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Perspectives on the locum tenens industry

Dr. Ken’s Corner: Is the Free Standing ER a Good Thing?

Not to be confused with urgent care clinics, the doors to free standing emergency rooms are open around-the-clock and are expected to provide the same level of care as a hospital-based emergency room. Staffed and equipped to take care of bona fide emergencies — from major trauma to heart attacks and strokes — the free standing ER is an idea that’s gaining popular support from patients and doctors alike. For patients, it means more convenient access and shorter ER wait times. For doctors, it means happier patients and a less stressful working environment.

Dr. Ken Teufel is the Medical Director at Interim Physicians.

According to the The Texas Tribune (August 21, 2015): “Five years after Texas became the first state to permit free standing emergency rooms, more than 160 of the facilities have set up shop around the state — a presence that suburban commuters and health insurers are finding impossible to ignore.” Critics claim that free standing ERs set up shop in wealthier ZIP codes, targeting higher income patients who carry private health insurance. Compared to their hospital-based counterparts, free standing facilities are said to promote a more “boutique” or “concierge” service model.

Adeptus Health (based in Lewisville, Texas), operating under the banner First Choice Emergency Room, is the nation’s largest network of independent free standing ERs; 50 of their ERs are in Texas.  According to The Texas Tribune, Adeptus has doubled its revenue to $211 million dollars from 2013 to 2014.  “In July, the company said it had opened 15 more facilities around the country so far this year.”

Unless they are hospital-owned satellite ERs, free standing facilities cannot bill Medicare or Medicaid; however, they can charge a facilities fee just like the hospital ER. Most urgent care centers do not tack on this additional charge. But, unlike most urgent care centers, free standing emergency rooms have to support services 24 hours a day, 365 days a year, and accept ambulance traffic. As one should expect, going to the emergency room for a minor problem is almost always more expensive than going to an urgent care clinic.

Some patients say they are confused by the terms “urgent” care and “emergency” care, and sometimes it’s difficult to determine whether a problem is a true emergency. Critics of free standing ERs claim they add additional costs to an already expensive health care system by duplicating personnel and equipment at multiple ER locations in close proximity. Perhaps the greatest benefit of free standing emergency centers would be in rural and smaller communities that no longer have a hospital. Then again, can they be financially sustainable in such settings?