FREESTANDING EMERGENCY ROOMS: Pay Attention to the Man Behind the Curtain

By Carrie deMoor, MD FACEP

About a month ago, an article by Dr. Britt Berrett caught my eye and I had the opportunity to sit down with him and his fellow faculty members at the University of Texas at Dallas this week. I had hoped to take the discussion live on Facebook so that the general public could benefit from our academic discussion. Dr. Berrett unfortunately declined. A few things were crystal clear from this meeting: 1) even highly educated, experienced healthcare administrators are holding on to myths and radicalized beliefs about care in Freestanding Emergency Rooms and the costs associated and 2) we need more consolidated research and facts that support this evolving model in healthcare. While Dr. Berrett and I will agree to disagree on most things, the last point regarding data collection and research on how this model fits in the future is something that we can both agree on. Having said that, Dr. Berrett and other naysayers are making broad statements that lack a factual foundation.
So what are the facts? According to the Centers for Disease Control the following is true nationwide:

  • There are 136.3 million ER Visits per year in the United States
  • Number of ER visits per 100 persons annually: 44.5- Almost 45% !
  • Only 16.2 million (11.9%) of these 136.3 million will require an actual hospital admission each year. This means that Emergency Physicians are capable of evaluating, treating, and releasing almost 89% of patients directly from the Emergency Department. This should NOT be misconstrued as meaning that 89% of cases could have been handled in a doctor’s office. This is a myth and categorically false. It only means that 11.9% required prolonged care. Asthma attacks, severe allergic reactions, dehydration, fractures, dislocations, head injuries, car accidents, vaginal bleeding and miscarriage, abdominal pain, chest pain, even seizure- to name only a few are things that are best seen and evaluated by a Emergency Medicine Residency-Trained Physician that has the expertise and experience to evaluate and treat acute life and limb threatening conditions and injuries. Urgent Care Centers cannot handle and do not have the resources to handle these types of conditions. Freestanding Emergency Rooms do- by Texas State law!
  • Nationwide 73% of patient wait longer than 15 minutes to be seen by a physician in emergency rooms. Freestanding Emergency Centers operate with efficiency that allows patients to be seen with little to zero wait at all.
    With this kind of demand, legislators and patients need to be acutely aware that there are other forces at play that prefer that you “pay no attention to the man behind the curtain”. Freestanding ERs are NOT what is driving up the cost of care.

So what facts do we know when it comes to healthcare costs?

  • Emergency care represents less than 2 % of the nation’s $2.1 trillion in health care expenditures.
  • Insurance companies (and hospital systems) are consolidating. They are narrowing their networks. Some large hospital systems are even providing their own insurance now.
  • The average cost for an Emergency Room visit nationwide is $2000
  • The average bronze plan deductible in 2016 is $6000 (this doesn’t include the premium costs).
  • Plans regulated by the Texas Department of Insurance are required to cover you under your in-Network benefits during an emergency, if the prudent layperson would believe that a potential emergency exists.

Freestanding Emergency Rooms are taking it on the chin as the low hanging fruit that some might want to blame for their out of pocket healthcare expenses, but let’s analyze the facts and generally accepted business principles here objectively:

  • Demand exists in the market and is rising partially due to the fact that insurance companies are making it difficult for patients to access in-Network primary care providers and specialists by keeping their networks narrow. This drives patients to seek care in alternative environments such as Freestanding ERs (where at least they SHOULD be covered under their In-Network benefits). Insurance companies and mega-hospital systems help create the demand and then complain about the potential financial consequence to their bottom line. Narrow networks remind me of a Casino- the house always wins- patients don’t.
  • Competition, rather than a monopoly, promotes competitive pricing- increased options and access to alternatives gives consumers a choice and helps to prevent price gouging by a dominant market player. Competition creates a greater demand for quality and a high level of service. Consumers will learn quickly who treats them competently and leaves them feeling satisfied with their care.
  • Bigger and more complex is not always better. Lower overhead costs and high efficiency allow for the opportunity to provide services at a reduced cost overall. If 89% of patients go home from Emergency Rooms annually, it probably makes more sense to have a spoke and wheel model with lower cost, more efficient entry points of care than it does to maintain multiple large hospital real estate properties. This model can make healthcare less expensive.
  • Insurance companies are selling insurance plans to patients who do not understand their care and that cannot afford their massive deductibles while knowing that 45% of them will need a trip to an ER every year which is likely to cost them 1/3rd or maybe all of their deductible at one time, and yet simultaneously give the same patients very little options to access timely treatment and care otherwise. THIS is what legislators need to be paying VERY close attention to. THIS is what is driving up out of pocket costs for patients. THIS is what should NOT be allowed. THIS hurts people- financially and possibly physically if they avoid needed care due to fear of their gap in healthcare coverage.FSEDs that provide a service that is in demand and that has certain associated fixed costs are not the problem. Unexpected gaps in coverage are.

The attacks on independent Freestanding Emergency Rooms are an attempt to distract legislators and the general public from larger problems creating financial strain on both patients and providers alike while insurance companies and mega hospital systems dominating the market share continue to post record profits. I encourage all consumers and legislators to pay very close attention to that man behind the curtain and the true motivation for defaming independent freestanding emergency rooms. It is not to help you, it is to attempt to squash the competition and capture the market. Consider the facts, educate yourself on your insurance plan, talk with your doctor, and stand by your emergency medicine physicians. We are standing by for you 24 hours a day, 7 days a week, 365 days a year regardless of your sex, nationality, religion, race, or ability to pay.Dr. de Moor is an Emergency Physician, and serves as the President- Elect of the American College of Emergency Physicians Freestanding Emergency Centers Section, Young Physician Member of the Texas Medical Association Board of Trustees, and Chief Executive Officer of Code 3 Emergency Partners.