The Vivid Pros and Cons of Freestanding Emergency Departments

Roger Stanmore MD, JDFreestanding emergency departments (FSED)  have proven to be the hot, new emergency care model, brandishing all of the expensive, life-saving equipment of traditional emergency rooms.

With that said, some are concerned that these 24-hour facilities, which offer on-site laboratory testing and diagnostic imaging, concentrate their services in high-income areas, predominantly servicing those with private insurance, rather than those with Medicaid.

Nothing stands still. Not time, not emergency care medicine. The surge and gains with regards to freestanding urgent care centers and emergency departments is a mark of progression, signifying the fact that the future of emergency care medicine is happening now. The economics of emergency medicine make sense for a number of communities, making emergency and ambulatory care more accessible.

Freestanding EDs are defined by the American College of Emergency Physicians (ACEP) as “a facility that is structurally separate and distinct from a hospital and provides emergency care.” There are two types of ownerships for these facilities: hospital outpatient departments (HOPD), which are owned and operated by medical centers, and independent freestanding EDs (IFECs).

Sources suggest that there are 10,000 urgent care centers, 5,000 hospital emergency departments, 5,000 ambulatory surgery centers, 2,800 retail clinics, and the 500 freestanding EDs. These functions have been enabled by technology and consumer preference, and ideally, both insured and uninsured parents are immunized from overbearing out-of-pocket debt that’s usually due following a visit to the standard emergency department. More than a visit costing about a third of emergency room costs, the wait time is also significantly shorter.

The freestanding ED has gained momentum in recent years, and this can be contributed to the fact that these facilities tend to be open 24/7. They’re equipped with CT scanners, labs, x-rays machines, and sophisticated diagnostic equipment than urgent care centers.

With that said, these facilities have been accused of precluding poor and non-white communities. These standalone ER facilities tend to be located in affluent, growing communities with high incomes, and often welcomes cherry-picked patients with private insurance. FSED have roused concern and criticism due to the fact that this particular type of care access blooms in areas that has higher annual spending, fewer minorities, and diminished need for emergency care access.

“In the states with the most freestanding EDs, it seems less likely that they will expand access to underserved populations,” corresponding author Jeremiah Schuur, M.D., vice chair, Clinical Affairs, Department of Emergency Medicine, Brigham and Women’s Hospital, said in a statement, “as they are preferentially located in areas where people had more available health services, higher rates of private health insurance, lower rates of Medicaid and higher median incomes.”

The lowered rates of Medicaid users can be attributed to the fact that only HOPDs are able to bill for Medicare patients, influencing the cause for independent facilities to seek out those who are privately insured. On the most part, FSEDs exist in Texas, Colorado, and other states that don’t require a certificate of need.

Expanding nationwide, freestanding emergency departments are equipped to care for those in need of cardiovascular stress test as well as anything from chest pain, asthma attacks, allergic reactions, seizures, gastrointestinal bleeding, infections, and other conditions traditionally cared for at hospitals. FSED have helped to decrease admission at emergency rooms and lower costs nationally. Some researcher suggest that this effort could be furthered if FSED partnered with medical home models and feel the need for community-based medical care.