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Are Freestanding Emergency Rooms Following the Money?

July 19, 2016

By Lisa Rapaport

(Reuters Health) - Freestanding emergency departments (EDs) are becoming more common in many communities across the U.S., often popping up in places where people are wealthier and likely to have private health insurance, a recent study suggests.

These EDs provide round the clock emergency care but are separate facilities from acute care hospitals. Freestanding EDs can provide many of the same services as their traditional counterparts housed inside hospitals - the big exception is they don't admit patients for ongoing care.

Nationwide, the number of freestanding emergency departments surged 62 percent to 360 as of March 2015, from just 222 in 2009, researchers report in the Annals of Emergency Medicine, July 12.

When researchers took a look at the three states with the greatest number of these freestanding EDs - Texas, Ohio and Colorado - they found the facilities located in areas with population growth, higher incomes, a higher proportion of people with private health insurance and a lower proportion of residents with Medicaid, the U.S. health insurance program for the poor.

"Freestanding EDs have the potential to increase access in several ways: they can be located in areas without emergency care, like a rural area, or they can open in an area without adequate emergency care, for example, where hospital EDs have chronic long waiting times," said lead study author Dr. Jeremiah Schuur of Brigham and Women's Hospital and Harvard Medical School in Boston.

"Overall, in the three states we examined in this study, freestanding EDs are not primarily locating to address the regional access to care - rather they are more likely locating in areas where the population has good payment sources, which are also more likely to have more sites of health care like doctors' offices and hospital EDs," Schuur added by email.

To assess where freestanding EDs are choosing to open up shop, Schuur and colleagues analyzed population and demographic data by ZIP code for these facilities and compared it to data for hospital-based EDs within the same state.

Nationwide, about 54 percent of freestanding EDs are owned by, or affiliated with, hospitals, while 36.6 percent are independently run by physician groups or other entrepreneurs.

Across the country, 45 percent of freestanding EDs were for-profit and 44 percent were non-profit.

In Texas, where there were almost 200 freestanding EDs, these facilities were mostly concentrated around urban areas in ZIP codes with fewer Hispanics, a greater number of hospital-based EDs and physician offices and more physician visits and medical spending per year, the study found.


Just 22 percent of the freestanding EDs in Texas were owned by or affiliated with hospitals, while about 71 percent were for-profit operations.

Things looked different in Ohio, where all but one of the 34 freestanding EDs were affiliated with hospitals and only about 6 percent were for-profit, the study found.

The picture was more mixed for Colorado's 24 freestanding EDs. About 46 percent were affiliated with hospitals and 62 percent were for-profit.

More research is still needed to understand how the expansion of freestanding EDs impacts access to care, outcomes and health spending in local communities, the authors note.

"Freestanding EDs have the potential to provide emergency care to the patients with less access," Nitish Patidar, a researcher at Quinnipiac University in Hamden, Connecticut, who wasn't involved in the study, said by email.

Paramedics may choose to bypass freestanding EDs when they transport patients that may need intensive care, said Dr. Benjamin Lawner, a researcher at the University of Maryland School of Medicine in Baltimore, who wasn't involved in the study.

"These facilities may not improve care for more complex medical conditions because they're simply not resourced with the same inpatient beds and availability of specialists," Lawner said by email.

Generally, patients should choose the closest ED when they have a true emergency, whether it's freestanding or not, said Dr. Erin Simon, a researcher at Northeast Ohio Medical University in Rootstown, who wasn't involved in the study.

"For less time critical emergencies where the patient feels they have the time and convenience to choose a location, freestanding emergency departments may represent a great alternative when (other places) have long wait times or overcrowding," Simon said by email.


Ann Emerg Med 2016.


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