of a medical degree to help guide you. Dr. Douglas Kupas, an emergency physician and EMS physician at Geisinger in Danville, Pennsylvania, says there are several factors you need to take into consideration when choosing where to go for health care in various situations. The most important is "the type of injury or illness that you have, its severity and whether it fits with the resources at the site."

[See: 10 Questions Doctors Wish Their Patients Would Ask .]

There are pros and cons associated with each provider:

• An emergency department likely offers the most resources and is able to handle virtually any medical problem that comes in. Most emergency departments are also attached to a hospital and can admit you directly if you need surgery or other critical intervention.
• An urgent care center may have an X-ray machine and/or the ability to perform some lab tests, but may need to transport you to an emergency department if the severity of the issue is beyond the scope of its services.
• Your primary care provider likely knows you and your medical history best, but may not be able to handle acute problems that require more advanced care as fast as an emergency department or urgent care center.

In addition to thinking about the resources your medical condition may require, you should find out whether your insurance is accepted at any of these locations. And there's a convenience factor with accessing these different kinds of care – your primary care physician may not be available in the middle of the night. But getting to the right place in a timely manner may be critical to survival. "It's a combination of where can I get in quicker, but also where can I get in quicker to the right place at the first time, because if you go to the wrong place, you might get quick service but have to be transferred on," Kupas says.

Each health care provider is best suited to handle various conditions. Here's a run-down.

Primary Care

"The primary care physician is generally someone you establish a relationship with who hopefully takes care of your ongoing medical needs," says Dr. Jay Ladde, associate program director and professor of emergency medicine at Orlando Health . "The primary care physician also serves as a surrogate to connect you with other health care providers . So, if you need a cardiologist or an orthopedic surgeon, you've got one physician [the primary care physician] who's managing your care, understands your ongoing problems and expedites your care," he says.

Dr. Tania Elliott, chief medical officer at EHE, a New York City–based healthcare management company dedicated to prevention, agrees that a primary care physician is an important health care ally you should visit for ongoing medical concerns. "If you have a chronic medical condition which requires regular follow-up, your primary care physician is the way to go."

This is in part because the primary care doctor offers continuity of care. "For things you need to continuously follow up with or a chronic issue that's coming and going," visiting your primary care physician is the best bet, Kupas says. In addition to routine check-ups, prescription refills and ongoing health management for chronic conditions like diabetes or high blood pressure, your PCP can also see you for acute problems like bronchitis or coughs and colds.

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"When you go to urgent care or the emergency room, the care is episodic, meaning that no one is really keeping track of your visits, medical problems, prescriptions or medical conditions the way that your primary care physician would," Elliott says. But if you have a PCP with whom you can develop a relationship that can help minimize overtesting, medical errors and unnecessary tests and procedures.

Elliott says finding out whether your primary care doctor can see you in a pinch ahead of time can make dealing with an acute issue if it pops up a little easier. "When choosing a primary care doctor, find out their policy on sick visits and follow-up visits to make sure they can get you in when you need them." She also recommends minimizing doctor-hopping. "When one healthcare professional doesn't have insight into care you may have previously received, it can lead to an incorrect diagnosis or over-diagnosis and very high costs."

[See: HIPAA: Protecting Your Health Information .]

Urgent Care

"Urgent care is good for episodic, but minor things and convenience," if you can't get into your primary care because it's after hours or the weekend, Kupas says. Ladde adds urgent care can serve as a sort of "intermediary between the primary care physician and the emergency room." These providers may be able to deliver care faster than your PCP in some cases, but may not offer as many options as the emergency department.

Examples of specific problems urgent care centers are well suited to handle include "minor insect bites and stings, sprains and strains, coughs and colds and minor wound care,"Kupas says. "Urgent care is also good for getting a school physical form filled out or flu shots and immunizations," he says.

Elliott says "urgent care is meant for non-emergency conditions." These conditions "may require an intervention or minor procedure such as stitches, X-rays, or evaluation of musculoskeletal injuries. We call these 'one and done' types of visits, that don't really require major follow-up," she says.

If you're in doubt, but can make contact with your primary care physician, Kupas recommends calling that doctor for guidance on whether you should wait to see him or her or if you should visit an urgent care center.

Emergency Department

"Emergency care is meant for true medical emergencies that would require hospitalization or surgery," Elliott says. "The most common causes are chest pain, severe abdominal pain, major trauma, suicide attempts, motor vehicle accidents and uncontrolled bleeding."

"I think most patients who are unstable or having conditions or symptoms" that could potentially "kill them or leave them in significantly bad shape if not addressed more immediately," that's when you go to the emergency department without delay, Ladde says. "Shortness of breath, cardiac issues and stroke issues often start early in the morning. We know this based on human physiology. And a lot of patients think, 'I'm going to wait a while,'" and call the primary care physician in the morning. But this can be a dangerous proposition, he says. "If it's something that you think is potentially life threatening – I understand, if it's 9 a.m. – call your PCP and see if can they expedite things. But if it's 4 a.m., you probably ought to address it now. You don't want the patient getting sicker or even worse, so jump on top of your medical conditions instead of reacting to them" later when they may have gotten much worse. Particularly in heart attacks and strokes, time is of the essence, and delaying treatment can lead to worse outcomes.

[See: 14 Things You Didn't Know About Nurses .]

In addition to handling severe problems, Kupas says "the emergency department is good for things where you're not quite sure." He says he sees a lot of patients who think, "maybe it's just heartburn, but it turns out to be a heart attack," so if you're uncertain, it's usually best to err on the side of caution and visit the emergency department . The emergency department is also the place to go if you think you've broken a bone, as an urgent care center may be able to X-ray it, but if it's broken, you'll likely need to be referred to an emergency department for additional care.

But not every acute medical problem is an emergency, and Elliott points out that "some people overutilize the emergency room for things that are not a true emergency, such as medication refills [and] cold or flu symptoms." She says many people also seek emergency care if they lack a primary care physician, a phenomenon that also occurs in urgent care, all of which can drive up health care costs and soak up resources that should be going towards patients who actually need the emergency care. So when you're dealing with a health issue, take a moment and consider whether the problem at hand truly is an emergency. If in doubt, go to the ER. If it can wait, see your primary care doctor or visit an urgent care center.

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What is acute care?

Acute care is an active, short-term treatment for an episode of illness or severe injury. Symptoms of acute illnesses usually emerge suddenly, but the recovery period is also typically brief.

