A demand for more efficient emergency care spawned the opening of two freestanding emergency rooms in Northwest Austin in 2013.

First Choice Emergency Room opened Feb. 15 near the Arboretum on Jollyville Road. Austin Emergency Center opened in March on Far West Boulevard.

Because freestanding ERs are still a new concept for some people, there might be some misconceptions that freestanding ERs are the same as urgent care clinics, said Dr. Okemefuna Okpara, medical director of Austin Emergency Center Far West.

"It is just going to be something that takes some time for people to understand because traditionally, when people think of going to the emergency department, they think of going to a hospital," Okpara said. "So walking into a strip mall and seeing something that says 'emergency room' does not always click with people."

What is a freestanding ER?

Freestanding ERs treat urgent and emergency conditions and have the capability to handle life-threatening situations. However, surgery is not performed at these facilities. Freestanding ERs are open 24/7 and are equipped with doctors who are board certified, such as those in emergency medicine, according to AEC. Freestanding ERs can treat injuries and illnesses such as pediatric fevers, broken bones, kidney stones, heart attacks, strokes and lacerations.

Even with the same the equipment and doctors as hospital ERs, freestanding ERs often have less wait time because there is less patient traffic, Okpara said. Freestanding ER equipment includes CT scanners, X-ray machines and full laboratories for bloodwork. One difference between the two types of ERs is freestanding ERs cannot admit patients like hospitals can. Freestanding ER patients could be transferred to a hospital depending on their condition.

At a hospital ER, patients with severe or life-threatening injuries and illnesses are seen first, and that can increase the wait time for other patients, Okpara said. Freestanding ERs such as St. David's Emergency Center and AEC typically have wait times of five minutes or less.

Patients also might choose to visit a freestanding ER because of the time of day an injury occurs, said Dr. Vard Curtis, medical director of St. David's EC in Pflugerville.

"Because we are open 24 hours, a lot of times something happens Saturday night at 2 a.m. that could be taken care of at a clinic, [but] clinics are closed. [Patients] have to come here," he said.

Difference in cost

How much people pay for emergency care depends on the type of facility they visit and their health insurance coverage. For example, because St. David's EC is affiliated with the St. David's hospital system, it accepts all forms of health insurance, and billing is the same as it would be at St. David's North Austin Medical Center, said Wes Fountain, chief financial officer at St. David's NAMC.

Freestanding ERs such as AEC and First Choice are not affiliated with a hospital and are independently operated. Freestanding ERs cannot accept or bill Medicare or Medicaid because a freestanding ER is recognized as a state, not a federal, entity. Both freestanding ERs and hospitals require a copay at the end of the visit, Okpara said.

He said the costs associated with a hospital visit can often be higher than it would be at freestanding ERs that are not affiliated with a hospital because the facility fee is usually higher. However patient costs at freestanding ERs that are affiliated with a hospital, such as St. David's, are likely to be the same. Patients will also pay a physician fee, which can range from $200–$350 at both types of ERs, Okpara said.

All patients who visit freestanding ERs or hospitals have the right to be seen by a doctor for a medical screening, regardless of their ability to pay their bill or whether they have health insurance, Okpara said.

"If someone comes in clutching their chest, you do everything that needs to be done to make sure they are not having a heart attack before any discussions of money are made at all," he said.

The medical screening at AEC includes a physical exam, checking the patient's vitals and obtaining the medical history, he said. If no treatment is done after the medical screening at AEC, the patient is not charged any fees, he said.

Demand for more efficient care

Regardless of fees, freestanding ERs have become more popular because of people's demands for a more efficient emergency care experience, Okpara said.

"I think the biggest selling point for these [freestanding ERs] is that people don't have to wait for their [emergency] care," he said. "The main reason why people don't have to wait is because there are never that many patients walking in simultaneously."

St. David's HealthCare opened a freestanding ER in Pflugerville in 2011 partially because people in the area who needed emergency care had to drive to Northwest or Central Austin, Curtis said.

"I think [St. David's EC] is a big convenience and time-saver for the people of Pflugerville, and in some cases it can be life-saving," he said. "I think it serves a medical need, it serves a time-saving need, it serves a convenience need."

First Choice spokeswoman Claire Gibson said First Choice chose its location near the Arboretum based on market research that showed a need in the area.

"We do a lot of market research before selecting a site and felt that there was a need for emergency medical care in North Austin," she said.