From strip malls to pharmacies to freestanding buildings, medical care increasingly is being found outside traditional hospital and doctors' office settings.
Finding the right fit means knowing the options.
"We believe our job is to educate the public on which level of health care might be the best for what they're experiencing," Porter Health Care System CEO Jonathan Nalli said. "Our position is that whenever you're feeling something that's not an emergency, you should always contact your primary care physician. If it's an emergency, always call 911."
Those in-between times are where urgent care and immediate care center type facilities come into play.
"The last 20 years, we've seen an increase in emergency department visits that are lower acuity," Nalli said.
A full or closed doctor's office can have people turning to urgent care centers.
“When the doctor’s office has closed for the evening or over the weekend, our outpatient immediate care centers accept patients on a walk-in basis,” said Janice Ryba, CEO of St. Mary Medical Center.
Their facilities have fully-equipped exam rooms and are staffed by physicians who specialize in family and internal medicine. They also have full diagnostic capabilities, including lab, general cardiology testing, X-ray and other imaging services, she said.
Before urgent care facilities, people often used emergency rooms for primary care or they would suffer through the night and try to call their primary physician first thing in the morning, Nalli said.
The cost of visiting an urgent care center often is more than a visit to a doctor's office but less than an emergency room trip.
The cost structure falls between the two because the level of resources expended on a patient is less than in an emergency department, Nalli said.
At the immediate care centers of Community Healthcare System, billing is comparable to one of its physician offices, which is less than a hospital emergency room visit, said Craig Bolda, COO of St. Catherine Hospital.
Community Healthcare System has been experiencing an increased demand for immediate care services, Community Hospital CEO Don Fesko said.
“Emergency departments need to treat the sickest, most critical patients first," he said. "Although patients in our hospital EDs come in on an emergent basis, we’re finding that the majority of them are being treated and released. Most patients who are treated and released right away typically have conditions that could have been seen, diagnosed and treated in an immediate care facility."
Staff at the health care system's immediate care centers treat minor illness and conditions, such as flu, mild asthma symptoms, burns, rash, animal bites, broken bones and sore throats, he said.
Janet Doms, regional director of emergency services for the Northern Indiana Region of Franciscan Alliance, oversees Franciscan ExpressCare in Crown Point. The ExpressCare facilities serve as an alternative to the emergency room for patients who have a non-emergency illness or injury, she said.
"I think, historically, there wasn't that convenient level of care available," she said.
Not every emergency room is inside a hospital.
Chesterton Health & Emergency Center, which celebrates its one-year anniversary this month, is one of the few standalone ER facilities in the state.
"It is a 24-hour emergency room, not urgent care," said Trish Weber, vice president of operations and chief nursing officer. "It's exactly the same as any other emergency department. It's just freestanding."
The center, owned and operated by Franciscan St. Anthony Health hospital in Michigan City, is staffed with board-certified emergency physicians and nurses and has equipment to handle emergencies.
Travis Thatcher-Curtis, clinical manager/EMS coordinator for the Chesterton and Michigan City facilities, said the emergency center is well-received in the community.
"It's overdue to have this sort of service," he said.
The facility includes trauma rooms, a full lab, imaging and a helipad.
Ingalls Health System operates similar facilities in Illinois, called Ingalls Family Care Centers.
"Our urgent aid is an extension of the Ingalls emergency department," said Beth Rose, director of the Calumet City location. "We used to be an urgent care type setting where we'd shut down at 8 or 9 o'clock. We went 24/7 twelve and a half years ago."
Staff have treated minor gunshot wounds and stabbings and have delivered babies, in addition to handling sinus infections and sprained ankles.
Methodist Hospitals does not operate any urgent care centers for now, but its emergency rooms have procedure rooms for immediate care and safe rooms for sensitive situations, said Victor Garcia, director of emergency and critical care services for Methodist Hospitals.