Some examples of acute care include:

• Trauma care
• Emergency medicine
• Acute care surgery
• Pre-hospital emergency care
• Urgent care
• Critical care
• Short-term inpatient stabilization

While chronic care is typically provided in a patient’s home or assisted living facility, acute care is generally provided in hospitals and emergency departments.

Why is acute care important in healthcare?

When it comes to treating sudden and serious illnesses, acute care is essential.

The conditions that require acute care are often severe and require immediate attention. Sometimes, just a few minutes can be the difference between a complete recovery or a lasting disability. Because of this, acute care is essential for preventing disability or death, especially within the first 24 hours of the illness.

The main goal of acute care is to address life-threatening issues and stabilize the patient. Once this is achieved, the goal then shifts to preventing physical and cognitive complications while improving functional status.

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Top EHR Systems at Acute Care Hospitals

Should I Come in for Acute Care or Head to the ER?

When you or a family member is sick or suffers an injury and needs immediate medical care, it’s not always easy to know if the emergency room (ER) or an acute care facility is the best place to go for help. 

At Healthy Life Family Medicine , our team of care providers offers same-day acute care services to patients of all ages in the Goodyear, Arizona, area. Our practice also believes in the importance of patient education, so we’ve put together this post explaining acute care and how to know whether you should visit our clinic or head to the ER.     

What is acute care, and what conditions does it treat?

Acute care is a branch of medicine that treats severe, short-term medical conditions. Acute conditions typically come on quickly and need prompt attention, and their treatment and recovery is generally short, unlike chronic conditions that persist for months or years.  

Because acute medical conditions vary in their degree of severity, there are different levels of acute care. One type of acute care is the emergency room, which is typically reserved for life-threatening situations that require advanced medical intervention, like injuries after a car accident.  

Other acute care takes place on a non-emergency basis, like the services available at Healthy Life Family Medicine. We provide same-day treatment and extended hours for patients with symptoms or injuries that need immediate attention but aren’t medical emergencies, such as: 

• Minor cuts and burns 
• Flu, cold, or COVID-19
• Strep throat
• Sprains and strains
• Fever and chills
• Rashes and hives
• Nausea and vomiting
• Urinary tract infections

Because we’re a family medicine practice, we help patients of all ages who require medical attention. When you come in for acute care treatment, your provider talks to you about the symptoms you’re experiencing and your medical history and then conducts a physical exam. 

Your provider creates a customized treatment plan to help you feel better as quickly as possible. Some patients benefit from a follow-up appointment to check on their recovery. 

How can I tell if I need acute care or the ER?

At Healthy Life Family Medicine, we know it’s not always easy to differentiate between conditions that require an ER visit and those that demand same-day, but not critical, attention. 

If you or a family member experiences a life-threatening medical emergency , or if you sustain an injury that needs immediate, advanced medical treatment, the right choice is always going to the nearest emergency room or calling 911. Here’s a look at some symptoms and injuries that warrant a trip to the ER:

• Difficulty breathing
• Experiencing one-sided numbness or weakness
• Slurred speech or sudden changes in mental state
• Serious burns
• Compound or severe fractures
• Severe cuts, head, or eye injuries
• Bleeding when pregnant
• Loss of consciousness
• Serious electrical shocks or lightning strikes
• Most seizures

Keep in mind that in emergency rooms, medical providers must prioritize the most serious, life-threatening conditions first. This means that if you arrive at the ER with a non-life-threatening condition or injury, you may wait hours for treatment. 

If you have a condition or injury that isn’t life-threatening but needs attention, like flu symptoms or a sprain, you’re best served by calling our practice to schedule a same-day appointment. Call our friendly staff at 623-889-3477 to get in to see one of our care providers today.

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Written by the Open Caregiving Team. Editorial review by Joyce O. Murphy RN, MSN .

What is acute care?

Acute care is when someone needs immediate medical attention for an illness or injury. This is often to make their condition more stable, as when someone is having trouble breathing because of asthma or the flu. Sometimes it is because a person is having mental health troubles.

What is the goal of acute care?

The term “acute” makes this type of care stand out from others like primary care or chronic care. The goal of acute care is to improve health right away.

When you see your primary doctor, you get that care in a primary care setting. Chronic care is when your loved one is receiving home care or nursing home care for a long-term condition.

What are examples of acute care?

Acute care happens in several types of healthcare settings, such as:

• A hospital’s emergency room (ER) . An example is when someone has extreme abdominal pain and the ER doctor diagnoses appendicitis.
• A health center or doctor’s office when a person’s condition is found to be serious. An example is when a person’s blood pressure is taken and found to be dangerously high.
• Emergency first responder care for someone in any kind of accident.

A change in a person’s health may mean they need acute care. Here are some examples:

• The need for acute care may be found when a person is getting ready for elective surgery. Their lab or other tests reveal a health problem that might delay surgery.
• A baby goes to the doctor for a well baby checkup and is dehydrated. The baby goes to the hospital for intravenous care.
• A person with a mental illness has a bad reaction to a new medication. They have a short stay at the hospital to become stable.

What is acute care rehab?

Acute care rehab is when a person has received medical or surgical treatment to improve their health. As a patient, they then participate in acute care rehabilitation to regain strength and function. They may have several therapies to help them prepare to go home. Examples include:

• Exercise and activities following joint replacement surgery.
• Medication, diet, and activity adjustments after heart surgery.
• Observation with medication and behavioral therapy following a mental health crisis.
• Someone who has had a stroke and needs physical, occupational, and speech therapy.

What is the difference between acute care and critical care?

Acute care for a patient is less involved and can be offered in a shorter time frame than critical care. The need for acute care may mean you have a short visit with the doctor or hospital stay. Examples include:

• Going to the emergency room for a sprained ankle.
• You visit your doctor and are found to have pneumonia. Your blood oxygen is low enough that you’re admitted to the hospital for a couple of days for treatment and observation.

Critical care is provided for a critically ill or injured person. They are admitted to an intensive care unit (ICU) or critical care unit (CCU) for continued observation and testing.

• The CCU may be a cardiac care unit designated for heart patients. This is the case for someone who had a heart attack and is waiting for surgery.
• Some hospitals have both medical and surgical ICUs. This is because of community size and the level of specialty care.
• These patients are monitored closely with machines and many healthcare staff.

What is an acute care facility?

An acute care facility is one that provides a variety of acute services, such as emergency care for all types of health problems and injuries.

