As the number of freestanding ERs grows, so does scrutiny
Freestanding emergency centers have sprouted in recent years across the suburban landscape, taking root in affluent neighborhoods and directly challenging nearby medical clinics and hospitals.
Five years ago there were a couple dozen standalone emergency centers in Texas, and now there are more than 200. Colorado, Ohio and other states also have seen steady growth.
As these centers offer another choice for people tired of deflating wait times at hospital emergency rooms, their escalating numbers are sending ripples across the healthcare field. Critics say they do little to help those in rural America with dire medical needs, siphon away skilled emergency physicians and too often stick patients with overinflated bills.
Groups such as the Texas Association of Freestanding Emergency Centers counter that people are getting an unprecedented level of care as the centers open close to consumers, don’t keep them waiting, provide an ER physician around-the-clock, and are equipped for any medical emergency.
Researchers with Brigham and Women’s Hospital in Boston conducted a study that found the number of stand-alone emergency departments grew from 222 in 2009 to 360 across 30 states as of March 2015. The most are in Texas, which in 2009 adopted a law that allowed private, for-profit ventures to provide the kind of emergency services that hospitals do.
“The idea of delivering fast, quick, high-quality emergency care ... is very innovative,” said Dr. Jeremiah Schuur, lead author of the Brigham and Women’s study published last month.
The freestanding ERs locate in zip codes with an attractive payer mix, Schuur said, meaning ones where more people are privately insured, have higher incomes and there are fewer Medicaid reimbursements. They’re more likely to open in parts of Texas already served by traditional hospital emergency rooms, he said.
“Depending on your viewpoint, they offer competition or a duplication of services,” Schuur said.
There doesn’t appear to be market incentive for many of the stand-alone centers to open in rural areas that are home to poorer populations. At least 45 hospitals in less populated parts of the U.S. have closed since 2010, and a quarter of those were in Texas, according to the Texas Organization of Rural and Community Hospitals.
So far, the freestanding ERs have not filled the void left by those closings.
“It is important for policymakers to know that this is a service that’s locating to serve one part of the population and not everyone,” Schuur said.
A spokesman for the Texas Association of Freestanding Emergency Centers did not return phone messages seeking comment, but John McGee, an association board member, told The Dallas Morning News this month that rules dictating federal reimbursement rates and other regulatory hurdles make it difficult to open locations in poor areas.
As hospitals face greater competition in providing emergency services, they’re also finding it more difficult to retain skilled ER doctors. Grant Douglass, president of Southwest Medical Associates, which contracts with hospitals and clinics in primarily rural parts of Texas to provide ER physicians, estimates that at least 1,500 doctors have been lured from Texas hospitals with the promise of better pay, less stress and a smaller volume of patients.