Rice study: Separate ERs don’t ease waits elsewhere
A key selling point when freestanding emergency rooms got their start in Houston a decade ago was they would offer full-service emergency care without the long waits and congestion of traditional hospitals.
But new research from Rice University economists shows that the walk-in emergency centers appear to have had little effect on the length of wait, treatment time, or overcrowding in the emergency rooms of the state’s biggest cities.
In fact, the Rice study suggests that the rise of freestanding facilities have increased the public’s overall use of emergency care — often an inappropriate choice for routine illnesses and injuries and usually the most expensive option.
“It’s clear freestanding emergency rooms are not working as a substitute for overcrowded hospitals and that was a claim that was made,” said Vivian Ho, a health economist at Rice’s Baker Institute of Public Policy and co-author of the research that appears online this month in the American Journal of Emergency Medicine. “I’m concerned that any ER visit has a higher price, and these are contributing to the overall costs of health care in Texas.”
The Texas Association of Freestanding Emergency Centers, the industry’s trade group, came to an entirely different conclusion from the Rice study, blaming insurance companies for contributing to crowding in traditional, hospitalbased ERs by steering patients away from their walk-in centers, many of which are not in insurer’s networks.
“Freestanding ERs exist to provide greater access to patient care — whether in Texas’ largest cities or more rural parts of the state,” the group said in a statement. “When compared with hospitalbased ERs, the wait times are shorter, the cost of care is comparable to, if not less, and the resulting hospital admission rates are roughly 20 percent less.”
Overall emergency room wait times have dropped in recent years across Texas hospitals, according to federal data. But Ho said her study found that the presence of a nearby freestanding emergency center in the state’s urban areas had little or no impact on waiting times.
In Houston, a patient with a broken bone can wait from just under one to three hours to receive pain medication in an ER, according to
“Freestanding ERs exist to provide greater access to patient care.”
Texas Association of Freestanding Emergency Centers, in a statement regarding the Rice study
recent federal data. The total time in some Houston hospital emergency rooms before being sent home can stretch to more than six hours, more than double the national average, statistics show.
Rice researchers, however, found that in smaller communities, the wait times at hospitals were apparently decreased by the introduction of a freestanding emergency room in their area, either hospital-affiliated or independently owned.
Texas has more than 300 freestanding emergency rooms, and the health care phenomenon is starting to spread to other states.
Freestanding emergency rooms have recently come under heightened scrutiny as patients complain of high facility fees and unclear insurance coverage. Often, for-profit freestanding facilities are outside major insurance networks, which can lead to unsuspecting patients being left with staggering bills that their insurer would not pay.
The proliferation of the centers in urban areas without a return on a promise to ease overburdened city hospitals is troublesome, the researchers said.
“Our results imply that freestanding (emergency departments) are increasing utilization of emergency care,” said Yingying Xu, who also authored the research, “Whether this additional care is beneficial to patients has not been shown.”
The research relied on from federal statistics, the American Hospital Association, and state freestanding emergency room location and licensing information between 2010 and 2016.