• People who go to the ER may go home after their visit. Or they may be admitted, depending on their health status.
• In some cases, a person is moved quickly from the ER to a large hospital with many specialist doctors.

What is post acute care?

Post acute care is when a person needs continued care for their health condition. This means they will move from a hospital to home or another facility. The options include:

• A person returns home with the care and support of Home Health Care services.
• They move to a long-term care hospital (LTCH).
• Inpatient rehabilitation facilities (IRFs), where a person’s health can improve with continued care. This includes therapies as well as health and personal care.
• Skilled nursing facilities (SNFs) that care for people who need skilled nursing care or therapy services. SNFs are often part of a Nursing Home .

How do I pay for acute care?

Medicare, Medicaid, and private health insurances all have options for paying for acute care.

• Each has limitations to what they will pay for. In some cases, they will not.
• It is best to talk with your health insurer to learn what is paid.
• You can talk with a hospital social worker or billing office for information if paying for acute care is a financial challenge.

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Related topics to learn about, family and medical leave act (fmla).

FMLA allows qualified employees to take up to 12 weeks of unpaid leave per year to handle family and medical circumstances while keeping their health benefits and job.

Patient Care Coordinator (PCC)

A Patient Care Coordinator (PCC) manages a person's care from assessment of personal needs to education for caregivers, including family members.

Personal Care Assistant (PCA)

A personal care assistant (PCA) is a caregiver who is trained to care for people with various needs in a variety of settings.

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Observation, Outpatient, or Inpatient Status Explained

• How Long Is a Stay?
• Types of Admission
• Admission Status Determination
• Dealing With Insurance

If you receive medical treatment that involves an overnight hospital stay, you are being treated on an inpatient basis. If you are treated in a hospital but don't need to stay, you are being admitted on an outpatient basis.

In between, a person may receive treatment and be admitted to a hospital so they can be watched and reassessed to determine if further treatment is needed. This is admission on an observation basis.

The decision on how you are admitted is largely directed by your condition and approvals by your insurance company. Based on medical codes that classify your condition and treatment (called CPT and ICD-10 codes), your insurer will decide how long—or if—you need to stay in a hospital.

This article explains when you need to be admitted on an outpatient, inpatient, or observation basis and how the decision is made.

How Long Is Your Hospital Stay?

For the purpose of insurance billing, the length of a hospital stay is based on how many midnights you will spend in the hospital. It is not based on the number of hours you are hospitalized.

So, even if you are admitted at 11:00 p.m., you will be billed for one hospital day (along with any accrued charges) the second it turns midnight.

The hospital bill you receive is separate from the bill you receive from your surgeon or anesthesiologist . The bill not only includes the daily room charge but also charges for food, medical supplies, medical services, and any tests or procedures, such as X-rays.

Definitions of Hospital Stays

Specific definitions are assigned to your admission status, some of which are not as straightforward as they seem. The definitions matter because they have a direct impact on both your billing and out-of-pocket costs .

By definition:

• Outpatient is when a person leaves the hospital after treatment on the same day. It can also be applied a someone who spends the night in the hospital for whom a doctor has not written an order for inpatient admission. They are still admitted and billed as an outpatient.
• Inpatient is when a person treated in a hospital is admitted for at least two midnights. It can also be applied to a person who was discharged or transferred to another hospital before two midnights and didn't occupy the bed. They are still admitted and billed as an inpatient.
• Observation is when a person is admitted to the hospital but has an unclear need for longer care. The purpose is to determine within the span of one midnight whether further treatment or inpatient admission is needed.

In practice, the term "admitted" generally infers inpatient care but can be applied to anyone who is admitted for treatment in a hospital.

Insurance and How Admission Status Is Determined

Every time you are scheduled to have a hospital-based treatment or procedure—such as surgery or to deliver a baby—your healthcare provider will submit prior authorization to your health insurance company. This is to ensure that the procedure is covered along with any hospitalization that may be needed.

The decision to pay and how much to pay is largely based on two codes submitted by your healthcare provider:

• ICD-10 code : This is an international classification of all medical diagnoses used for insurance claims processing. The U.S. version is issued by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS).
• CPT code : Otherwise known as the current procedural terminology (CPT) codes, these classify medical services and procedures. These codes were designated by the U.S. Department of Health and Human Services under the Health Insurance Portability and Accountability Act (HIPAA) .

The codes are used by the insurer to determine what services are authorized for coverage of your condition, including whether the treatments are administered on an inpatient or outpatient basis. If inpatient care is indicated, the codes will also direct how many days you are authorized to stay.

If you require emergency care, the ER department will submit a specific CPT code after treatment designating the need for hospital observation. The code can be transitioned to inpatient care if it is decided that further treatment is needed after an overnight stay.

Asking About Overnight Hospital Bills

The amount you pay for a hospital stay is based on your insurance plan, including the deductible . If you have private or employer-sponsored insurance, there may be copayment or coinsurance costs you will need to pay out of pocket.

If out-of-pocket costs are a factor, there may be an outpatient procedure that can be used in place of an inpatient procedure. As long the treatment is appropriate and effective, it is a reasonable option to discuss with your healthcare provider.

For people with Medicare , outpatient services are covered as part of Medicare Part B , while inpatient services are covered under Medicare Part A . Medications may fall under Medicare Part D .

Because there are many rules and regulations governing payment based on the type of Medicare you have, you can reach out for assistance by calling the Medicare Helpline at 1-800-MEDICARE (1-800-633-4227).

The same applies to other federal programs like Medicaid , Children's Health Insurance Program (CHIP) , Tricare , and Veteran's Health Administration (VHA) .

On the other hand, if you have been discharged from the hospital and are confused about your bill, the hospital billing department can explain the charges and may be able to direct you to financial assistance if you foresee problems paying the bill.

A hospital outpatient, inpatient, or observation status is about more than just how long you are in hospital. The definition of each can place you in a different category of billing.

The determination of outpatient, inpatient, and observations is based on your condition and treatment recommendation. Based on the CPT and ICD-10 code assigned by your healthcare provider, your insurer will determine what form of treatment they will cover and how many days of hospitalization are needed, if any.

Centers for Medicare and Medicaid Services. Billing and coding: acute care: inpatient, observation and treatment room services .

Medicare.gov. Are you a hospital inpatient or outpatient?

Centers for Medicare and Medicaid Services. Hospital outpatient quality reporting program .

Centers for Medicare and Medicaid Services. Advanced copy- revisions to state operations manual (SOM) hospital appendix A .

