Texas ER Operators: “We Have 1,500 More Beds Ready for Patients”

Three Proposals for Full Utilization of 200 Texas Freestanding ERs During COVID-19 Pandemic

Austin, TX – March 25, 2020 – The Texas Association of Freestanding Emergency Centers (TAFEC) announced today their effort to ease the burden facing hospitals dealing with the COVID-19 pandemic by working with state and federal leaders on three proposals to allow freestanding emergency centers (FECs) across Texas to be fully utilized during this public health crisis. With a few regulatory changes, more than 200 FECs across the state could provide beds for more than 1,500 patients. 

When Andrea’s body stopped responding to medication she was prescribed, she thought she was just having a hard time recovering from an illness. Andrea decided to check in with staff at Complete Care to see if there was a reason why she wasn’t getting better. When she got to Complete Care’s Fossil Creek location, Andrea’s symptoms were worsening rapidly. Luckily, Complete Care doesn’t require patients seeking care to have an appointment. Read more here...

Austin, TX— A new study published in the prestigious American Journal of Emergency Medicine found patient satisfaction is higher at Freestanding Emergency Centers (FECs) than at Hospital-Based Emergency Departments (HBEDs).

The study collected data in the following four areas: a. physician courtesy; b. physician listening ability; c. whether patients were informed about their treatment; and d. physician concern for patients’ comfort. In all areas, FECs received higher patient satisfaction than HBEDs.

House Bill 1832 Passes 113-35, Moves to the Texas Senate

Austin, TX - May 8, 2019 –The Texas Association of Freestanding Emergency Centers (TAFEC) commends the passage of HB 1832 by a strong majority, as it would prohibit health insurance companies that operate in Texas from violating the Prudent Layperson Standard. Most often, insurers do this by implementing policies or practices that render coverage for emergency services dependent upon a final diagnosis. This is already against the law; HB 1832 would ensure that there are strong penalties against violators of this vital patient protection law.

By Eric McLaughlin, M.D., TAFEC Board Member, and Richard Yount, CEO, Patients Emergency Room

Steer (verb): to control the course of, to guide by mechanical means

Article written by Dr. Carrie de Moor is the CEO of Code 3 Emergency Partners based in Frisco, TX

A recent Houston Chronicle story highlighted consumer confusion about freestanding emergency centers (FECs) and questioned whether a patient’s ER care at an FEC would be covered by their insurance.

New BCBSTX ER Patient Penalty Policy Goes Into Effect Today

Statement from Rhonda Sandel, RN, CEO of Texas Emergency Care Centers, and Board Member of the Texas Association of Freestanding Emergency Centers (TAFEC):

Houston, Texas (August 6, 2018)—On April 18, 2018, Blue Cross Blue Shield of Texas (BCBSTX) announced a new “HMO Emergency Benefit Management Process.” Citing that their members were using the ER “for things like head lice or sprained ankles, for convenience rather than for serious or life-threatening issues,” the company announced the creation of a new policy that greatly restricts Texas patient access to the Emergency Room (ER).

We stayed open. We never closed our doors. Anything that came, we took care of them without regard to whether we get reimbursed or not... Everybody was the same...

Watch this true story of real Texans with a heart for service. It chronicles medical personnel—devoted doctors, nurses, and technicians—in the storm’s path who risked much to keep their Freestanding Emergency Centers open in the lead-up to Hurricane Harvey, in the midst of the storm, and throughout its harrowing aftermath.

 Watch it Here

Like a handful of others, many years ago we made the decision to invest the necessary time and resources to properly serve the FEC Texas market. Even with our 30 years of revenue cycle management (RCM) experience partnering with Texas ER Physicians, properly assisting the FEC client is apples to oranges. Our introduction to the FEC industry came about over four years ago, from a referral from a long‐time ER Physician client who was working shifts at a local FEC location. Like so many others, the FEC owner had entrusted a RCM company proficient in billing the professional component of the ED visit, but after a year left the FEC hanging on financially by a thread.

The timing was ideal for us as we had just recruited a new Coding Manager with a wealth of experience in facility / ancillary services coding. Concurrently our programmer and long‐term clearing house partner completed the design and testing of the UB‐04 format vs. HCFA‐1500 format. Lastly, we created a separate “Customer Care” team to make outgoing and receive incoming calls from FEC patients. Speaking with the FEC patients allows us to educate them on the health claim adjudication process along with assistance understanding the health plan benefits – this has been a critical step for us and our clients.

