There’s been a lot of confusion around COVID-19, vaccines, testing, and quarantining. In this episode of The Frisco Podcast, Dr. Jay Woody, founder of Legacy ER and Urgent Care, provides clarity and offers guidance, and shares how to ensure you’re not overpaying for acute care.
[00:54] Legacy ER’s success story
[03:27] What sets Legacy apart
[08:30] About the COVID-19 vaccine
[13:58] Doubts on COVID-19 testing and isolation periods
[21:30] COVID-19 testing at Legacy
[27:14] Find Legacy ER online
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Welcome to the Frisco Podcast. I’m your host Scott Ellis. In this episode, we are having a chat with Dr. Jay Woody, the founder of Legacy ER. And we’re going to talk a little bit about Legacy ER and the topic of the day, COVID. So, Dr. Woody, welcome to the Frisco Podcast.
Thank you for having me. Excited to be here today.
Thank you, good to have you here. Um, obviously with everything going on, there’s a lot to talk about, particularly around COVID. Uh, but before we get into that, I wanted to talk specifically about Legacy ER. That is a business that you started. It’s something that I would call a “Frisco success story.” Um, but why did you start Legacy ER, and uh, how long have you guys been in business now?
So, my background is I’m Board-Certified in Emergency Medicine. Uh, worked in the traditional hospital, big hospital, ER settings. Uh, spent, uh, all my formative years down at Parkland Hospital, our level-one trauma center here in Dallas. And then sort of moved out to some other hospitals that most of you be familiar with in the community. And what, what, uh, I really saw was the patient experience was, was typically lacking and there also were a lot of patients that were coming through the emergency department. They didn’t actually need to be in the ER. They needed acute care, but they didn’t need emergency services. And what was happening is those patients that needed acute care, but not necessarily emergency care, they were being penalized financially by the big bills that we all know come out of the emergency department. And so, sort of taking my, my sort of passion of improving the patient experience and also, uh, including that billing experience as well. That’s really the genesis of where Legacy ER & Urgent Care, you know, came, came from. And we opened our doors in August of 2008. Uh, back when Frisco was just a tiny, tiny little arm town, um, which, uh, for those of you that were here then, or remember, you know, it was pretty much a bunch of dirt fields where we opened up our original location on Main and Legacy. And, uh, obviously things have changed in the last, you know, 12+ years. And now of course we’re surrounded by retail there and where we don’t have farm fields around us anymore, but it’s been very, very exciting. We now have two locations in Frisco and a total of six locations here in the North Dallas area. Uh, we, we’ve also been blessed to, uh, have a sort of success story that’s very Frisco-centric and we now have, uh, additional two facilities in New Mexico, uh, three facilities in Indiana and, uh, one facility with another one soon-to-open in Florida. So, uh, really, you know, I live in Frisco, been here for about 16 years. And so this is, I I believe as a Frisco-success story and I’m excited to still be here and, and intimately involved with the business and care for the people of Frisco.
Well, good. And we’re glad to have you here and thank you for opening those up. I know that early on, when we first started chatting with you, you wrote an article for Lifestyle Frisco about the difference between the different kinds of urgent care facilities, and hopefully I’m broadly classifying those. There’s ER, like Legacy ER, but then there are other types of facilities that are also, I guess, urgent care, but the way they operate and the way they bill are kind of different.
Yeah. So, so I think, you know, I think we all understand the traditional hospital-based emergency room and we know how they bill. Is it’s it’s ER billing. Uh, and then sort of in 2000 about 2010, um, there became this trend of freestanding ERs, which I think, again, a lot of us probably saw the, the rise and sort of the fall of those. Those facilities where emergency rooms outside of a hospital, but they also only did emergency billings regardless of what type of care or level of care that you needed. It was emergency billing. So for example, if you just had a simple strep throat, they could definitely handle that, but it’s gonna, it’s gonna cost ya, you know, at least a thousand plus dollars for that. Um, and so the difference in what our model does is we have urgent-care billing for those minor problems such as strep throat.
