Freestanding Emergency Centers

A Free-Market Solution to Emergency Healthcare Services

Freestanding emergency centers (FECs) could transform emergency healthcare services in the United States. Due to overcrowded waiting rooms, long wait times, inefficient processes and below-average customer service, emergency room visits are often unpleasant; however, with the use of FECs, that can change. State officials should consider this private-sector alternative to help resolve some of these widespread hospital emergency room inefficiencies.

According to the Texas Association of Freestanding Emergency Centers (TAFEC), FECs offer 24/7 care, have ER physicians on-site at all times, provide round-the-clock lab imaging services with instant results, and stock medications not required for urgent care centers. They also contain full CT scan and radiology services, cardiopulmonary monitoring, nebulizer treatments, and airway management, intravenous fluids and medications, and overnight observation capacity.

Architectural and equipment requirements mandate the work space be large enough and pleasing while providing comfort and ease for patient care. FECs require all necessary technology ER departments in the hospitals have to ensure the highest quality of care is provided to patients.

There are three forms of FECs throughout the United States. The first is the hospital outpatient department (HOPD), which is an affiliate of a larger hospital or health system and functions as a satellite office. (They are not attached to the actual hospital.) According to statute, a hospital affiliate must be within 35 miles of the hospital. This is the most common model and is in place in 40 states. The second type is the independent FEC that is unaffiliated with a hospital and is usually physician-owned. The third type is a joint-venture partnership between an FEC and a hospital. This form allows for the navigation of legislative and regulatory barriers of entry and provides flexibility in partnering with a more established health system.

Freestanding emergency care centers need to work closely with hospitals in their communities if their patients suffer a medical emergency such as a stroke. In this case, the center will facilitate the hospital transfer for admission to receive treatment. Among all urgent and emergency care providers, freestanding ERs receive the highest satisfaction scores from patients, physicians and staff. The American College of Emergency Room Physicians states that only eight percent of emergency patients have non-urgent conditions, and two-thirds of emergency visits occur after business hours or when the doctor’s office is closed. All FECs can meet these needs while reducing hospital crowding and letting hospital ERs focus on taking care of the most pressing issues.

FECs also offer higher-trained professionals than traditional urgent care centers, including emergency room (ER) doctors that have completed full residencies in emergency medicine and who are board certified in emergency medicine (A.B.E.M.). They also have the option to become certified through the American Osteopathic Board of Emergency Medicine (AOBEM) which offers the certification required to work in a FEC. ER doctors are trained to work within pediatric and adult emergency settings, and experience both fields during their training. Because FECs can bill for similar rates to hospital emergency rooms and comply with the federal requirements of the Emergency Medical Treatment and Labor Act (EMTALA), they must provide care to all patients, regardless of health insurance or ability to pay.

Unlike in a traditional hospital setting, FEC facilities offer adaptability and flexibility for patients, translating into true quality care. They typically include eight to twelve beds, allowing physicians to see patients quickly and provide the necessary care in the smaller environment. The smaller facility also allows doctors to spend more time with each patient. Patients are closely monitored, instead of immediately admitted to the hospital when diagnosed with a complication.

FECs originated in Texas, where over 200 centers are currently in operation. According to Modern Healthcare, the number of emergency department visits is increasing, and between the FECs and hospital visits, emergency care for patients can be significantly improved.

Moving a step closer to increasing the number of FECs, there is a focus on Ohio, where Adeptus, a significant Texas healthcare operator that owns the First Choice chain of freestanding emergency rooms, has purchased property and filed plans with the local government to propose a 24-bed full-service hospital in Columbus. Lawmakers in California have also started to allow FECs in their state. They are considering allowing Saddleback Memorial Medical Center in Laguna Hills to operate an FEC in Orange County, in case San Clemente’s hospital shuts down.

FECs can be a viable free market solution designed to improve access to quality emergency care. By providing hospital-level capacity, it makes them a hugely improved option for their patients. With Texas and Ohio already embracing the FEC model, more states should break down barriers and allow freestanding emergency centers to provide community based and private emergency services to greatly improve quality of healthcare.

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