practice management

PM Pediatrics: Keeping Children Out of the ER and Urgent Care

Children will always end up in urgent care and the emergency department (ED). There’s no avoiding it. But many children end up in these care settings because their guardian didn’t know that their pediatrician was available — or didn’t want to “bother” them outside of office hours. 

While families should always seek immediate care if a child is experiencing trouble breathing, unconsciousness, or another life-threatening emergency, let’s explore ways to help keep children out of emergency settings for non-critical conditions or concerns. 

Why do most children end up in urgent care?

Most guardians will take a “better safe than sorry” approach when it comes to seeking care for their child. Most often, we see children being brought to urgent care or the ED for:

  • Newborn concerns. The ED is often an expensive source of reassurance for parents. Many newborns end up in these settings when they come down with a fever, or when a family isn’t familiar with what can be expected (e.g., a low-grade fever).
  • Asthma. Trouble breathing, especially after physical activity, often creates an immediate cause for concern. But when a child already has a care plan in place to manage their asthma, their pediatrician can provide recommendations to address the concern without an emergency visit. Regular well or telehealth visits can keep asthma under control and are less scary for patients: be sure to have a strong recall program for these patients.
  • Simple injuries. When a child is bleeding or crying, it can strike an adult as being an emergency. But many times, removing an object from a child’s nose or treating a sprain can wait to be addressed by the child’s pediatrician. Your practice may even have the equipment necessary to set bone breaks and other similar injuries, so it’s important to make sure parents know this.

Keeping patients out of urgent care or the ED

Many challenges come with seeking care for a child outside of a pediatric office. When your patient ends up in urgent care or the ED:

  • It leads to lost revenue for your practice. First and foremost, the urgent care setting receives the revenue for the encounter. But in some cases, insurance carriers hold it against the primary physician when a “covered life” has ED or urgent care experiences. This black mark against a provider can undermine the meeting of financial goals, and when a clinical benchmark for a practice isn’t met, the practice could fall into a lower payment tier for all patients on that same plan.
    • The child won’t receive continuity of care. The provider who sees a child in these settings won’t know the patient like you do. As a result, they might even suggest care that doesn’t align with a current plan of care, or will suggest a treatment that unknowingly conflicts with the best interest of the child and/or their family.
  • It creates an unclear paper trail. Pediatricians won’t always get the information they want from the ED after a child is discharged. Still, EDs will recommend that the patient see their primary care provider, often within 24 to 48 hours after the emergency visit, leaving the pediatrician to play catch-up.
  • The child is exposed to a medical setting/illness. Medical settings designed for adults can be difficult for children to visit, and these visits increase the chance of a child being exposed to someone with a serious illness. And because it’s difficult to find emergency evening or weekend care, siblings who come along are often exposed as well.

Help families know where to go

As their child’s care provider, pediatricians play an important role in educating families on when a health concern requires immediate medical attention, and when it can be handled at the pediatric office.

Most guardians want someone to physically see their child and tell them if immediate care is needed. But many times, families feel guilty about contacting their pediatrician outside of normal office hours — or they simply don’t know that it’s an option.

In an effort to give families peace of mind, we’ve seen pediatricians succeed in keeping their patients out of urgent or emergency medical settings when they promote the following services:

Patient portal

Families enrolled in the PCC patient portal are able to send images and messages directly to you via PocketPCC, which can help alleviate their concerns and avoid unnecessary trips to urgent care. They are also able to engage in asynchronous communication to get the quick answers they need to determine next steps for their child’s care. These communications are saved directly to the patient portal for later reference, and since the portal is linked to your EHR, the information is always secure and up to date. And it’s all included with a PCC subscription.

Walk-in hours

Many families will just assume that their pediatrician can’t see their child at the last minute. Make sure that your patients know about your walk-in hours and that you intentionally create time for same-day sick scheduling when reasonable. If families know that you can often see their child on the same day when their child is experiencing a non-emergency health concern, they will skip the trip to urgent care and head directly to your office.

Pediatric telehealth and phone visit capabilities 

Sometimes, families just need reassurance after hours that their concern can wait for the morning. Other times, a family might not know if telehealth and phone visits are covered by their insurance. As a result, they often don’t consider these services when it comes to sudden care needs. 

Helping families understand what is covered, and being transparent about how these costs compare with in-person visits, can help you increase telehealth utilization and limit ED visits.

Credible online information

Families will always turn to their pediatrician for information about their child’s health. PCC licenses content curated by the American Academy of Pediatrics (AAP), allowing you to put credible, timely information into the hands of the families you work with. Paired with a patient portal, you can easily send this information (or provide it directly on your website) to educate families and give them the knowledge they need to make educated decisions around their child’s health.

For practices that want to go a step further, you can create accessible videos, blog posts, or social media posts for your community to answer common urgent questions about fevers, colic, sleep, concussions, and more.

Make sure to bill for all care provided

If you see a patient on the weekend or outside of normal working hours, make sure to bill for after-hours care — even if an insurance carrier will pass the cost on to your patient. 

The AAP has a saying: No margin, no mission. It’s important to properly bill for the services you provide. While you may feel uncomfortable knowing your patients will pay more, it’s important for patients to see the value of your time, especially when you step away from your personal time to provide care.

There’s also a long list of care that many pediatricians may not realize they can bill, including:

  • Treating sunburn
  • Removing nasal foreign bodies
  • Removing splinters
  • Treating nurse maid’s elbow
  • Supplies used (e.g., splints, ACE bandages, crutches, etc.)

Not only is billing important to your practice, but carriers require that you report all of the treatments you provide. Making time to regularly review what can be coded will help you remain operational and able to take care of your patients.

Develop a pediatric urgent care mindset

A lot that goes into keeping patients out of urgent care and the ED revolves around communication. PCC offers the tools that make it easy to keep in touch with your patients (and keep them out of emergency settings). Reach out to us — we’re excited to speak with you about ways to improve access to care, communication, and your practice’s bottom line.

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PCC has been offering pediatric-specific software, support, and practice management advice for over 30 years. Our goal is to remove the obstacles so that pediatricians can serve communities, improve their practice, and remain independent.