And we have ER billing for those cases that typically would have to only be cared for in a hospital emergency room. So for example, people needing a CT or cat scans, sort of advanced labs or imaging. Uh, normally you have to go to the hospital to get that, but with our model, you can use those levels of service. As well as if you don’t need those then you’re not going to pay that emergency bill. You’re going to have to lower urgent-care billing. So that, that is what is unique about our model and, and, and, you know, makes us sort of sets us apart. And obviously that’s good for patients because healthcare is super expensive. So you, you really only, only want to pay for the, the care that you need and not for anything more or anything less – works both ways. And so I think, uh, you know, that’s, that’s what makes this model very patient-centric. We’ve also found that the payers like it because it saves them money as well. But we’ve also found that little businesses that are self-funded like it because if their employees go to the ER and they don’t need our services, that that business is going to pay a lot for having the level of service that their employees didn’t need. So this, this model is you connect it helps all three of those sort of pillars of the, you know, the community and healthcare system.
That’s good information because I have a feeling that the billing side of that and the differences are something most people were just not familiar with and wouldn’t know that one’s going to be more expensive than the other, even if the treatment’s the same in many cases. So knowing that you guys can, can adjust accordingly is, is very helpful.
Yeah, no, and I think it takes the guesswork out of patient’s hands because a lot of times, for example, I’m a parent. And so I know how, you know, I wear a parent-hat sometimes. I wear a doctor has sometimes. So most of us that are parents, if our, if our child is injured, say, you know, falls out of a tree or off the monkey bars, you know, we panic a little bit and we say, “Hey, where do we go? And we can go to the pediatrician. Can we go to the urgent care? Or we need to go to the ER.” And if you’re not sure most of us default to the, to the highest level of care, we say, “You know what? It’s my kid. I’m gonna go to the ER, ’cause I know they can take care of him.” And that’s absolutely true, but if they don’t need the ER, then that’s where that sort of financial penalty comes back and hurts you.
But again, you know, we’re, we’re asking patients to sort of be medical providers and most of us didn’t get that training. And so it’s not fair to put people in a position where they have to pick and if they pick wrongly, then, um, you know, they penalize one way or the other. The converse can be there as well. For example, if you ended up going to, uh, only urgent care, but you needed that higher level of care, well then, now you’ve got, you know, ambulance, uh, involved, transporting you to another facility. You know, you’ve got two co-pays or two, you know, two times hit your deductible. So again, our model solves for you. Don’t have to know. You don’t have to be a medical clinician to figure out, you know, where- do I go to the hospital? Do I go to the freestanding ER? Do I go to an urgent care? You just, you come to us and we’ll make sure that you take care of, and we’ll also make sure that you only get a bill that’s appropriate with the level of service that you needed.
In Frisco-proper what locations do you have for Legacy ER?
Yes, we have two locations in Frisco-proper. Um, one is at Main St. & Legacy. And the other location is at Custer & Eldorado. Also we’ve got McKinney, Allen, Coppell, and North Richland Hills. So kind of, you know, across the whole sort of North-Dallas-metroplex area.
That sounds good. Just so that you know, people in the community know where to go. Okay. Next up is, uh, we’re going to talk a little bit about COVID. This is obviously the topic du jour. There’s a lot of information and I think sometimes very confusing information being spread around the disease itself, around the vaccines that are coming out, uh, so on and so forth. So I wanted to ask you a couple of questions specifically- COVID specific, uh, first and foremost, um, let’s talk about the vaccines real quick. And what do you know about them? I, my impression is that these vaccines have been well tested. They are safe despite the fact that they were brought to us in record time. Um, but what have you been hearing? What do you know about getting vaccinated and should people be looking forward to getting vaccinated as soon as they’re able to do so?
I’ll start off with saying that, uh, I am, uh, very much looking forward to getting vaccinated. I obviously being on the front line, um, you know, uh, in the sort of front of the queue, if you will. And I do believe in, uh, the vaccine and I think, um, you know, that’s given me hope sort of, as we close out the end of this year, you know, the vaccine is sort of one of the most helpful things for me and other health care providers, you know, for where we’re going forward. So with that being said, I know there is definitely some apprehension out there because of the vaccine was developed so quickly. I get it. You know, I, as much as I know, I’m not an expert in vaccines. I’ve done a lot of reading about them and based on my understanding and based on you know people much smarter than me and experts in this area, you know, I feel comfortable with these vaccines and, and frankly impressed with the effectiveness of them because I think what most people don’t realize, you know, we, we all know about vaccines.
We’ve been getting them all our life and most of them are good. Most of them are not great, but they work because everyone gets it. And so we sort of get that herd immunity that people are talking about. These vaccines are- even the ones that aren’t the best are actually in the “great” category, my opinion. And so I think any now- there’s a couple of manufacturers that are making these vaccines. Um, I, you know, I think they’re, they’re safe and they’re effective. And I am, like I said, looking forward to, uh, getting mine and sort of navigating that right now, because not only is important for me but it’s important, important for all the healthcare providers that you know, and my employees, because we, we got to keep them safe so they can continue to sort of help you and the others if you fall ill.