Centers for Medicare and Medicaid Services. Hospital coverage under Part B .

American Medical Association. ICD-10 .

American Medical Association. CPT overview and code approval .

By Jennifer Whitlock, RN, MSN, FN Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. She has experience in primary care and hospital medicine.

Acute Care Visits

Quick onset of illness can happen to anyone at any time and may be very distressing if you do not have access to medical advice. Most acute illnesses are viral and will resolve without medical intervention within 7-10 days.

As long as you are not experiencing any shortness of breath or chest pain, most patients are safe to wait be seen. (If you have severe shortness of breath or chest pain, please call 911 and go to the emergency department for emergent evaluation!)

However, if you would like to be seen for any concern, please call the office to schedule an appointment. We will do our best to have you seen same-day or very soon. As an established patient of Woods Family Medicine, you will always have access to the walk-in hours from 7am-8am on Monday, Wednesday, or Friday.

Acute concerns are episodes involving:

• Fever greater than 100.5 ° F
• Cough less than two weeks
• Sore throat
• Urinary pain
• Vaginal discharge

Woods Family Medicine

1510 sw 119 th street oklahoma city, ok 73170, 405-353-1460.

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Acute Problem Focused Visits

At an acute visit, you’ll evaluate a new issue, like cough or rash, in the context of the patient’s overall health. Since time is limited, you will not collect the entire database.  Rather, you’ll focus your data gathering on the questions and exam maneuvers that will help you diagnose the chief concern. You will have the ability to review the patient’s electronic health record (EHR) to be aware of other chronic medical conditions and medications that may impact their current concerns and obtain additional details if relevant to the acute condition.

You’ll collect an HPI in the usual way – starting with the patient’s story then filling in gaps with focused questions, perhaps using OPQRSTAAA as a guide.

For the other history sections, you’d only ask the pertinent questions.  Pertinent means that it’s somehow related to the differential diagnosis for this acute problem. Since the differential diagnosis for cough includes postnasal drip, bronchitis, pneumonia or GERD, you’d gather data that would help to differentiate between these illnesses.

Rather than eliciting a complete past medical history, you would ask about conditions important to know about when assessing a patient with cough: allergies or asthma, other lung disease or GERD. Pertinent social history could include tobacco exposure or other environmental irritants. The pertinent review of systems questions might include fever, nasal congestion or runny nose, shortness of breath, chest pain, or acid reflux.  You would not ask other review of system questions.

Physical Exam

For an acute condition your exam should be hypothesis driven. This means that you decide which physical exam maneuvers will support or argue against the conditions on your differential diagnosis.  For cough, that might include an exam of the nose, oropharynx, and chest.

The Foundations of Clinical Medicine Copyright © by Karen McDonough. All Rights Reserved.

Estimates of Emergency Department Visits in the United States, 2016-2021

The National Hospital Ambulatory Medical Care Survey (NHAMCS), conducted by the National Center for Health Statistics (NCHS), collects annual data on visits to emergency departments to describe patterns of utilization and provision of ambulatory care delivery in the United States. Data are collected from nonfederal, general, and short-stay hospitals from all 50 U.S. states and the District of Columbia, and are used to develop nationally representative estimates.

This visualization depicts both counts and rates of emergency department visits from 2016-2021 for the 10 leading primary diagnoses and reasons for visit, stratified by selected patient and hospital characteristics. Rankings for the 10 leading categories were identified using weighted data from 2021 and were then assessed in prior years; however, rankings were relatively consistent over the evaluated years. See tables in the Definitions section below the visualization for changes in leading primary diagnoses and reasons for visit from 2016-2021. Estimates in this visualization highlight and expand on information provided in the annual NHAMCS web tables , which can be used to assess how these categories and rankings changed over the evaluated years.

Use the tabs at the bottom of the visualization to select between “Primary Diagnosis” and “Reason for Visit”.  Use the drop-down menus at the top of the visualization to select the estimate type, the estimate category, and the group breakdown of interest.

Access Dataset on Data.CDC.gov (Export to CSV, JSON, XLS, XML) [?]

Definitions

Based on International Classification of Diseases, 10th Revision, Clinical Modification (ICD–10–CM).  See Table 11 of the NHAMCS: 2020 Emergency Department Summary Tables for code ranges of diagnosis categories, available from: https://www.cdc.gov/nchs/data/nhamcs/web_tables/2020-nhamcs-ed-web-tables-508.pdf .

SOURCE: National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey, 2016-2021

Based on the patient’s own words and coded according to: Schneider D, Appleton L, McLemore T. A reason for visit classification for ambulatory care. National Center for Health Statistics. See Appendix II of the 2020 NHAMCS public-use documentation for code ranges of reason categories, available from: https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHAMCS/doc20-ed-508.pdf .

Calculated by dividing the number of ED visits by estimates of the U.S. civilian noninstitutionalized population (obtained from the U.S. Census Bureau’s Population Division) for selected characteristics including age, sex, and race and ethnicity. Visit rates for MSA are based on estimates of the U.S. civilian noninstitutionalized population from the National Health Interview Survey, compiled according to the Office of Management and Budget definitions of core-based statistical areas. More information about MSA definitions is available from: https://www.census.gov/programs-surveys/metro-micro.html . Visit rates for patient’s expected source of payment are based on patient’s primary expected source of payment and proportional insurance data from the National Health Interview Survey.

During data collection, all sources of payment were collected. For patients with more than one source of payment, the hierarchy below was used (with Medicare counted first and self-pay and no charge counted last) to collapse payments into one mutually exclusive variable (expected source of payment). Visits that had a missing or unknown expected payment source were excluded (between 10-14% [weighted] from 2016-2021).

• Medicare: Partial or full payment by Medicare plan includes payments made directly to the hospital as well as payments reimbursed to the patient. Charges covered under a Medicare-sponsored prepaid plan are included.
• Medicaid: Partial or full payment by Medicaid plan includes payments made directly to the hospital or reimbursed to the patient. Charges covered under a Medicaid-sponsored prepaid plan (HMO) or “managed Medicaid” are included.
• Private: Partial or full payment by a private insurer (such as BlueCross BlueShield), either directly to the hospital or reimbursed to the patient. Charges covered under a private insurance-sponsored prepaid plan are included.
• Uninsured: Includes self-pay and no charge or charity. Self-pay are charges paid by the patient or patient’s family that will not be reimbursed by a third party. Self-pay includes visits for which the patient is expected to be responsible for most of the bill, even if the patient never actually pays it. This does not include copayments or deductibles. No charge or charity are visits for which no fee is charged (such as charity, special research, or teaching).
• Other: Includes Worker’s Compensation and other sources of payment not covered by the above categories, such as TRICARE, state and local governments, private charitable organizations, and other liability insurance (such as automobile collision policy coverage).

