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Freestanding Emergency Departments

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  • Freestanding emergency departments are emergency departments that are physically separated from hospitals.
  • Freestanding emergency departments can evaluate and stabilize any patient.  They will arrange for transfer for additional care or hospital admission if needed.
  • In an emergency, a freestanding emergency department may be closer than an emergency department which is attached to a hospital.  Going there first would allow lifesaving medical treatment to begin sooner than going to a more distant hospital.
  • Freestanding emergency departments are not urgent care centers.  They have advanced diagnostic and laboratory facilities and are capable of treating any emergency medical condition and are always staffed by emergency physicians.

What are freestanding emergency departments?

Freestanding emergency departments (also called freestanding emergency centers) are usually open 24/7 and staffed by emergency physicians.  They have the same equipment as hospital emergency departments but are physically separated from hospitals. They can be owned by hospitals and run as outpatient departments or they may be privately owned.  There are two kinds:

  • A “Hospital Outpatient Department” is the Centers for Medicare and Medicaid Services designation for a freestanding emergency department that is owned and operated by a hospital.  The hospital is required to treat patients in the same manner as those treated in the hospital’s emergency department.  This means that patients have access to the full spectrum of specialists available at the main hospital. The physicians working in this kind of facility are on the hospital’s medical staff.

Emergency visits at these facilities are covered by Medicare and Medicaid and are usually considered to be “in network” for health insurance plans if the primary hospital is.  These facilities must comply with all federal regulations regarding emergency department operations, including EMTALA (which requires hospital emergency departments to screen and stabilize the medical emergencies of all patients, regardless of ability to pay). They are also subject to inspection by the Joint Commission/Centers for Medicare and Medicaid Services. Joint Commission accreditation is not mandatory for freestanding emergency centers but some voluntarily request inspection.

The easiest way to know you are in a hospital outpatient department is the sign (mandatory) stating the facility accepts Medicare/Medicaid payment and describing your rights as a patient being treated at a Medicare/Medicaid participating hospital.  Most freestanding emergency departments, which are prominently labeled with a hospital’s name, are operating as hospital outpatient departments.

Independently owned freestanding emergency departments. These facilities are independently owned and operated and cannot accept Medicare/Medicaid payments.  The Centers for Medicare and Medicaid Services has not recognized them as emergency departments.  As a consequence, they are not bound by federal regulations regarding emergency department operations, including EMTALA. Some states, most notably Texas, have passed state laws that impose rules similar to EMTALA on all freestanding emergency departments. Other states, such as Illinois, prohibit private ownership of freestanding emergency departments.

How does a freestanding emergency department differ from a traditional (hospital-based) emergency department?

The main difference is that a patient at a freestanding emergency department who requires admission to the hospital (for treatment, observation, surgery or a cardiac catheterization procedure) will need to be transported to a hospital.

For patients at a freestanding emergency department, which is owned by a hospital, that admission will most likely be at the main hospital. Independently owned departments often negotiate transfer agreements with local hospitals.

In medical emergencies, such as heart attacks and strokes, these transfers occur very quickly after the patient is stabilized. For patients who are discharged from the emergency department, studies have found no functional difference between a freestanding emergency department and a traditional one.

Are the financial implications for patients visiting a freestanding emergency department different from hospital emergency departments?

  • No, the charges for services are equivalent to hospital charges. Patients receive bills for professional fees, a facility fee and ancillary fees (if radiology or lab services are needed). Facilities fees are needed because, like traditional hospital emergency departments, freestanding emergency departments have emergency physicians, nurses, techs and staff, and advanced laboratory and imaging capabilities available, usually around-the-clock. 
  • Hospital outpatient departments will accept Medicare/Medicaid payment. They are generally considered “in network” for health insurance plans if their main hospital is. Co-payments are usually the same as they would be for the main hospital. Under EMTALA, hospital outpatient departments are obligated to screen for and stabilize the medical emergencies of all patients, regardless of their ability to pay
  • Independently owned freestanding emergency cannot accept Medicare/Medicaid payment. They often negotiate arrangements with health insurance plans for “in network” status. Co-payments may be more, less or equal to those of other emergency visits. State laws requiring health plans to cover the costs of emergency department visits vary with regard coverage for visits to independently owned freestanding emergency departments. Most of these departments voluntarily agree to treat all patients, without regard for their ability to pay.  Some states, most notably Texas, require this as a condition of operation.

How does a freestanding emergency department compare with urgent care? 

Urgent care centers are great for minor medical problems that could be treated in a primary care physician’s office.  They are similar to after-hours doctor clinics but are not open 24 hours a day and may not be staffed by physicians.  Some urgent care centers have x-ray equipment.  Freestanding emergency departments, by contrast, are staffed by emergency physicians and have laboratory and radiology equipment, including but not limited to CT scanners, ultrasounds and x-ray machines.  They are usually open 24 hours a day, 7 days a week, and are equipped to handle any type of medical emergency, such as, heart attacks, strokes and major trauma. 

Why are so many freestanding emergency departments in Texas? 

Legislation was passed in 2009 creating an opportunity for independent licensed freestanding emergency departments in Texas to form.  This law allowed for higher levels of service for emergency care to be provided at freestanding emergency departments and gave some patients closer geographic access to emergency care. Additionally, many hospitals are choosing to expand their outreach in communities by opening freestanding emergency departments, which increases access to emergency care.

Does ACEP have any policies on freestanding emergency departments? 

Yes.  The ACEP Board of Directors approved a policy on freestanding emergency departments in 2014.  It is available on the ACEP website at: http://www.acep.org/Clinical---Practice-Management/Freestanding-emergency-Departments/

For additional information, see ACEP’s white paper on freestanding emergency departments at http://tinyurl.com/nuqcwrg.


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