In more than a decade of running Mountain Medical Immediate Care in Bend, Dr. Jim Stone has learned just about anything can walk through the door.

One day, it was a man who told the receptionist his mother, who was waiting in the car, was having trouble breathing.

“I stuck my head out the door and looked and mom was sure in the car, in the front seat, but she was in full cardiac arrest,” said Stone, the clinic’s owner and medical director. “Fortunately, she was a little person, I was able to pick her up and carry her into the clinic and started CPR.”

A number of trends in the health care industry — less access to primary care physicians, an aging population, very expensive, often out-of-network emergency rooms — have fueled the proliferation of urgent care clinics across the country within the past decade, not to mention a boon in business for those that were already around.

“It’s an opportunity for people who run a business to have a successful business, and also a product of American culture, which is driven by convenience and expediency, and not waiting a long time,” said Dr. Therese Canares, a pediatric emergency physician with Johns Hopkins Children’s Center in Baltimore who has studied urgent care.

For patients, though, the clinics present an often confusing question of which level of care — urgent care or emergency — is best suited for their particular symptoms. Caregivers in both settings said it’s not uncommon for patients to make the wrong choice and wind up being rushed by ambulance from urgent care to the ER.

“Bless their heart, they’re trying to avoid the ER, but they don’t realize their indigestion, sweating and a little bit of dizziness really is not acid reflux or a flu bug. You’re having a heart attack,” said Dr. Eric Wattenburg, who owns Your Care, an urgent care clinic in Redmond. “The general public can’t always sort that out.”

On the flip side, patients who chose the ER but didn’t need to can be saddled with a several-thousand-dollar bill for the flu.

Further muddying the situation is the fact that there’s no requirement that urgent care clinics be certified — although their providers must be licensed — and no continuity in what services the clinics must provide.

In Central Oregon, for example, Bend Memorial Clinic’s Eastside Urgent Care on Northeast Medical Center Drive offers advanced imaging such as MRI and CT. Its other two only have X-ray and ultrasound equipment. Your Care doesn’t yet have an X-ray machine.

Urgent care providers can have a variety of backgrounds, too; many come from emergency medicine and others from family medicine. Canares said she’s seen urgent care providers with no pediatric experience treating children, or providers with an OB/GYN background treating all patients.

In interviews, providers agreed anything life- or limb-threatening calls for a trip to the ER. One rule of thumb: If patients who can usually walk on their own can walk into the clinic on their own, it’s probably OK to go to urgent care. If not, they should go to the ER, said Dr. Terri Mucha, an urgent care physician and chairwoman of Bend Memorial Clinic’s urgent care department.

Things like colds, flus and other acute illnesses are the “bread and butter” of urgent care, Wattenburg said. Such clinics can also handle minor cuts, burns — even sprains or minor broken bones. Last week, Wattenburg said he handled a patient with a broken bone. In urgent care, providers generally put on a splint or cast and refer the patient to an orthopedist.

“We know that nothing really gets done in the ER besides the evaluation, stabilization and then you set them up to go see the specialist,” he said.

Compound fractures — when the bone is visible through the skin — should go to the ER.

Other conditions aren’t as cut-and-dried. Chest pain, for example, can be related to the heart, lungs, ribs, muscles or gastrointestinal system, so it can be difficult to know where to go, Mucha said. If patients decide to go to BMC urgent care for a more serious issue like chest pain, they should go to the east-side location, where there is more advanced imaging equipment. Urgent care providers said they try to gather extensive patient histories to determine whether or not the chest pain is likely related to a heart attack.

But Beth Reynolds, a registered nurse with St. Charles Immediate Care (the same thing as urgent care), said chest pain is a true emergency, and urges anyone experiencing it to go to the ER.

If they’re not sure whether the chest pain is heart-related, “That’s where the proper place to get it all figured out is,” she said.

Anyone with severe abdominal pain and or signs of a stroke, however subtle or transient, should go to the ER, Reynolds said.

Stoke symptoms can also be elusive — blurred vision and a bit of dizziness, Wattenburg said.

One thing is for sure, though: Skipping the ER in favor of urgent care can save a lot of money. Most urgent care clinics work by charging patients like most outpatient visits to a doctor’s office do: a flat fee to be seen and additional fees for any tests or procedures that are done.

At St. Charles Immediate Care, the visit costs $89 for patients who pay at the time of the visit rather than charging their insurance. A strep throat test adds another $10 onto that, or a cut that requires stitches or staples adds $169. At Your Care in Redmond, a new patient exam costs $129, and visits drop to $109 for returning patients. BMC and Mountain Medical declined to provide rates.

A visit to the ER, by contrast, can easily surpass $1,000. A trip to the ER for a urinary tract infection cost $940 in 2013, compared with $108 at an urgent care clinic, according to a cost analysis by CareFirst BlueCross BlueShield, which operates in Maryland, the District of Columbia and portions of Northern Virginia.

Canares said if people are torn about whether to visit the ER or urgent care, they should try calling their primary care providers, many of whom maintain 24/7 phone lines staffed by nurses or doctors.

“It’s difficult for a family or parent to know, ‘when is it an emergency?’ ‘When is it not?’” she said. “I think because of that culture of convenience and also a little bit of parental anxiety … some parents can end up bringing their child to the wrong place and wasting time and wasting money and wasting resources and not getting the best care for their kid.”

— Reporter: 541-383-0304,

tbannow@bendbulletin.com