Race and Hispanic ethnicity were collected separately and converted into a single combined variable that includes non-Hispanic White, non-Hispanic Black, Hispanic, and non-Hispanic other people. Non-Hispanic other people includes Asian, Native Hawaiian or Other Pacific Islander, and American Indian or Alaska Native people, and people with two or more races. Missing values for race and ethnicity were imputed as described in the 2019 NHAMCS public-use documentation, available from: https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHAMCS/doc19-ed-508.pdf .

Please send comments or questions to [email protected] .

Data Source

National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey, 2016-2021

Suggested Citation

National Center for Health Statistics. Emergency Department Visits in the United States, 2016-2021. Generated interactively: from https://www.cdc.gov/nchs/dhcs/ed-visits/index.htm

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Island Health

Emergency Department: What to expect at your ED visit

We understand that when you check into the ED, you are not feeling well. We see many different kinds of injuries and illnesses and are prepared for your visit. Our main priority is to have you get great care from our team as quickly and as comfortably as possible.

Why do patients have to wait to be seen in the ED?

The number one priority of an ED is to see and stabilize critically ill or seriously injured patients. Island Hospital’s ED has ten patient beds. In the ED, we are obligated to care for the sickest patients first. A triage nurse will assess your condition shortly after you arrive and you will be treated in order of severity. We can’t predict how many patients may arrive at any given time in the ED. No matter how long you have to wait, we understand it’s not ideal. We make every effort to make wait times as brief as possible. Your patience and understanding are appreciated.

At times when all rooms are full in the ED, hallway beds may be utilized to ensure that you are evaluated by a doctor or nurse as soon as possible.

If you believe your condition has changed since you arrived, please notify a team member.

How long will my visit be?

Every patient’s care plan will be different depending on the types of diagnostic tests and treatments that are ordered. Estimated wait times for certain tests and results: • Lab work: 60 minutes • X-ray: 75 minutes • CT or ultrasound: 120 minutes • MRI: 135 minutes

Based on the results of your testing, additional testing may be ordered.

What happens if I need to be admitted to the hospital?

We do our best to get you to an inpatient bed as soon as possible. When the hospital is at full capacity, we will care for you in the ED until a bed upstairs becomes available.

Island Hospital utilizes a Hospitalist Program that is made up of practitioners who specialize in caring for patients while in the hospital.

What happens when I’m discharged from the ED?

Upon discharge from the ED, you will be given a printed summary of your visit, which will include all tests, procedures, medications given and your plan of care. The summary will contain important instructions for you to schedule a follow-up visit with your own primary care physician or another physician/group. We encourage patients to schedule their follow-up appointments as soon as possible after their ED visit.

In addition, your summary information will be available to view on the myIslandHealth patient portal.

Don’t have a physician? Our staff can help. Call (360) 293-3101.

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Published on September 17, 2021

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Please Call 911 If You Are Experiencing A Life-Threatening Medical Emergency

In the exam room, the distinction between one type of visit and another isn't always clear. It's important to know when — and how — you can bill for both .

BETSY NICOLETTI, MS, CPC, AND VINITA MAGOON, DO, JD, MBA, MPH, CMQ

Fam Pract Manag. 2022;29(1):15-20

Author disclosures: no relevant financial relationships.

In family medicine, it's common for a medical problem to crop up during a routine preventive visit, or for a preventive service to crop up during a problem-oriented visit. For example, let's say you're finishing up a Medicare annual wellness visit when the patient lifts his shirt and says, “Oh yeah, I'd also like you to look at this rash,” which results in a prescription. Or, at a follow-up visit for a patient's chronic condition, you notice he is overdue for a flu shot and colorectal screening, so you perform a preventive visit too.

From a coding perspective, there is a bright line between a preventive medicine visit and a problem-oriented visit. One is for promoting health and wellness, and the other is for addressing an acute or chronic medical problem. But in the exam room, the distinction isn't always clear. The question for family physicians is this: When does the work in the exam room warrant billing for two distinct services?

The answer lies in knowing the requirements for various preventive medicine and Medicare wellness visits, knowing when you've done enough beyond those requirements to also bill for a separate E/M service, and knowing how to document and code it all. The good news is the 2021 E/M coding changes made it easier than it used to be.

When physicians and other clinicians address a medical problem during a preventive or wellness visit, they can often bill for both services.

Knowing the core components of preventive or wellness visits can help physicians recognize when they have done enough work beyond those requirements to bill for a separate evaluation and management service.

Because preventive and wellness visits come with no cost sharing, it's best practice to explain to patients that a separate service performed during the same visit may result in a charge to them.

PREVENTIVE MEDICINE VISITS

Preventive medicine visits (CPT codes 99381-99397) are for patients covered by commercial insurance, Medicaid plans, and some Medicare Advantage plans. Patients value these visits because they are not subject to co-pays and deductibles. After age two, one preventive visit is covered annually.

According to CPT, preventive medicine visits are “comprehensive preventive medicine evaluation and management services of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures.”

Codes 99381-99387 are for new patients and 99391-99397 are for established patients. Both are further broken down by age group. The extent of the exam, the content of the counseling and anticipatory guidance, and the recommended screenings and immunizations vary depending on the patient's age and gender. “Comprehensive” in the CPT definition is not synonymous with the comprehensive exam required in other E/M services. This is a common misconception among physicians and patients alike.

CPT states that if a new or existing problem is assessed and managed at the time of the preventive visit, the physician should also bill a problem-oriented visit (an office visit) on the day of the preventive care. But insignificant problems that do not require extra work should not be billed as office visits. If a patient comes in for a preventive visit and the clinician also looks at a rash or notices the patient's blood pressure is elevated, these observations alone are not enough to bill a problem-oriented E/M visit. There must be some medical decision making (MDM) that occurs, such as prescribing a topical treatment for the rash or choosing not to prescribe a medication for the high blood pressure and instead suggesting the patient change his diet.

Once you've documented your MDM, you can bill an E/M visit using codes 99202-99215 with the preventive medicine visit code. Make sure to add modifier 25 to the E/M code to signal to the payer that two distinct visits were done on the same day.