Yeah, absolutely. And I know that you guys definitely are on the front lines of this, and we’re very grateful for everything that the healthcare providers have been doing to, to try to keep us all as safe and healthy and moving forward as possible.
Well, thank you. It has, uh, no doubt been a, a challenging year for, I think all of us in Frisco, in Texas, and essentially the whole world. So, uh, and then especially challenging for those of us in the healthcare field. So again, that’s why, uh, I’m hopeful that the vaccine has arrived. There’s been a lot of talk about it, but now the fact that I personally know colleagues that have received the vaccine, um, I’m excited and like I said looking forward to looking forward, to get getting, getting mine and starting that process since it’s a two, two-shot process.
Yeah, that’s right. It’s one and then a second, a couple months later.
Well, think it’s one and then depending on which vaccine it is, it can be three weeks to, uh, some more after that. Um, but yeah, it is. And I will emphasize too, it is important to get that second round or else the vaccine isn’t as effective as, uh, the sort of the numbers you might’ve heard in media.
Very good. So I, I, without getting too deep into the science that would probably elude most of us anyways- as I understand that these are, uh, mRNA based vaccines, which are a little different than what we’ve had in the past. And the technology behind that’s kind of fascinating and how they actually engineered these differently than vaccines that we’ve had in the past. So do you think that plays into the efficacy, though, of them? Is that part of why?
I think so because, uh, the, these are fascinating, um, vaccines and the technology behind is very fascinating. And so, uh, essentially what, you know, in the old days they would take, you know, a virus or something and they would weaken it and expose a person to it. And so your body kind of attacked it and built up antibodies to it. Sometimes they would take pieces of the protein of a virus or whatever it is, your vaccine again, and give that to a person so that your body can, again, build up an immune response to this. The way this vaccine just, I won’t get too technical, but in a nutshell, it’s basically, uh, put in these little lipid mini lipid droplets, which is why the sort of temperature control is so important because this lipid is, is unstable. And the mRNA is, is put into your body and your cell incorporates that MRA and actually starts sort of making, uh, making its own back, making the products that helps your body amount an attack. So very different technology. And I think that that, that is why the efficacy of it is so great because your body- your own body’s immune system is doing the work to make this happen.
Interesting. Um, let’s talk about testing. Some people have been, certainly have gone out and gotten tested. Other folks, um, have not been tested, uh, once you’ve been tested, if you get a positive result, there’s typically some kind of quarantining protocol that goes along with that. Um, and then it may be even different whether you’ve been potentially exposed to something or you’ve got full-blown COVID. And to be honest, I’m not even clear on, you know, if that happened to me, what is the quarantining protocol? What am I supposed to do? How do I know when it’s safe for me to be around other people again? Can you maybe clarify that for us a little bit, just so that as people are, uh, you know, potentially a situations where they might be exposed to somebody or they find out later somebody they were around was exposed or had COVID and you have some idea of what looking at doing or how they’re going to handle it?
Yeah. It has been a very confusing and there’s been constant changing on that. So, um, I appreciate the opportunity to kind of help hope, uh, direct people so that we can also work together to help each other and get us, get us out of this pandemic. So I’ll start with the person who is positive, because that one, that one’s sort of the easiest, uh, if you will. So if you test positive, the current CDC recommendations are that based on the day that the symptoms started, not necessarily when you took the test, but the day the symptoms started, that’s day 1. And you basically need to march out 10 days post the day that your symptoms started. And then on that sort of last day, if you are fever-free without taking, you know, Motrin or Tylenol or anything like that, and, and this is fever-free, and you have improving symptoms, you are out of quarantine. There’s confusion on when does-
When do I start counting my days? And it’s not, it’s not the day you tested positive. It’s- because typically what happens is a guy starts to feel bad, and then all of us are in denial and we’re like, “Oh, I’m sure it’s nothing.” And then the next day, our significant other says, “Hey, he really need to go to the doctor.” And so you go in and they test you and you’re positive. But that’s like, you’re on day 2 now, because your symptoms started that day. It’s not from the day of testing. And then again, you got to march out those 10 days, and then assuming, no, no fever and assuming improving symptoms, not no symptoms, but improving symptoms, then you are free to roam about the city.
