A recent study, conducted by Brigham and Women’s Hospital and published in the Annals of Emergency Medicine, has generated a lot of media attention toward the freestanding emergency center (FEC) industry, including a recent Associated Press article. TAFEC believes there is a need for additional information so readers understand the complicated political and regulatory landscape FECs must navigate with regard to these findings, and has addressed the following areas to provide further context:
1. Access to Emergency Care for All
2. National Regulation Governing FECs
3. Relieving Pressure on Hospitals
4. Comparing FECs to Urgent Cares
5. FEC Patient Satisfaction
6. Retaining Emergency Physicians
Access to Emergency Care for All
Most importantly, TAFEC would like it to be clear that FECs provide critical access to care for ANY patient that walks in their door, regardless of their insurance or ability to pay. As with all emergency care providers, FECs are legally required to administer medical screenings and stabilize patients before discussing how a patient intends to pay for their care. FECs often see and treat patients knowing they will not receive any compensation for their services, similar to what traditional hospitals experience. For a given FEC provider, unpaid claims can amount to millions in lost revenue.
National Regulation Governing FECs
Because more than one-third of the freestanding facilities studied were independent FECs, it is important to explain the situation with regard to the Centers for Medicaid and Medicare Services (CMS). Currently, CMS has not yet recognized non-hospital freestanding emergency centers – something that would require a legislative change in Washington D.C. Therefore, independent FEC facilities do not receive reimbursement for care provided to Medicare/Medicaid patients. Treating patients without compensation is not financially sustainable.
Additionally, federal regulation restricts hospitals from opening freestanding emergency centers (also known as hospital outpatient departments or HOPDs) beyond 35 miles from their main hospital campus. This regulation significantly impacts site location for hospital-owned freestanding emergency centers
Until non-hospital FECs receive fair compensation patients without private insurance and hospitals are allowed to open beyond the 35-mile restriction, it is unlikely that FEC operators will venture into areas where large percentages of the payer mix are Medicare/Medicaid.
TAFEC is supporting the National Association of Freestanding Emergency Center (NAFEC) as it advocates for CMS recognition and changes to federal law governing HOPDs so that the FEC industry can make inroads to serving more rural areas with higher concentrations of Medicare/Medicaid patients. TAFEC believes FECs are the best, most sustainable option for providing access to care in these communities.
Relieving Pressure On Hospitals
Following the passage of the Affordable Care Act, the pressure placed on traditional hospital emergency rooms across the country has increased significantly. Patients wait for hours just to be seen by a physician and, when they are finally seen, they are treated as a number within a system focused on volume and turnover. This can lead to hospitals admitting patients who do not require in-patient services, thus increasing healthcare costs. In southern states that have not expanded Medicare/Medicaid, maintaining large regional hospitals can be expensive and recent trends indicate that many are closing in rural areas.
In contrast, FECs see patients quickly, spend time with them, and provide quality emergency care. This is why patients are so satisfied with the model. Having smaller, more agile facilities triaging patients and sending those in need of in-patient care to hospitals is more efficient than having patients travel from all over to a regional hospital, only to wait in long lines to see a physician.
The relationship between FECs and traditional hospitals is not duplicative, and Texas hospitals are still operating at capacity even with the rise of FECs. The growth of the FEC industry will ultimately support the need for traditional hospitals with surgeons, specialists, and trauma capabilities, and that shift will involve collaboration and integration. Together, FECs and hospitals can improve the delivery of emergency care in terms of lowering costs, reducing wait times, and improving patient satisfaction.
Comparing FECs to Urgent Cares
Once again, the media missed the mark by comparing FECs to urgent care facilities, despite their significantly differing levels of service. Freestanding emergency centers are required to be open 24/7, 365 days a year. Emergency medicine's top priority is being ready for every patient and is unique in that this delivery of care is unscheduled. In contrast, primary care physicians, minute clinics, and urgent care facilities have limited hours and often require scheduling appointments in advance. That means for late night injuries or holiday sicknesses, the emergency room may be a person’s only option for emergency care.
Freestanding emergency centers are required to have a trained ER physician and registered nurse at all times. Urgent care facilities and similar alternatives are not required to have a physician available during all business hours. At times, a physician’s assistant will be the highest trained medical professional at an urgent care or minute clinic. Having the most experienced and qualified personnel is another important feature that enables FECs to provide the highest levels of service.
Freestanding emergency centers are equipped to handle serious emergencies – heart attack, stroke, lacerations, or other medical emergencies – at a moment’s notice. To do so, freestanding emergency centers must maintain state of the art equipment, which enables staff to quickly diagnose and treat a medical emergency. FEC facilities have laboratory and radiology equipment, including CT scanners, ultrasounds, and x-ray machines. FECs are able to run tests and process results efficiently. They also have a stocked, Class F pharmacy on-site to quickly deliver needed medications to patients so they can get back to their daily lives. FECs stand ready for all levels of emergency at every hour of every day. FEC alternatives like primary care physicians, minute-clinics, and urgent care clinics are unable to treat patients with serious emergencies and are not required to house such complex medical equipment.
FEC Patient Satisfaction
The FEC model is expanding rapidly across the country because patients are overwhelmingly satisfied with the care they receive at these facilities. The quality of care at an FEC is unsurpassed, and there is an emphasis on customer service. Patients feel welcomed and at ease in a clean, comfortable FEC setting. FEC staff take the time to get to know their patients, thoroughly explain recommended treatment, and often times follow up with a personal call to check on patients after leaving the FEC facility. This emphasis on customer service is the reason why multiple TAFEC member companies have received recognition from Press Ganey Associates, Inc. as top facilities that consistently achieve the 95th percentile of performance in Patient Experience nationwide.
Retaining Emergency Physicians
Numerous surveys have shown that an FEC produces higher satisfaction rates among emergency physicians than a traditional hospital. Most physicians cite the ability to spend time with patients and provide quality care as the primary reason for making the switch to an FEC. In contrast, physicians believe they are not able to provide the same quality of care in a hospital setting, which emphasizes patient volume and speed of care. Emergency physicians were trained to help patients to the best of their ability, and many feel that they have the best opportunity to do so within the walls of an FEC.
FECs are delivering high-quality emergency care with little to wait time for patients, and the recent growth of the FEC model in Texas and in other states across the country can be attributed to its vast popularity and improved patient outcomes. Emergency care does not have to take hours or be an unpleasant experience for patients.
FECs have the potential to change the way we deliver emergency healthcare. Shifting to this “hub and spoke” model for emergency healthcare is beneficial because it can save money and produce better results for patients. As FECs change our perception of emergency care, we should embrace the model as a potential solution to some of our biggest healthcare challenges in Texas.