In 2010, Texas became the first state to allow freestanding emergency rooms to operate without hospital affiliation.

Since then, emergency options in Plano have grown to include additional affiliated and nonaffiliated facilities.

Like hospital emergency rooms, freestanding ERs 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, executive director of the Texas Association of Freestanding Emergency Centers in Austin. “In many ways, what you see in a freestanding emergency room is very similar to what you would see in an emergency department within a hospital.”

ER Care OptionsThe rise of freestanding ERs

Texas received an F grade in access to emergency health care, according to the American College of Emergency Physicians’ 2014 National Report Card. The findings spoke to the need for additional access to such care, First Choice Emergency Room spokesperson Warren White said.

In May, officials at Texas Health Resources announced a partnership with FCER’s parent company, Adeptus, which will bring several more FCER locations online by the end of the year. FCER has 27 locations in four North Texas counties: the list includes two locations in Plano, the first of which is located on Preston Road north of Park Boulevard. Adeptus opened its second Plano FCER at Legacy Drive and Coit Road in late May.

Texas Health officials said the partnership is a response to changing consumer demands as the North Texas population continues to increase. Adeptus is the largest provider of freestanding ERs in the country and has significant experience in partnerships with large health systems, Texas Health Plano President Josh Floren said. By Jan. 1, all First Choice ERs will be part of Texas Health’s network.

For the longest time, freestanding ERs were regarded as competition by hospitals, Floren said.

“For us, it’s about expanding access points,” he said. “Gone are the days of the acute care hospital.”

How do they compare?

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

Freestanding 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, Floren said.

FCER is only one of many chains adding new locations throughout the state. A recent survey by the American College of Emergency Physicians detailed the nationwide shortage in access to emergency medical care is driven by an increase in emergency visits, regulatory changes and evolving medical care consumption habits, including fewer individuals having a primary care physician.

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 preauthorization 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. 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.

“Many freestanding ERs in Texas do receive patients via ambulance, but it is a community-by-community situation,” he said.

Plano Fire-Rescue transports about 10,000 patients to local emergency departments every year, said Mark Gamber, EMS medical director for Plano Fire-Rescue. Gamber is also an emergency physician at Medical Center of Plano 24/7 Emergency Care, a freestanding ER at the southeast corner of SH 121 and Coit Road.

Patients who need to be transferred from hospital-affiliated freestanding ERs are often directly admitted to hospitals like The  Medical Center of Plano without needing to be seen again in their emergency room. Patients transferred from unaffiliated freestanding ERs are often first transported to hospital-based emergency rooms prior to being admitted, although sometimes they may be directly admitted, Gamber said.

Patients who need to be transferred from a freestanding ER to Texas Health Plano are only charged for one emergency room visit, not both, Floren said. Instead, patients are admitted to the hospital’s medical admission unit, which opened in January. Since then, Texas Health Plano has seen its number of transfers double, Floren said.

Plano Fire-Rescue has a policy to transport its patients to hospital-based ERs, which provide an intensive care unit and perform a medical screening exam, Gamber said. Plano Fire-Rescue will transport a patient to a freestanding ER by patient request, however, with approval by the EMS physician, Gamber said.

“Roughly one- third of our 911 patients are admitted to the hospital from the emergency department. Thus, it is appropriate to take the patient to a hospital that can admit them... without the added expense and delay of a second transfer.”