We don’t want to encourage too much of that, but I understand that the point- with your mask, of course. With your mask, of course. Okay. So that’s the situation for “I’ve got symptoms. I’ve tested positive.”
That’s right. So let’s take the scenario. You live in a household where somebody tests positive. And so now you’re saying, “What, what do I and the rest of my household need to do?” Well, one is I would even quarantine that person in the home themselves. And I would also have them wear a mask if they come out to sort of any common areas, just sort of to help prevent the spread to the others. But the other people in that household, or if it’s at work or wherever it is you got exposed, um, you- now, there are two pathways that the CDC has come out with. They, they both require that you have zero symptoms during the monitoring period, but there’s two, the two pathways are, one is again, the date of exposure is Day 1. You march out 7 days. And if you’ve had zero symptoms within those 7 days, you can get a test done. And if that test is negative, you, you’re out of quarantine. The other pathway is again, start at Day 1 of exposure. You march out 10 days with no symptoms. And at the end of the 10 days, you’re out of quarantine.
Gotcha. Okay. That’s very clear. I think that makes total sense. So hopefully everybody will be able to follow along with that easily enough. And it gives us some idea of what to do if they have been exposed to someone that don’t have symptoms, or if they’ve actually tested positive, and now they know what, you know, kind of what they’re in for.
That’s right. And just to clarify, this is a change from what the quarantining recommendations used to be. It used to be 14 days post-exposure. So again, if some of those, some of your listeners are thinking, “Wait, I thought it was 14 days,” it used to be there was only one pathway. And it was 14 days if you have no symptoms, you’re, you’re out of quarantine. CDC revised those in order to try to encourage compliance. There is a slight increase of risk missing a few people with the two pathways I described. But those are the currently accepted recommendations. Um, and it also- the hope is that will increase compliance because what was happening is I think not everybody was staying at full 14 days. And obviously then we were getting some people that were positive that were out in the community, kind of spreading it around. So I, too, hope that the sort of shorter period will help everyone, you know, try to be as diligent as possible and stay compliant.
So that leads me to another question. And that is about individuals who may have contracted or have contracted COVID, but are asymptomatic. We’ve all heard a lot about asymptomatic spreaders. And I think that confuses a lot of people as well. Um, so I’m hoping you can maybe enlighten us a little bit to- if somebody gets tested for whatever reason, has a positive result from that test, but never shows any symptoms, there are still the risks that people who’ve been exposed to them in that timeframe may come down with COVID, correct?
That is correct. And going back at what does that patient that you described, um, where, what is their time frame start? Since they had, if they truly had zero symptoms, then you use the day of testing “positive” as Day 1. But, you’re right. We don’t really know when they were contagious, how many days prior to the testing. And so that’d be- that sort of, you know, contact tracing is ideal. Um, I know there’s not a lot of that going on, but that is something maybe people heard about, you know, contact tracing, but that would be where, you know, anyone that the person that turned positive or anyone that they sort of have been around, not social distanced, and, you know, over the certain period of time prior, you can notify them. So then, one, they can either be tested, or follow the exposure/quarantine recommendations. I think it’s very complicated. And I think that’s one of the challenges why compliance has been difficult. Because one is, um, you know, not clear messaging, two, the messaging is very confusing, and three, it has changed over time and morphed. And so again, I get it and understand it and I sort of live it every single day. I still have to, uh, you know, I still am challenged to, to keep up with what’s the right thing to do.
Yeah. Understood. But I really appreciate the clarification on all of those fronts. And hopefully anybody that’s listening to this, uh, here in Frisco will- it’ll make sense to them, but we’ll also have it written up on the page that this episode will be on, on the website. So, uh, hopefully this will give people a little bit more clarity around what to expect. And then last but not least, if someone wants to get tested for whatever reason, can they come to Legacy ER for that?
Absolutely. So, um, sort of a good segue if it’s okay. Kind of talk about the testing and the different testing. So, so there are a number of categories of testing. There, there are, there’s something called antigen testing. Um, this is testing for active disease. And it’s, it’s that type of test is looking at, um, some of the parts of the virus itself. Now there’s another type of testing called PCR testing. And that actually is looking for the mRNA that or the RNA that’s actually within the virus. Uh, there, there is some discussion about which test is better than the other. From, uh, all the data that I’ve looked at, they’re very similar, but the PCR test is considered the gold standard. The problem with the PCR testing is currently most of that has to go to a reference lab and it’s taking from 3 to 10 days to get those results back.