For more details on when to bill both visits, how to level the E/M portion, and what to include in your documentation, see “ One visit or two? ”

ONE VISIT OR TWO?

Medicare wellness visits.

Original (traditional) Medicare does not cover CPT codes 99381-99397, because Medicare has its own wellness visits with their own “G” codes and requirements. As mentioned, some Medicare Advantage plans do cover the preventive medicine CPT codes in addition to Medicare wellness visits. However, a Medicare wellness visit and a preventive visit should not be billed on the same date of service. Medicare developed the Initial Preventive Physical Examination (IPPE, also known as the “Welcome to Medicare” visit) (G0402) and initial and subsequent annual wellness visits (G0438 and G0439) to encourage Medicare patients to receive screenings and preventive care, and to work with their physicians to develop a personalized prevention plan. 1 The requirements are slightly different for the three codes, but in general they require collecting or updating medical, family, and social history; screening for depression; evaluating the patient's ability to perform activities of daily living; assessing the patient's safety at home; recording vital signs; asking about opioid and substance use; and providing guidance about preventive services and a personalized prevention plan (for more details, see the table in “ Medicare 101: Navigating the Rules for Coverage and Benefits in Clinical Practice ”). Similar to CPT's preventive medicine visits, Medicare wellness visits do not require a full head-to-toe physical exam.

The assessment and management of acute or chronic problems are not components of the IPPE or annual wellness visits. When that service is medically necessary during a Medicare wellness visit, the physician can also bill for a problem-oriented E/M office visit on the same day, again using the appropriate CPT code (99202-99215) with modifier 25.

SELECTING THE LEVEL OF SERVICE FOR THE E/M CODE

Hopefully you're now familiar with the E/M coding rules that changed in 2021. 2 Performing a problem-oriented E/M service on the same date as a wellness visit adds a layer of complexity when it comes to choosing the level of service for the E/M code. But, as mentioned, the new rules actually make it easier than it was before.

When selecting a code (99202-99215) using the new E/M guidelines for office and outpatient services, physicians may use either total time on the date of the visit or MDM. History and exam are no longer necessary to select the level of service (though they should still be documented to provide the best care). This makes it easier to select a level of service for the problem-oriented visit when it's combined with a wellness or preventive visit because there are fewer overlapping components when coding based on MDM. The E/M service is your assessment and management of an acute or chronic condition, which is not required in either CPT preventive services or Medicare wellness visits.

It's trickier to code the E/M service based on time because you must make sure to only count the time spent managing the problems, not the time spent on the preventive or wellness service. The February 2021 CPT Assistant newsletter was particularly clear on this, stating “if time is used for selection of a level of the office/outpatient E/M code, the time spent on the preventive service cannot be counted toward the time of the work of the problem assessment because time spent performing a service cannot be counted twice. The code for the problem-assessment portion of the encounter will likely be selected based on MDM.” 3 It might make sense to consider MDM-based coding as the best practice when combining E/M visits with wellness visits.

A problem-oriented visit includes the history of the problem and any symptoms or complaints related to it. It may or may not include a physical exam or data review (e.g., notes reviewed, tests ordered, tests reviewed, or independent historian). It includes the evaluation and management of a problem or condition. When these components are documented in addition to the preventive visit, add a problem-oriented visit code. For more on which components are required for which visits, see “ How to credit combined visits .”

Let's look at some examples of when it would be appropriate to bill for a problem-oriented E/M code (CPT 99202-99215) along with a preventive or wellness visit.

Patient 1: A 70-year-old male, established patient with a history of diabetes and hyperlipidemia comes in for a Medicare annual wellness visit. All required components of the wellness visit are completed. The patient then asks for a refill of his diabetes medication. The physician asks the patient if he is taking his medication as prescribed and following the diet recommendations discussed during the last visit. The physician also performs a focused physical exam, discusses medication management for diabetes and hyperlipidemia, and orders maintenance labs. The physician documents her significant review of the patient's problems, bills for the annual wellness visit with code G0439, and adds a 99214 E/M code because she addressed two stable chronic illnesses and performed prescription drug management. She adds modifier 25 to the E/M code.

Patient 2: A 32-year-old female, new patient comes in for a preventive medicine visit required by her employer. The physician completes all requirements for the preventive visit. During the history portion, the patient tells the physician that she has been having some knee pain exacerbated by running. The physician obtains additional history about the pain, examines her knee, tells her to reduce her running until the pain subsides, and gives her a handout on knee exercises. He also recommends she try a knee brace and follow up if the pain does not lessen with rest. The physician documents the extra work done to address the knee issue, then bills code 99385 for an initial preventive medicine visit for a patient age 18–39, along with E/M code 99203 because he addressed one acute, uncomplicated injury. He adds modifier 25 to the E/M code.

Patient 3: A 49-year-old female, established patient comes in for her annual preventive visit. The physician completes all requirements for the preventive visit. The patient then mentions she has been excessively tired recently and has been having trouble sleeping. The physician obtains a detailed history of the problems, does a thorough physical exam, and orders some labs (complete blood count and thyroid-stimulating hormone). The physician documents the extra work, then bills code 99396 for a periodic preventive medicine visit for a patient age 40–64 and E/M code 99213 for addressing two acute illnesses (fatigue and insomnia) and ordering two labs. The physician adds modifier 25 to the E/M code.

WORKFLOW TIPS

It's hard to plan for surprise problems that come up during a preventive or wellness visit. But your staff can help by asking patients up front if they have any other issues that need to be addressed. This step should occur when staff are scheduling or confirming patient visits, allowing you to block off more time if necessary.

Scheduling staff should also be aware that Medicare wellness visits have strict rules about how often they can be billed. They must be separated by at least 12 months from the previous wellness visit. Having staff check eligibility for Medicare wellness visits using the HIPAA Eligibility Transaction System can help you avoid denials. 4 The timeframes for CPT preventive visits are more forgiving; they can be performed once every plan year (usually a calendar year, but some plans vary).

Patients who know their preventive/wellness visit will be covered with no deductible or co-pay may mistakenly assume all services provided during that visit, including E/M, will be no cost to them. It is best to educate patients on the costs associated with a problem-oriented office visit and let them know that performing one with a preventive or wellness visit will result in the same co-pay they would incur if the problem-oriented visit was on a different day. Most patients will accept this, because getting both visits in the same trip is more convenient for them. Posting flyers in the exam rooms or waiting room about the difference between preventive/wellness visits and problem-oriented visits, and the costs associated with each, can also prevent patient dissatisfaction.

