Freestanding Emergency DepartmentsT H E V I V I D P R O S A N D C O N S O F

R O G E R S T A N M O R E M D , J D

FREESTANDING EMERGENCY DEPARTMENTSFreestanding emergency departments (FSED) have proven tobe the hot, new emergency care model, brandishing all of the

expensive, life-saving equipment of traditional emergencyrooms.

With that said, some are concerned that these 24-hourfacilities, 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. Thesurge and gains with regards to freestanding urgent care centersand emergency departments is a mark of progression, signifyingthe fact that the future of emergency care medicine is happening

now. The economics of emergency medicine make sense for anumber of communities, making emergency and ambulatory care

more accessible.

Freestanding EDs are defined by the American College ofEmergency Physicians (ACEP) as “a facility that is structurallyseparate 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 hospitalemergency departments, 5,000 ambulatory surgery centers, 2,800 retail

clinics, and the 500 freestanding EDs. These functions have been enabled bytechnology and consumer preference, and ideally, both insured and uninsuredparents are immunized from overbearing out-of-pocket debt that’s usually due

following a visit to the standard emergency department. More than a visitcosting 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 becontributed to the fact that these facilities tend to be open 24/7. They’re

equipped with CT scanners, labs, x-rays machines, and sophisticateddiagnostic 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 inareas 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 theywill expand access to underserved populations,” corresponding author

Jeremiah Schuur, M.D., vice chair, Clinical Affairs, Department of EmergencyMedicine, Brigham and Women’s Hospital, said in a statement, “as they are

preferentially located in areas where people had more available healthservices, 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 onlyHOPDs are able to bill for Medicare patients, influencing the cause for

independent facilities to seek out those who are privately insured. On themost part, FSEDs exist in Texas, Colorado, and other states that don’t require

a certificate of need.

Expanding nationwide, freestanding emergency departments are equipped tocare for those in need of cardiovascular stress test as well as anything from

chest pain, asthma attacks, allergic reactions, seizures, gastrointestinalbleeding, infections, and other conditions traditionally cared for at hospitals.FSED have helped to decrease admission at emergency rooms and lower costsnationally. Some researcher suggest that this effort could be furthered if FSEDpartnered with medical home models and feel the need for community-based

medical care.

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