In 2010, Texas became the first state to allow freestanding emergency rooms to operate without hospital affiliation. Since then, emergency options in McKinney have grown to include seven locations.

Freestanding emergency rooms, like hospital emergency rooms, are required by the state to handle most emergency situations. They are licensed by the state of Texas; operate 24 hours a day, seven days a week; and are staffed by board-certified emergency physicians and nurses.

“These freestanding emergency centers are just like an emergency room— they’re just outside the walls of a hospital, and that seems to be the concept that everyone has a hard time understanding,” said Brad Shields, the executive director of the Texas Association of Freestanding Emergency Centers. “In many ways what you see in a freestanding emergency room is very similar to what you would see in a emergency department within a hospital.”

Emergency care options increaseEmergency care options increaseThe rise of freestanding ERs

FirstChoice Emergency Room spokesperson Warren White said according to the American College of Emergency Physicians’ 2014 National Report Card, Texas received an F in access to emergency health care, which speaks to the need for additional access to such care.

In May, officials at Texas Health Resources announced a partnership with FCER’s parent company that will bring several more FCER locations online by the end of the year. FCER has 27 locations in four North Texas counties, including one on Eldorado Parkway in McKinney, which opened early 2015.

THR officials said the partnership is a response to changing consumer demands as the North Texas population continues to increase.

FCER is only one of many chains that are spreading throughout the state.

Legacy ER & Urgent Care operates dual urgent care and emergency care centers in McKinney, Frisco, Coppell, Allen and North Richland Hills.

Dr. Jay Woody, a fellow of the American College of Emergency Physicians, founder and chief medical officer of Legacy ER & Urgent Care, said the company hopes to make this model of health care as widespread as possible.

Woody said it is important consumers understand the difference between an emergency room—whether freestanding or attached to a hospital—and urgent care.

The Legacy ER model allows less serious medical issues to be treated through the urgent care process for a lower cost.

A recent ACEP survey stated the nationwide shortage in access to emergency medical care is driven by an increase in emergency visits, regulatory changes and evolving medical care habits, including fewer people having a primary care physician, White said.

Emergency care options increaseFreestanding ERs are becoming more popular because many times they are located within the patient’s neighborhood, have dramatically reduced wait times and physicians are able to spend more one-on-one time with patients, he said.

Brent Majors, director of emergency services at Baylor Scott & White Medical Center-McKinney, said freestanding ERs are on the rise because hospital-based ERs were previously bogged down with patients with severe health issues, which attributed to long wait times.

“Freestanding ERs do get patients back to the doctor sooner, but people are finding out that they are having to be sent somewhere else to get the higher-level care they need,” Majors said. “People are getting more in tune to that and want that more definitive care sooner.”

How do they compare?

Hospital-based emergency room operators agree that there are many similarities between freestanding emergency rooms and hospital emergency rooms.

Hospital-based ERs and freestanding ERs are both required to provide the same level of access and services, with the exception of trauma care. They are required to remain open 24 hours daily, have ER physicians on-site at all times, provide 24-hour lab and imaging services, and stock specific pharmaceuticals for common emergency situations.[polldaddy poll=9433714]

“The main commonality is that everyone is in this together,” Majors said. “We may have competing business models or plans, but everyone wants to take care of the patients as best they can, no matter what. In the health care industry, our doctors and nurses all want the same outcome. Sometimes the way we set ourselves up, we are able to provide those services in a more expeditious way than others, and across our industry we recognize that. It is a hot topic, especially in this market.”

According to TAFEC, freestanding ERs charge equal to or less than hospital ERs for emergency care, and both are federally mandated to treat everyone, regardless of their ability to pay.

According to, the Affordable Care Act rates emergency services as one of the 10 “essential health benefits” that health insurance plans must cover. Coverage for emergency services cannot require pre-authorization or limit a patient to an in-network facility. Patients cannot be penalized for going out of network or for not having prior authorization, and one’s insurance company must pay for ER services at an in-network rate.

Know where to go

Both hospital-based ERs and freestanding ERs can accept patients from an ambulance in an emergency situation.

“State law requires all freestanding ERs to have an ambulance bay dedicated to dropping patients off or picking patients up,” Shields said. “The law also requires that freestanding ERs participate in the [Emergency Medical Service] system, which means we are required to take patients who are brought to us by 911 or EMS. On the flip side, the EMS or 911 services are not required to bring patients to freestanding ERs.”

Although both freestanding ERs and hospital-based ERs are required by the state to handle most emergency services, trauma care is not a requirement. According to TAFEC, a licensed freestanding emergency center provides emergency care and is not a trauma-care hospital.

Trauma care designated hospitals are equipped to deal with emergencies such as trauma surgery, neurosurgery and critical care.

Typically, Shields said, freestanding ERs will have transfer agreements with area hospitals to transfer patients who need to be admitted for trauma care or extended stays.

“Where the difference becomes apparent is that hospital-based ERs have more availability of next-step resources,” Majors said. “If you go to an ER with a heart issue, the hospital has an in-house, readily available process to treat that need instead of in contrast to freestanding ERs, where they would have to transport someone to a hospital for treatment.”

Emergency care options increase

Danny Kistner, McKinney fire chief and head of the city’s EMS, said when his department is dispatched to an emergency, there are a series of decisions that happen simultaneously. First, he said, the emergency responders have to determine the person’s emergency. Then, depending on the situation, emergency personnel will transport the person to the nearest appropriate hospital or the person’s facility of choice.

“Hospitals can have certain designations—like a cardiac center or a stroke center—and depending on what the person is presenting as their emergency, we will take them to the appropriate facility that specializes in that type of care,” Kistner said. “Time from the onset of chest pain to the [catheterization] lab is very critical, so it does not make a lot of sense to take someone to a hospital that doesn’t have the right equipment only to be evaluated and then transferred to the proper hospital. We try to take the middleman out of the equation.”

Kistner said to his knowledge, no McKinney patients have asked specifically to be taken to a freestanding ER in an emergency situation.

“We are fortunate enough in McKinney that our distance to hospitals with beds and a full facility is so short that right now it makes more sense to transport a patient to a hospital that has inpatient ability,” Kistner said. “For example, some of our hospitals have the extended-stay capability; freestanding ERs just don’t have the inpatient ability to take them to a room upstairs or to move them into ICU.”

Shields said the decision to take a patient to a hospital-based ER or a freestanding ER  depends upon the request of the patient or knowledge of the EMS crew.

“Many freestanding ERs in Texas do receive patients via ambulance, but it is a community-by-community situation,” he said. “If the EMS director in that community knows the freestanding ER and how they operate, they might be more open to taking patients there. If the director is uncertain of who that facility is, then they may bypass it to go to an emergency room at a hospital.”