Dr. Matthew Cross

Over a year ago, the way I practiced medicine disgusted me. I worked in a busy emergency room in a large metropolitan hospital in San Antonio that had long waits, no available hospital beds, overworked staff, and a continuous flow of ambulances waiting outside.

In recent testimony, the Texas Association of Health Plans (TAHP) referenced a large medical bill, $53,000 for an ingrown toenail, as an example of price gouging by independent freestanding ERs. However, analyses by multiple third-party billing companies show that the patient was treated at a hospital outpatient department (HOPD), and that the reason for the large bill was due to a billing error by the facility’s billing company.

A close look at the bill issued to the ingrown toenail patient makes it clear the facility that issued this bill is not a freestanding ER at all, but is an ER affiliated with a larger hospital. The bill includes the CPTO 11755 and 20972 medical codes, however independent freestanding ERs do not bill for these services. Also, the use of an S medical code indicates that the facility can accept Medicare, which independent freestanding ERs are not currently able to accept.

Coalition Outlines Unethical Health Insurance Practices that Place Texas in 'State of Emergency'

In my 10 years of experience working at a healthcare billing company in Houston, I’ve seen it all. Every tactic, strategy, and policy by insurance providers to deny a patient’s claim or reduce payment to healthcare providers across the state. And as the healthcare landscape changes, insurers appear to operate with less and less regulations and oversight. It’s a rigged system, and it’s Texas patients who pay the price.

Unfortunately, as time passes, it is becoming more difficult to interact with insurance companies. These days my company must fight tooth-and-nail over every single claim to ensure our customers are getting the coverage to which they are entitled – coverage outlined in their individual health plan. If we don’t, insurers will cut every corner and not hold up their end of the bargain.

Dr. Jorge Trujillo M.D.
Medical Director Frontline ER Richmond Location

After completing my residency in emergency medicine in 1994 at Texas Tech Health Science Center in El Paso Texas, I returned to Houston and began my hospital based emergency medicine career. At that time Texas Tech was the only school in Texas offering training in emergency room medicine. It is amazing how much patient care and the landscape has changed since those early days of emergency room medicine.

One of the most critical issues impacting the healthcare of Texans is timely access to healthcare. In fact, the American College of Emergency Physicians gave Texas an F in access to emergency care in their 2014 Report Card. Unethical business practices and nefarious actions by health insurance companies are keeping Texans from being able to choose expeditious and cost effective emergency services.

Part of TAFEC's mission is to provide high-quality, accessible, emergency medical care options. At G&A Partners, we specialize in providing business owners high-quality and high-touch HR and payroll administrative solutions via access to a team of HR, benefits and payroll experts, all for about the same cost of hiring one full-time employee.

At G&A Partners, we focus on a few core areas:

Adeptus Bankruptcy Sparks Industry Response to Increase Insurance Oversight

Adeptus Health announced today that it and certain subsidiaries have filed voluntary petitions for relief under Chapter 11 of the United States Bankruptcy Code. This announcement comes after Adeptus was named in a class action lawsuit regarding the company’s billing practices, which were alleged to be excessive and deceptive. While Adeptus and First Choice are not active members of the Texas Association of Freestanding Emergency Centers (TAFEC), this event highlights several ongoing concerns for freestanding emergency center operators.

It is now the responsibility of our legal system to determine whether these accusations against Adeptus have merit. TAFEC expects its members to be transparent and honest with patients throughout their freestanding emergency center experience (including regarding the facility’s charges and billing), and to educate the communities in which our members operate about their capabilities and levels of service.

The State of Texas is one of Austin’s largest employers, with about 70,000 workers locally. If an addition to the senate budget bill passes, those employees will have less options to choose from in the event of a medical emergency.

That is because of a “rider” the Senate Finance Committee voted to add to Senate Bill 1, the Senate’s budget bill. A rider is a provision added to a bill under consideration by the legislature having little connection with the subject matter of the bill.

The issue of surprise medical bills is getting plenty of attention in Texas these days, and the freestanding emergency center industry has become a popular target. An innovative model that provides reduced wait times compared to traditional hospital ERs, freestanding emergency centers have increased access to emergency care in a state that sorely needs it. Today, these facilities number more than 325 throughout Texas.

Despite the access they provide, misconceptions about freestanding emergency centers persist, and false accusations of lack of transparency and misleading patients are common. It is telling that this is the narrative coming from health insurance companies, as their responsibility to cover the cost of emergency care for those they insure is at the heart of this issue. That responsibility is outlined in the insurance code statute that includes emergency care as an essential health benefit.