Physicians could ask these patients to return for the problem-oriented visit on another day, but if time allows for providing both services at the current visit, it is only fair and reasonable to do so. Knowing the rules for combined visits, and the convenience they offer patients, should give physicians the confidence to bill fully for their services.

The ABCs of the Initial Preventive Physical Examination. Medicare Learning Network. Accessed Nov. 15, 2021. https://www.mvphealthcare.com/wp-content/uploads/download-manager-files/CMS-ABC-Initial-Preventive-Physical-Examination-ICN006904-01-2015.pdf

Millette KW. Countdown to the E/M coding changes. Fam Pract Manag . 2020;27(5):29-36.

Evaluation and management (E/M) 2021; AMA CPT Assistant . 2021;2:7-8.

HIPAA Eligibility Transaction System (HETS). Centers for Medicare & Medicaid Services. Updated Oct. 25, 2021. Accessed Nov. 15, 2021. https://www.cms.gov/research-statistics-data-and-systems/cms-information-technology/hetshelp

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Colts hosting ot travis glover on official top 30 pre-draft visit, share this article.

The Colts will be hosting Georgia State offensive tackle Travis Glover on an official pre-draft visit, according to Justin Melo of The Draft Network.

Each team is permitted to have 30 of these pre-draft meetings. It’s an opportunity for the player to come to the facility, where the team is able to have one-on-one time with them to go over film, see how they would fit in the locker room, and to go through medicals if needed.

Glover is listed at 6-6 323 pounds and is reportedly 15 pounds down from that figure this offseason. He was not invited to the NFL Combine, but at his Pro Day, Glover recorded 23 reps on the bench press and a 32-inch vertical with 35.5-inch arms.

You’ll be hard-pressed to find a more experienced player than Glover. A five-year starter with 4,164 career snaps and experience at both tackle positions, along with also playing some left guard.

Over the last two seasons, he has allowed five total sacks and 24 pressures over 707 pass-blocking snaps. Glover ranked 29th among all tackles in PFF’s pass-blocking grade and had his best season in 2023 as a run blocker by that metric as well.

Glover competed in both the Hula Bowl and the Senior Bowl during this pre-draft process.

“I can’t wait to get in the building and learn from the veterans around me,” said Glover in an interview with The Draft Network . “I can’t wait to find my fit and execute our playbook. I feel like I’m going to get better every single season. I’m going to keep developing. I’m excited to compete.

“I’m going to start off by executing small goals once I get inside the building. I want to make the team first and foremost, and then I want to find my way onto the field. I want to make the biggest impact my team needs from me.”

The Colts have invested in the offensive tackle position in recent drafts, selecting Blake Freeland, Bernhard Raimann, and Jake Witt. However, with tackle being a premium position and this draft class loaded with talent, the opportunity to add to this position group at some point will likely be there for GM Chris Ballard.

Glover is projected as a Day 3 pick or potential undrafted signee.

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Patriots reportedly hosting ot prospect on top-30 visit friday, share this article.

The New England Patriots are reportedly hosting Notre Dame offensive tackle Blake Fisher on a top-30 visit on Friday, per NFL Network’s Ian Rapoport.

Fisher could fill a glaring need for the Patriots along an offensive front that looked like one of the worst in the league down the stretch last season. Granted, the group was hampered with a slew of injuries, but the lack of quality depth and youth came back to bite them in the end.

The Patriots are hosting Fisher, along with North Carolina quarterback Drake Maye, who could be within reach with the team owning the No. 3 overall pick in the 2024 NFL draft.

The #Patriots are hosting UNC QB Drake Maye on a Top 30 visit today, source said, along with Notre Dame OT Blake Fisher. https://t.co/mxxBv42HdZ — Ian Rapoport (@RapSheet) April 5, 2024

Former Patriots quarterback Mac Jones’ struggles were well-documented, but a big reason for his problems under center was the lack of consistency in pass protection. If New England does decide to take another quarterback in the first round, they must do a better job of keeping a cleaner pocket.

Going after a talented offensive tackle like Fisher, who is projected as a Day 2 target, would be a major step towards doing so.

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Packers hosted oklahoma ot tyler guyton on top 30 pre-draft visit, share this article.

The Green Bay Packers hosted Oklahoma offensive tackle Tyler Guyton on a top 30 visit ahead of the 2024 NFL draft, according to Bill Huber of Packer Central .

Teams are allowed to host up to 30 prospects on visits ahead of the draft. Packers Wire is tracking all the reported visits  here .

Guyton, a potential first-round pick, has become an increasingly common option for the tackle-needy Packers at No. 25 overall in national mock drafts.

Guyton (6-8, 322) transferred from TCU and eventually made 14 starts and 20 total appearances — mostly at right tackle — for Oklahoma over the last two seasons.

Per Pro Football Focus, Guyton allowed two sacks and 16 total pressures across almost 1,000 total snaps between 2022 and 2023. He didn’t allow a single sack in 2023. Guyton is PFF’s No. 30 overall prospect in the draft class.

Lance Zierlein of NFL.com called Guyton an “ascending tackle prospect” with a “bright future as a high-level pass protector” in the NFL, and he believes Guyton can play left or right tackle at the next level.

At the NFL Scouting Combine, Guyton ran the 40-yard dash in 5.19 seconds, hit 34.5″ in the vertical leap, covered 8-11 in the broad jump and finished the short shuttle 4.71 seconds. His Relative Athletic Score is 9.71 out of 10.0.

Guyton is the No. 23 overall prospect for Daniel Jeremiah of NFL.com .

“Overall, Guyton is still a work in progress, but he has elite traits and tools,” Jeremiah wrote.

The Packers lost David Bakhtiari and Yosh Nijman this offensive, stripping the offensive line of depth and experience at offensive tackle. Guyton may not have guard-tackle versatility, but he could be the ideal developmental prospect at offensive tackle, which could allow the Packers to move Zach Tom — who has five-position versatility — around the offensive line.

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2025 georgia wide receiver schedules tennessee visit, share this article.

2025 wide receiver prospect Travis Smith Jr. will visit Tennessee.

Smith Jr. will unofficially visit the Vols on Saturday, he announced . He visited Alabama on Feb. 3 and Auburn on Jan. 27.

Smith Jr. unofficially visited the Vols on Oct. 14, 2023 and Nov. 18, 2023.

