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.
I am happy to see an ER physician interested in FSEDs. To learn more you may want to visit www.fsedconsulting.com My company helps ER physicians open, own and operate their own FSEDs.
ReplyDeleteHave a great day!
Pete Peters
888-493-8056 Opt 1
509-339-5802