In 2010, Texas became the first state to allow freestanding emergency rooms to operate without hospital affiliation. Since then, emergency options in Frisco have grown to include nine 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.”
The rise of freestanding ERs
First Choice 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 the three FCER locations in Frisco. THR officials said the partnership is a response to changing consumer demands as the North Texas population continues to increase.
Some ERs with a hybrid urgent care/ER model are also coming online. 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.
Freestanding ERs are becoming more popular because many times they are located within the patient’s neighborhood, have reduced wait times and physicians are able to spend more one-on-one time with patients, he said.
Justin Doss, chief operating officer of Medical City Frisco, said freestanding ERs are on the rise because of consumer demand from families who want immediate access to health care.
“Freestanding ERs, compared to a hospital, are much cheaper to be able to go through, to build and operate,” Doss said. “The different companies that have come up with a model where they can put up a freestanding ER on every corner is part of what consumers are looking for: a faster access to emergency services.
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.
“[Freestanding ERs] take volume out of our ERs,” Doss said. “So from that standpoint, it does affect it, but we have a very good working relationship with many of the freestanding ERs out there. Ultimately, we’re all there to provide great patient care, and so as long as we continue to partner with those freestanding ERs then hopefully it will only continue to improve the level of care that our community gets.”
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 healthcare.gov, 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.
“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.”
Though many freestanding ERs have ambulance bays, Frisco Fire Department’s policy is to only transport patients to hospital ERs, Fire Chief Mark Piland said.
“We don’t know the extent of care patients’ require,” Piland said. “We also don’t know the capabilities of all the different free standing facilities. We do know what a hospital is capable of based on its certification level. When you call us, we’re committed to transporting patients to hospitals where they can receive the most comprehensive care.”
Some hospitals also do not accept ambulances. Baylor Medical Center in Frisco, for instance, will not accept emergency patients in an ambulance unless it is a woman in labor, Piland said.
Piland 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.
“Our first priority is, ‘What is the condition of the patient,’” Piland said. “We want to get you to the most effective facility for what’s wrong with you. … The level of the treatment needed for the patient is the driving factor.”
Frisco EMS will sometimes transport patients outside of the city either if the patient asks to go a certain hospital or if a hospital outside of Frisco provides specialty care that a patient needs. Piland said his department tries its best to be as accommodating to patients as possible.
“I know there’s some EMS systems, they have rules that say they have to transport to the closest facility,” he said. “We take you where you want to as long as it doesn’t jeopardize your medical care.”
Although both freestanding ERs and hospital-based ERs are required by the state to handle most emergency services, trauma care is not a requirement.
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.
Doss said where the difference becomes apparent is that hospital-based ERs have immediate access to next highest level of care.
“If someone comes into a freestanding ER with chest pains, they are going to have to get immediately transferred to some place that probably has [diagnostic imaging] capabilities,” Doss said. “Whereas if you go directly to a hospital, the amount of time that it takes us to identify that the patient may be having a life-threatening emergency and get them into an operating room or into a lab is going to be minutes versus having to be transferred from a freestanding ER to a hospital.”
Shields said the decision to take a patient to a hospital 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.”
Lindsey Juarez and Nicole Luna contributed to this story.