The 6-foot-4, 191-pound four-star wide receiver is from Westlake High School in Atlanta, Georgia.

Smith Jr. is the No. 114 overall player in the class of 2025. He ranks as the No. 13 cornerback and No. 17 player in Georgia.

Tennessee is one of seven Southeastern Conference schools to offer Smith Jr. The Vols offered him a scholarship on Sept. 5, 2023.

PHOTOS: Tennessee’s Wide Receiver U

https://twitter.com/Travis_Smith_Jr/status/1776436727193735360

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Persistence of S1 Spike Protein in CD16+ Monocytes up to 245 Days in SARS-CoV-2 Negative Post COVID-19 Vaccination Individuals with Post-Acute Sequalae of COVID-19 (PASC)-Like Symptoms

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There have been concerning reports about people experiencing new onset persistent complications (greater than 30 days) following approved SARS-CoV-2 vaccines (BNT162b2 (Pfizer), mRNA-1273 (Moderna), Janssen (Johnson and Johnson), and ChAdOx1 nCoV-19 (AstraZeneca)). We sought to determine the immunologic abnormalities in these patients and to investigate whether the potential etiology was similar to Post-Acute Sequalae of COVID (PASC), or long COVID.

We studied 50 individuals who received one of the approved COVID-19 vaccines and who experienced new onset PASC-like symptoms along with 45 individuals post-vaccination without symptoms as controls. We performed multiplex cytokine/chemokine profiling with machine learning as well as SARS-CoV-2 S1 protein detection on CD16+ monocyte subsets using flow cytometry and mass spectrometry. We determined that post-vaccination individuals with PASC- like symptoms had similar symptoms to PASC patients. When analyzing their immune profile, Post-vaccination individuals had statistically significant elevations of sCD40L (p<0.001), CCL5 (p=0.017), IL-6 (p=0.043), and IL-8 (p=0.022). Machine learning characterized these individuals as PASC using previously developed algorithms. Of the S1 positive post-vaccination patients, we demonstrated by liquid chromatography/ mass spectrometry that these CD16+ cells from post-vaccination patients from all 4 vaccine manufacturers contained S1, S1 mutant and S2 peptide sequences. Post-COVID vaccination individuals with PASC-like symptoms exhibit markers of platelet activation and pro-inflammatory cytokine production, which may be driven by the persistence of SARS-CoV-2 S1 proteins in intermediate and non-classical monocytes. The data from this study also cannot make any inferences on epidemiology and prevalence for persistent post-COVID vaccine symptoms. Thus, further studies and research need to be done to understand the risk factors, likelihood and prevalence of these symptoms.

Summary SARS CoV-2 S1 Protein in CD16+ Monocytes Post-Vaccination

Competing Interest Statement

Competing Interests: BP, EBF, EL, CB, and AP are employees of IncellDX. BP, RY, JB, EO, DJ, and MK are independent contractors of the CCTC.

Funding Statement

This study did not receive any funding

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethics Statement: The independent Chronic COVID Treatment Center (CCTC) Ethics and IRB group reviewed and approved the study. All the patients/participants provided their written informed consent to participate in this study.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Abbreviations: PASC, post-acute sequelae of COVID-19; POVIP, post-vaccination individuals with PASC-like symptoms; NCM, non-classical monocytes; IM, intermediate monocytes; CX3CL1, C-X3-C motif chemokine ligand 1; CX3CR1, C-X3-C motif chemokine receptor 1; IL, interleukin; RANTES, regulation on activation, healthy control T-expressed and secreted; CCR, chemokine receptor; IFN, interferon; TNF, tumor necrosis factor; MIP, macrophage inflammatory protein; PBMCs, peripheral blood mononuclear cells; VEGF, vascular endothelial growth factor; LH, long hauler or PASC.

Data Availability

All data produced in the present study are available upon reasonable request to the authors

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Second gentleman Doug Emhoff to visit Arizona for a White House event, NCAA Final Four

Second gentleman Doug Emhoff, the husband of Vice President Kamala Harris, will visit Arizona on Monday.

Emhoff will host an event focused on “lowering costs for Americans,” and he will attend the NCAA men’s basketball championship game at State Farm Stadium in Glendale, the White House told The Arizona Republic.

His announcement means that the president, vice president and their spouses all will have separately visited Arizona since the beginning of March –  a sign of Arizona’s paramount importance in President Joe Biden’s re-election effort this year.

In 2020, Biden defeated his predecessor, former President Donald Trump, in Arizona by less than half a percentage point.

Biden visited Arizona in mid-March to mobilize Latino voters and announce a multibillion-dollar grant for technology giant Intel Corp. under the 2022 CHIPS and Science Act. 

Shortly before that, Vice President Kamala Harris delivered a speech in Phoenix to criticize Republican-led efforts to restrict abortion.

And first lady Jill Biden visited Tucson in early March for another event centered on abortion.

That’s on top of other surrogates, including Michigan Gov. Gretchen Whitmer , a co-chair of Biden’s re-election bid, and Rep. Jamie Raskin, D-Md. , the ranking member of the influential House Oversight and Accountability Committee, who have both visited Arizona recently to campaign on behalf of Biden.

It’s not Emhoff’s first visit to Arizona during the current administration. In 2023, he visited the state with Harris and met with military veterans from the Gila River Indian Community in Laveen Village. And in 2021, Emhoff and Jill Biden toured a pop-up COVID-19 vaccine clinic in Phoenix to encourage people to get vaccinated.

Emhoff’s event focused on the cost of living comes at a moment when polling suggests the public’s confidence in Biden’s economic leadership remains low to middling.

During the pandemic, inflation soared to 13% in metro Phoenix, which at the time was the highest of any major U.S. city. Voters nationwide tend to say they have less confidence in Biden to helm the economy compared with Trump, his Republican opponent in the November election.

Biden’s advisers have been eager to point out that inflation has fallen steeply since its peak during the pandemic, faster than in most of the U.S.’ economic peer nations, and that consumers’ confidence in the economy appears to be rising.

There’s debate among economists whether Americans’ current negativity towards the U.S. economy is warranted. So far, Biden has sought to validate voters’ skepticism even while arguing he has made progress on the issue.

“I inherited an economy that was on the brink. Now our economy is the envy of the world!” Biden said in his recent prime-time State of the Union address. He continued later in the speech: “And there’s more to do to make sure you’re feeling the benefits of all we’re doing."

Laura Gersony covers national politics for the Arizona Republic. Contact her at [email protected] or 480-372-0389.