“Our locations in that area have continued to grow steadily in patient volumes as more people become educated on the differences between emergency care and urgent care,” Breeze said.

Sublime Care Emergency Room, which opened its first location in March on FM 2920, chose Spring for its location because of its accessibility near I-45, said Vanessa Conn, facility administrator with Sublime Care Emergency Room.

Cypress Creek ER just opened its second location in January on FM 2920.

“We have grown to a second location with future expansion plans throughout North Houston and Spring,” said Steve Munier, Cypress Creek ER vice president of business development.

Low overhead, high convenience

The demand for the increasing number of health care facilities in the area was created from ER facilities seeing a surplus of patients who have insurance, Munier said. The freestanding ER business was originally created by hospital-based ER physicians.

“They realized that we have all of these private insured patients that are sitting around in a large hospital emergency room for hours where they could be treated at another facility and be seen by a doctor in 15-30 minutes,” he said.

Hospitals need to be fully staffed and equipped, but freestanding ERs and urgent cares are less expensive to operate than a hospital emergency room, The Larking Group CEO Kelly Larkin said.

The Larkin Group is working on a joint venture with the CHI St. Luke’s Health system to provide freestanding ERs through CHI St. Luke’s Health.

“The overhead in these facilities is very low,” Larkin said. “Urgent cares have the lowest overhead. Urgent care makes a lot less per patient and has a higher volume [of patients]. They can still break even.”

The freestanding ERs only need about eight patients a day to break even, profitwise, she said.

The services freestanding ERs provide are billed at hospital ER rates because they can provide a similar level of care to patients. Patients are willing to pay for the convenience of being seen quickly, Conn said.

“They do not have to go through the hassle of being transferred by ambulance to yet another health care institution and go through that institution’s admitting process just to be discharged eight to 23 hours later,” Conn said.

However, she said there is a marked difference between the services urgent care facilities and freestanding ERs provide.

“Urgent cares are more geared towards patients that have nonlife-threatening injuries or illnesses,” she said. “These centers are just a step up from primary care providers due to the fact that they are open 12 hours but still utilize a nurse practitioner, physician assistant or doctor.”

The ubiquity of urgent care centers and freestanding ERs is a reflection of a consumer demand that wants everything to be more convenient, said Patrick Jankowski, senior vice president of research for the Greater Houston Partnership.

“If you can get treated in your own backyard, you’re more likely to do that then drive 20 miles into town to get treated,” he said.

He said infrastructure costs are cheaper, and attracting workforce employees is simpler.

“The land is so much cheaper out there,” he said. “It’s easier for them to recruit practitioners who only have a mile to drive, rather than 25 miles.”

Health care industry effects

The abundance of health care choices is creating more competition, Jankowski said. He said he believes the proliferation of the health care facilities is drawing patients away from hospitals. More nonemergency care options can replace hospital services for less acute conditions.

Although hospitals are in competition with freestanding ERs and urgent care facilities, many local hospitals have begun opening freestanding ERs and primary care clinics of their own to offer more convenience to Spring-area residents, Breeze said.

Houston Methodist Hospital opened Houston Methodist Spring Emergency Care Center on FM 2920 four months ago while Memorial Hermann has begun construction on another walk-in facility off Boudreaux Road and the Grand Parkway in Spring, which is due to open in January, health care officials said.

North Cypress Medical Center also owns three satellite locations in northwest Harris County—two in Cypress and one in Houston off of Hwy. 249.

“What they figured is that if you can’t beat them, join them,” Breeze said.

Hospital-based ERs also have an advantage over other freestanding locations. The Centers for Medicare & Medicaid Services states only hospital-based off-site emergency rooms are allowed reimbursement for Medicaid and Medicare patients, Conn said. CMS does not recognize privately owned freestanding facilities.

“There’s a lot of reasons hospitals are going to do [freestanding ERs]—to protect market share,” Larkin said. “If the hospital has patients in a certain area, a competitor might actually [open a facility].”

She said hospitals lose patients in area where other facilities are located. Hospitals aim to choose locations that are not already served by an urgent care or freestanding ER.

“The revenue to the hospitals in these facilities is very positive,” Larkin said.

She said hospitals are beginning to consider opening urgent care options as well because urgent cares are more cost-effective.

Freestanding ERs and urgent cares draw from the patient pool, creating competition for market share with hospitals, Conn said. In response, hospitals are also partnering with freestanding ERs.

“We partner with a lot of the local hospitals,” said Jeanette Wright, director of emergent care with Sublime Care Emergency Room. “[Houston Methodist Hospital] is one of our big ones, and so is Tomball [Regional Medical Center].

Wright said the hospitals know the patients from freestanding ERs who need transfers to hospitals have already had their insurance vetted. The hospitals do not have to do the extra work with the admittance process of determining if the patient is insured.

Being Prepared

There are more than 100 freestanding emergency rooms in the Greater Houston area, said Juliet Breeze, CEO of Next Level Urgent Care.

“People mistake these centers for urgent care and bring strep throat or a bad cough, and they’ll go into something that is not a hospital, so they figure it’s going to be less expensive,” she said.

She recommends patients research in advance to avoid being overcharged.

“When you’re bleeding, that’s not the time to find out [that] the place next door doesn’t take your insurance,” she said.

Treatment for an ankle sprain in an urgent care costs $200 versus $2,000 in an emergency room—freestanding or hospital-based, Breeze said.

“Patients come to our clinic all the time asking if we are really an urgent care since they want to make sure that we aren’t going to charge thousands of dollars for straightforward after-hours care,” she said.