One winter weekend morning, Susan Mooney was walking her dog when she slipped on the ice, landing on her elbow.

“I couldn’t be sure it wasn’t broken, but I wasn’t taking chances,” said Mooney, 66, a retired licensed vocational nurse and school teacher. “We’ve had the same family doctor for the 35 years we’ve lived here, but the office is closed on weekends.”

Instead of heading to a hospital emergency room, Mooney walked into Durango Urgent Care, where she’d gone a half-dozen times in similar situations. She was seen quickly and learned that she had escaped with only a painful bump.

Mooney’s experience reflects a change in health-care delivery that’s sweeping the country. More people – unable to get timely appointments with their regular physician and unwilling to brave a hospital emergency room where waiting times can be long and the bills eye-popping – are turning to urgent-care centers.

The shift is occurring because emergency rooms, which by federal law must accept all comers, often are swamped. Patients show up seeking treatment for the flu, a minor cut, an allergy, a headache and other problems that aren’t life-threatening,

In fact, the National Center for Health Statistics found in a 2010 survey of 449 emergency-service areas that 83.1 percent of visits could be classified as urgent (43.4), semi-urgent (32.7) or nonurgent (7.0). Only 16.9 percent are classified as true emergencies.

People who can’t find a primary-care provider who’ll take new Medicare or Medicaid patients – whom some doctors shun because of low reimbursement rates and piles of paperwork – also take a place in line at the emergency room door.

In comparison, urgent-care centers generally offer drop-in availability, top-flight medical attention and often a bill that better fits the pocketbook.

Urgent care’s growth

The centers came into their own about a decade ago and caught on so quickly that in 2006 an enterprising emergency-room physician in Maryland started Doctors Express, then licensed franchises in the manner of Subway sandwiches or Grease Monkey auto services.

Doctors Express remains the only nationally franchised urgent-care company. Acquired by American Family Care early this year, is has 69 locations, with the 70th opening this month.

Comparing costs between emergency-room and urgent-care treatment is treading on uneven ground. In addition to what the physician charges, insurance, out-of-network service, co-pays, deductibles, number of tests conducted and facility fees vary across the country.

An Anthem Blue Cross Blue Shield website estimates the average co-pay in an ER is $150-$250 compared with $35-$55 in urgent care.

The American Debt Help Association, citing Medica Choice, a network of 4,000 clinics and hospitals in the Midwest, explored differences between typical ER and urgent-care prices. An examination for an upper respiratory infection costs $486 in the ER, $111 in an urgent-care center; being seen for an earache costs $400 in the ER, $110 in urgent care; treatment for an allergy costs $345 in the ER, $97 in urgent care.

La Plata County has three urgent-care centers as alternatives to emergency rooms at Mercy Regional Medical Center and Animas Surgical Hospital. Average wait time in the Mercy emergency room last year was 15 minutes; Animas Surgical Hospital advertised a 13-minute average wait in 2012.

A fourth possibility is the La Plata Community Clinic, served by volunteer doctors and dentists who treat the uninsured, the unemployed and those of low-income.

3 urgent cares in La Plata

Durango Urgent Care opened in 2006. It is owned by Paula Dunne, a registered nurse, the CEO; her husband, Dr. Jack Cartier, the medical director; and businesswoman Suzanne Cartier Bowker, the chief financial officer. The trio also owns Aztec Urgent Care in New Mexico.

Mercy Regional Medical Center, a member of the Centura Health network, which provided emergency care during the winter at Purgatory for 25 to 30 years, decided in 2008 to keep the clinic open year-round as an urgent-care center.

A recent newcomer is Animas Urgent Care, a spin-off of Animas Surgical Hospital, in Bodo Industrial Park. The doors opened June 25 and the grand opening was Aug. 22.

The three facilities offer treatment to patients who don’t exhibit life-threatening symptoms. They don’t pretend to be more than immediate-access and affordable providers of treatment for nonthreatening issues.

Urgent-care centers treat colds and coughs, cuts and bruises, asthma and allergies, provide sports physicals, handle worker compensation cases and offer X-ray and laboratory services. They can repair simple bone fractures and treat minor burns.

But patients with such problems as a fracture revealing bare bone, chest pains, sudden blurred vision, loss of consciousness, severe abdominal pain or numbness in limbs, are sent to an emergency room.

Safety valve

Paul Gibson, director of emergency services at Mercy, found that the Purgatory urgent-care center played a safety-valve role.

In fiscal 2013 (July 1, 2012 to June 30, 2013), 1,010 people were seen at the Purgatory clinic, Gibson said. Of those, 150 had problems too severe to treat there, so they were sent to the Mercy emergency room in Durango.

The rest were seen by medical providers at the clinic.

The previous fiscal year, 912 patients were seen at Purgatory, with 150 to 170 referred to the emergency room in Durango, Gibson said. The Urgent Care Association of America said there are 9,000 urgent-care clinics in the nation.

The association doesn’t know how many visits the centers divert from emergency rooms, but urgent cares see more than 3 million patients a week and more than 160 million annually.

Durango Urgent Care accepts all insurance and Medicare patients. Medicaid as well as Medicare patients are seen in Aztec. Patients who pay cash on the day of treatment get a 20 percent discount.

ERs and high costs

The use of a hospital emergency room for complaints that could be treated in a lesser setting has become a national trend. Among the ranks of chronic emergency-room visitors are people who don’t have a family physician or who can’t find a provider who accepts Medicaid or Medicare. A study in 2005 by the U.S. Centers for Disease Control and Prevention found that 68 percent of ER cases were either urgent, semi-urgent or nonurgent, in other words, these emergencies could have been handled in an urgent-care center.

It remains to be seen if Animas Urgent Care, open since June 25, relieves pressure on the parent hospital’s emergency room, said outpatient coordinator Lizette Langefels. Animas Urgent Care accepts Medicaid and Medicare patients as well as those with insurance. It has discounts of up to 40 percent on exam fees for self-payers who settle their bill on day of service.

The La Plata Community Clinic is a safety-net clinic that takes care of the indigent and uninsured. Doctors and dentists donate their time, but care is not free. All patients pay something on a sliding scale.

The clinic sees some patients who otherwise might end up in an emergency room, said Sharon Adams, executive director of ClinicNet, an advocate and technical aid provider for 45 safety-net clinics in Colorado.

Urgent care vs. ER

Emergency rooms and urgent-care centers handle cases of different severity. Lists of typical cases for each are taken from various sources.

Urgent-care clinics

Colds/flu

Cough

Diarrhea

Vomiting

Skin infections

Sports injuries

Simple fractures and sprains

Headaches/migraines

Asthma/allergies

Minor cuts

Dehydration

Emergency rooms

Chest pain

Difficulty breathing

Sudden blurred vision

Seizures

Overdoses

Vomiting blood

Fractures with exposed bone

Severe abdominal pain

Severe burns

Loss of consciousness

Numbness in limbs or face