Freestanding Emergency Rooms: A quick alternative to the hospital, or an expensive way to be treated?

When you’re injured, sick or in pain, all you want is medical attention fast so the pain goes away and you can start feeling better. You might not really care where or how you get help just so your problem is taken care of. If you’re unlucky enough to need care in the middle of the night, on the weekend, or far away from your regular doctor, a hospital emergency room might seem like your best option.

Now, at least in Texas, another choice might be what is called a “freestanding emergency room,” or FSER. These are emergency departments that are physically separate from hospitals. They may or may not be associated with an existing hospital system, but if they are independent, they likely have agreements with nearby hospitals if additional care or a hospital admission is deemed to be required.

Since they are so new—the legislation allowing them passed in 2009—experts are still somewhat unclear on the issues surrounding FSERs. Although they claim to provide 24/7 access to care in a comfortable environment with shorter wait times while adhering to the same standards as a hospital-based emergency room, some experts, including Jane N. Bolin, BSN, JD, PhD, professor at the Texas A&M Health Science Center School of Public Health and director of the Southwest Rural Health Research Center, have concerns.

First is the cost. FSERs often look like urgent care clinics, and patients think they will be billed as they would in an urgent care clinic, not as one would expect in a hospital emergency room. FSERs take private insurance, but people will likely have to pay a higher emergency room copay, not the lower doctor’s office (or even the specialist) copay. And although the law requires FSERs to stabilize anyone who walks through their doors, those with Medicare, Medicaid or no insurance at all may be left with medical bills in the thousands of dollars

Bolin also worries that physician credentialing (a term describing complex background checks required when doctors seek privileges at a hospital), in an independently owned FSER might be more lax than in a major hospital system. After all, a handful of physicians—all of whom probably also have an ownership stake in the practice—cannot be expected to police themselves in the same way the board and compliance specialists of a hospital can. Therefore, although many FSERs no doubt have wonderful staff who are just looking for a better work-life balance than they could find working for a hospital, Bolin still cautions healthcare consumers to be wary.

It can be difficult to know where to go for care, but a number of resources to determine the level of care that you need are available to help. As a general rule of thumb, an urgent care center can treat the same things as a primary care doctor’s office, and should usually be used after hours or on weekends. Although they are great for treating minor medical issues, they may not be open 24/7 or staffed by physicians, and they may not have comprehensive laboratory and radiology equipment. Emergency rooms, whether freestanding or attached to a hospital, should be reserved for real emergencies—major injuries or serious warning signs of a heart attack or stroke, for example.

“What I would consider, if it were my husband or one of my daughters, is whether the facility has credentialed doctors who have admitting privileges at a local hospital and is able to handle any situation without having to call emergency help,” Bolin said. “I would be worried about the travel time to the hospital if immediate live-saving care is needed.”

“If immediate life-saving care is needed,” Bolin added, “then it makes more sense to go directly to the hospital.”

In Texas, freestanding emergency centers are licensed under their own law (House Bill 1357), which defines them as a specialized health care entity, separate from urgent care clinics and hospitals. Since Texas—the first state to allow FSERs without a hospital affiliation—passed the law setting licensing guidelines for these facilities, their numbers have exploded from 25 centers in 2011 to 145 today.

Right now, most of those freestanding emergency rooms are in wealthy suburban areas. However, it is probably rural areas—which have a higher per capita rate of emergency department visits that don’t result in hospital admission—that need them the most. “Texas, which is heavily rural, might benefit from FSERs in rural areas,” Bolin said. “When the nearest hospital-attached emergency room is a good distance away, a freestanding emergency room that can be reached quickly could be the best option for lifesaving treatment.”