With the advent of new rules being implemented by health care reform, there will be an increasing need for access to health care. In Texas, freestanding EDs have been created in an attempt to help increase access to health care. However, what some do not realize, not all health care insurance will cover or reimburse for services provided by some of these EDs
Texas currently licenses 37 freestanding emergency care clinics most of which are in the Houston area). Currently, Texas legislation requires that freestanding EDs must abide by EMTALA, provide laboratory testing necessary for emergency situations, provide radiology services such as X-ray, CT scans, ultrasound, be staffed by physicians and nurses trained in emergency medicine and have the ability to provide for patient transfers between the freestanding ERs and other medical facilities.
Starting September 1, 2012, Texas will require all freestanding emergency departments to be open 24 hours a day, 7 days a week. After this date, only licensed emergency centers may use emergency terminology (e.g, emergency or ER).to advertise themselves. Hospital extension ERs do not have to abide by these rules. Some insurers argue that if the freestanding ED is not associated with a hospital or open 24/7, that it is not an ED for billing purposes, and that has been their argument for not paying or reimbursing for these services. It is believed that after implementation of these rules it may aid with the current insurance problems.
Other states are dealing with these facilities in different ways. For example, a Washington State Senator has been trying for many years to obtain a moratorium on freestanding EDs until their effect on the health care system can be analyzed. CMS is also trying to figure out how to deal with these centers as well.
As the increase in access to health care continues over the next few years, it will be very interesting to see what happens with these facilities, if their implementation expands across the country and the effect on regulations.
More information can be found in the following resources:
· Texas Department of State Health Services, Freestanding Emergency Medical Care Facilities, 25 TAC §131. Available at: http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=4&ti=25&pt=1&ch=131
· Texas Department of State Health Services, Directories of Freestanding Emergency Medical Care Facilities, Available at: http://www.dshs.state.tx.us/hfp/apps.shtm#freestanding
· Eldridge, K. Eliminating Patient Confusion: New Regulations for Freestanding Emergency Rooms, iTriage. Available at: http://blog.itriagehealth.com/eliminating-patient-confusion-regulations-freestanding-emergency-rooms/
· SoRelle, R. The Emergence of Freestanding ED’s, Emergency Medicine News, June 2011.
· SoRelle, R. Washington Legislator Seeks to Stall Freestanding ERs, Emergency Medicine News, April 2012.
· Welch, S. My Night at Elite Care, Emergency Medicine News, February 2012.