By Dr. Janna Welch
Dr. Janna Welch is an ER physician at Five Star ER, the Assistant Program Director – University of Texas at Austin Dell Medical School Emergency Residency Program.

Following the election, we have been made painfully aware of the problems facing our country. The many challenges of our changing healthcare system are among the biggest, and that is no less true for Texas.

One challenge is the increasing number of elderly in Texas. While our population continues to grow by leaps and bounds, it is also aging significantly. According to the U.S. Census Bureau, the number of people in Texas age 60 and over is expected to more than triple between 2010 and 2050. As seniors require the most care, that translates into increased costs to the overall system.

Another area of concern is limited access to emergency care. Historically Texas ranks among the worst states in this category according to the American College of Emergency Physicians, which gave Texas an ‘F’ grade for access to care on its 2014 Report Card. In fact, only three states in the country ranked lower than Texas in providing adequate access to emergency care.

Making matters worse, recent trends indicate that it is becoming more difficult for traditional hospitals to continue operations in rural areas, and many end up closing their doors for good. Since 2010, Texas has had 10 rural hospitals close, and an April report by iVantage Health Analytics identified 75 others at risk of closure – by far the most of any state.

When hospitals close, a void in emergency care is created, causing patients to travel to neighboring emergency care facilities. This places additional pressures on already overcrowded and overworked hospitals, and also increases EMS ambulatory transport times for patients. Longer transport times mean there are less ambulances available to respond to the next life threatening call.

These issues highlight the need for alternative approaches to emergency care. One that is taking hold in Texas is the freestanding emergency center, or FEC. Although they are not physically attached to a hospital, FECs are fully-equipped emergency care facilities that help reduce the number of patients reporting to overcrowded hospital ERs. By screening and triaging patients in an accurate manner, FECs provide a valuable clinical service and only transfer patients who require complex inpatient services, like surgery or specialist care, to a traditional hospital.

Shorter wait times are another advantage offered by FECs. When a patient arrives at a traditional hospital ER, often times they are met with long wait times before being seen by a physician. This can lead to serious consequences, as sitting in a waiting room for four hours without receiving medical attention allows symptoms to worsen. Studies have shown that as hospital wait times for patients increase, so too does their risk of death.

The aging population, and overall increase in patient volume, also impacts the cost of care. As strained hospital ERs see more patients with the same number of physicians and staff, the result is less quality time spent with patients. In an effort to treat the long line of waiting patients, it is easy to understand why hospital ERs might admit patients without warranted symptoms. When the average cost of admitting a patient to the hospital is $35,000, costs can add up quickly. Analysis of admission rates shows that FECs admit patients at a lower rate than their hospital ER counterparts.

Given the slowing of the Texas economy, rising Medicaid costs, overcrowding of emergency departments, and the state’s aversion to tax increases, the 85^th Texas Legislature will be forced to make some difficult decision. It is critical that we consider new, innovative methods of delivering emergency care like FECs.

In 2010, Texas became the first state to create a specific license for FECs. Today, there are more than 200 of these facilities throughout the state. Because of their small footprint and focus on emergency services, FECs can service areas where hospitals would not be able to sustain.

By having FECs as an alternative to hospital-based ERs, we can address the symptoms created by hospital closures and overcrowding, while simultaneously reducing the costs of healthcare, lowering admission rates, and providing exceptional patient outcomes.