Freestanding ERs to get Medicaid funding.
Freestanding centers will be eligible to temporarily get federal funding
For the latest updates, go to houstonchronicle.com/coronavirus
Texas’ freestanding emergency rooms will temporarily be eligible to receive federal reimbursement to care for Medicare and Medicaid recipients under guidance issued Tuesday by the Trump administration.
The move is aimed at easing some of the burden on hospitals, which in other parts of the country have been overwhelmed by patients seeking treatment for COVID-19, the disease caused by the coronavirus.
More than 200 freestanding emergency rooms in Texas have the option to become a Medicare/ Medicaid-certified hospital, or become affiliated with one of those hospitals under the waiver. Once certified, those centers are eligible to receive federal funding to care for those on Medicare, the government health insurance program for the elderly, and Medicaid, the program for low-income people, as long as a public health emergency is declared.
“This actually recognizes us during this time of pandemic and makes sure that patients know they can come to us,” said Rhonda
Sandel, president of the National Association of Freestanding Emergency Centers.
Sandel, the CEO of Texas Emergency Care Center, which operates locations in Atascocita and Pearland, said the recognition signals to patients who may have previously been told to avoid freestanding ERs that they will be covered. Freestanding ERs became controversial in recent years because they operate out-of-network for many insurance plans, leaving patients to pay high costs through a practice known as balance billing.
Federal law prohibits balance billing of Medicare and Medicaid patients.
Tuesday’s guidance comes a month after freestanding ERs nationally and Texas lawmakers began pushing for temporary recognition during the coronavirus outbreak.
“The (freestanding ERs’) presence throughout the state is equivalent to three large, 500bed hospitals whose estimated $1.5 billion of infrastructure can be turned on overnight without any capital expenditure at all by the government,” U.S. represen
tatives and senators from Texas wrote in a letter to the Center for Medicare and Medicaid Services.
The Texas Association of Freestanding Emergency Centers made three proposals to state and federal regulators in late March for federal reimbursement, arguing that the freestanding ERs could alleviate overcrowding in hospitals, provide access for rural communities and make use of resources going unused.
“Expanding the number of providers available to Medicare and Medicaid beneficiaries eases some of the burden shouldered by traditional hospitals,” Seema Verma, CMS’ administrator, said in a statement, “and allows the health care system to treat more patients at a time when capacity is often limited.”
With the new guidance, an estimated 1,550 beds will become available to care for COVID-19 patients on Medicaid and Medicare in Texas.
The costs and processes
Some freestanding ERs, such as Sandel’s, have already begun applying for Medicare and Medicaid certification. They don’t know when the applications will be approved.
Until they are, these emergency rooms will still treat Medicare and Medicaid patients for free without getting reimbursed the federal government, said Dr. Eric McLaughlin, a physician at Elite Care in Rice Village who serves on the board of the Texas Association of Freestanding Emergency Centers.Under the federal and state law, all emergency departments must treat patients coming in for care regardless of ability to pay.
Many freestanding ERs are located in ZIP codes with higher median incomes and a smaller population that qualifies for Medicaid, according to a 2016 study from researchers at Boston’s Brigham and Women's Hospital.
Medicaid and Medicare patients don’t account for a large share of Elite Care’s patient population. The reimbursements wouldn’t be a big revenue stream for Elite Care, McLaughlin said But certifying freestanding emergency rooms for this federal program will show whether more low-income patients will consider getting care at Elite and other freestanding ERs.
“I don’t want to miss out on what could be an experiment in finding out how we could be of great benefit to our community,” McLaughlin said.
Freestanding emergency centers have a checkered past in Texas. In a 2018 study by AARP Texas, patients on private insurance have reported confusion about whether those ERs bill at in-network rates.
“Although we appreciate making sure older Texans have access to care during the coronavirus crisis,” said Blake Hutson, AARP Texas’ associate advocacy director, “we hope Medicare closely monitors charges at freestanding ERs.”
Houston’s health care system also seems to be doing just fine, analysts said. Hospital beds haven’t reached capacity yet, nor have emergency rooms overflowed.
‘Not a money grab’
As of Tuesday, there are 5,211 confirmed coronavirus cases and 80 deaths in Harris County.
“I’m not aware of there being a need for additional ER room capacity,” said Ken Janda, an adjunct professor in health care management at Rice University. What might be of more use, Janda said, is directing more funding toward producing more test kits and personal protective equipment.
Analysts and freestanding ER doctors, however, said more beds might be necessary if the outbreak isn’t brought under control, the process known as flattening the curve.
“It’s possible there will be a reemergence,” Janda said. “If Texas ran into a situation like New York was in, then we may very well need them.”
Having the financial backing from federal administrators to expand access to 1,550 beds scattered throughout the state could be a big boost. But it’s not about reimbursement, Sandel insisted.
If all goes well, leaders of freestanding ERs hope it could pave the way for permanent recognition from the Centers for Medicare and Medicaid Services.
“This is not a money grab,” Sandel said. “We want to care for the most vulnerable populations of Texas.”