Roger Stanmore discusses the numerous pros and cons of freestanding emergency departments. Please visit RogerStanmore.com to learn more.

1. FreestandingEmergencyDepartments
T H E V I V I D P R O S A N D C O N S O F
R O G E R S T A N M O R E M D , J D

2. FREESTANDINGEMERGENCYDEPARTMENTS
Freestanding emergency departments (FSED) have proven to
be the hot, new emergency care model, brandishing all of the
expensive, life-saving equipment of traditional emergency
rooms.
With that said, some are concerned that these 24-hour
facilities, which offer on-site laboratory testing and diagnostic
imaging, concentrate their services in high-income areas,
predominantly servicing those with private insurance, rather
than those with Medicaid.

3. Nothing stands still. Not time, not emergency care medicine. The
surge and gains with regards to freestanding urgent care centers
and emergency departments is a mark of progression, signifying
the fact that the future of emergency care medicine is happening
now. The economics of emergency medicine make sense for a
number of communities, making emergency and ambulatory care
more accessible.
Freestanding EDs are defined by the American College of
Emergency Physicians (ACEP) as “a facility that is structurally
separate and distinct from a hospital and provides emergency
care.” There are two types of ownerships for these facilities:
hospital outpatient departments (HOPD), which are owned and
operated by medical centers, and independent freestanding EDs
(IFECs).

4. Sources suggest that there are 10,000 urgent care centers, 5,000 hospital
emergency departments, 5,000 ambulatory surgery centers, 2,800 retail
clinics, and the 500 freestanding EDs. These functions have been enabled by
technology and consumer preference, and ideally, both insured and uninsured
parents are immunized from overbearing out-of-pocket debt that’s usually due
following a visit to the standard emergency department. More than a visit
costing about a third of emergency room costs, the wait time is also
significantly shorter.
The freestanding ED has gained momentum in recent years, and this can be
contributed to the fact that these facilities tend to be open 24/7. They’re
equipped with CT scanners, labs, x-rays machines, and sophisticated
diagnostic equipment than urgent care centers.

5. With that said, these facilities have been accused of precluding poor and non-
white communities. These standalone ER facilities tend to be located in
affluent, growing communities with high incomes, and often welcomes cherry-
picked patients with private insurance. FSED have roused concern and
criticism due to the fact that this particular type of care access blooms in
areas that has higher annual spending, fewer minorities, and diminished need
for emergency care access.

6. “In the states with the most freestanding EDs, it seems less likely that they
will expand access to underserved populations,” corresponding author
Jeremiah Schuur, M.D., vice chair, Clinical Affairs, Department of Emergency
Medicine, Brigham and Women’s Hospital, said in a statement, “as they are
preferentially located in areas where people had more available health
services, higher rates of private health insurance, lower rates of Medicaid and
higher median incomes.”

7. The lowered rates of Medicaid users can be attributed to the fact that only
HOPDs are able to bill for Medicare patients, influencing the cause for
independent facilities to seek out those who are privately insured. On the
most part, FSEDs exist in Texas, Colorado, and other states that don’t require
a certificate of need.

8. Expanding nationwide, freestanding emergency departments are equipped to
care for those in need of cardiovascular stress test as well as anything from
chest pain, asthma attacks, allergic reactions, seizures, gastrointestinal
bleeding, infections, and other conditions traditionally cared for at hospitals.
FSED have helped to decrease admission at emergency rooms and lower costs
nationally. Some researcher suggest that this effort could be furthered if FSED
partnered with medical home models and feel the need for community-based
medical care.

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