So you’re a little bit of a disadvantage because of the time frame, even though it is potentially a slightly better test. Um, there is, uh, more access to rapid antigen testing. Um, and the benefit of that is in 15 minutes, you have a result from that test. Now, the test is “negative,” there are some caveats to that. If the test is “positive,” then it’s “positive” and you need to do the things that we just talked about. And Legacy ER, we have access to both the rapid antigen testing, and we also have access to the PCR testing. So you can get either one of those tests. Again, both testing for active disease. Um, there’s also some- you might’ve heard of something called antibody testing and that’s actually looking for antibodies within your body, uh, that would show that you have been exposed to COVID-19 previously. Not currently, but previously, and it’s looking for something called IgG. It’s an immunoglobulin. And that typically shows up, uh, about 3 to 4 weeks post-infection. So, so for example, if you were sick with COVID right now and I checked for your anti-body, then yours would most likely be negative.
Okay. Interesting. So, how, I guess, practical for most people is that test? It seems like the PCR or the other one would be better to find out if I’m actually gotten sick.
Yes, absolutely. You’re right. The antigen testing or the PCR testing are obviously- those help us determine, you know, quarantining, you know, exposures, all those things. The antibody testing is probably a little bit more of a novelty. Um, you know, gosh, I was sick three months ago. Really bad: high fever, cough. Was it COVID? I would like to know. Like, do I have antibodies to COVID or do I not? Um, so I think it is helpful in some ways, as far as expert regarding, but it’s not helpful sort of acutely right now because you know, we really, right now we’re dealing with active cases and active disease and the rapid antigen test or the PCR test, or- that’s what we need access to today to, to help direct people and guide them, you know, what, what do they need to do to protect their friends and family.
Okay. That makes sense. So before we, uh, before we knock off here, is there anything else regarding COVID or Legacy ER, that you would like to leave us with before we-
Yeah, so a couple of things. One is, uh, just, uh, reaffirm: we have, you know, like CR we do the rapid antigen testing. We can do the PCR testing. We can also do the antibody testing. So those are all available, available to those who need it. And, you know, the other thing is we’ve gone to great lengths to protect our patients who come through. And I think that’s something particularly beginning, you know, people were not accessing healthcare and they were winding up getting into trouble, you know, having, uh, complications with appendicitis or not seeking, you know, the health or injured extremities and things like that because everyone was so afraid of COVID. But what, what I can reassure everyone is, you know, we have all the proper PPE equipment. Um, we’ve actually invested in some pretty cool technology that has ionizing radiation to sort of clean our rooms. Um, make sure, you know, all the countertops and services are, are code-free. And so I think just to sort of put people’s minds at ease, if you come in and we’re gonna keep you safe and we’re keeping our employees safe so that they can continue to take care, take care of you.
Good. Well, thanks again to you and all of your staff for being there for us when we need you, whether it’s COVID or something else, we appreciate you guys hanging in there.
Absolutely. And I am appreciative of all of the people in the Frisco community. They’ve been very supportive of us. We’ve had lots of nice notes and, and treats and well-wishes from everyone. And so we, during this time, when, uh, sometimes it seems overwhelming the number of patients coming through the bombardment with COVID-19 is continuing to rise despite our best efforts, you know, the support from the community has really helped us. So thank you, you know, City of Frisco for, for what you’ve done for us.
Very good. And last but not least, if people want to find out more about Legacy ER, where can they go?
You know, I think, uh, the best place these days is online. Um, you can just, uh, you can just Google Legacy ER Urgent Care and it’ll show us all. It shows all our locations. There is a specific area that talks about COVID-19, um, informational plus the testing details. Um, there’s also a pretty cool, um, FAQ section about COVID-19 and testing. So I think that would be a great resource to go to our website to learn more about COVID and testing and sort of what Legacy ER & Urgent Care offers in that regards.
Okay. And if they wanna go straight there, what is the website URL?
Um, it is, uh, www.legacyer.com.
Alright, there you go. We’ll make sure to link that up in the show notes along with the transcript of everything we’ve talked about here today. So I want to thank you again, Dr. Jay Woody for joining us on The Frisco Podcast.
I appreciate your time and thanks for letting me, uh, offer, uh, some, some information today.
Thank you to all of you who are tuning into The Frisco Podcast. We appreciate you listening in and we’ll talk to you next time.