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Free-Standing ERs: The Future of Rural Emergency Medicine?

Aug 20th, 2013

Free-standing emergency rooms are facilities that provide full emergency care outside of a hospital setting (though some may be affiliated with a hospital system).  While there are only an estimated 400 of these facilities nationwide, the number has grown from about 200 since 2011.  

The benefits of these facilities are highly debated.  On one hand, they offer increased access to emergency care, either in rural areas where patients have no nearby hospital, or in metropolitan areas where they offer increased convenience and choice, as well as short waits.  However, the cost for services at these emergency rooms is very high. In most cases, the cost is comparable to that for the same services rendered in a hospital emergency room; however, by many accounts, these facilities see caseloads similar to those of urgent care centers, and treat very few cases of chest pain or trauma.  The free-standing ER then bills the patient or patient's insurer for treatment that could have been provided elsewhere at a lower cost.  For uninsured patients, that means an unexpectedly high bill.  For other patients, it means their insurance company will cover the brunt of the balance, while raising future premiums to compensate.

The greatest benefit these free-standing emergency rooms can actually offer is to rural areas with no nearby hospital.  With more rural hospitals closing, these facilities can be a boon to affected communities.  However, most of the free-standing ERs have opened in affluent communities in metropolitan areas, where patients are more likely to be covered by a private insurerer, as opposed to rural patients who are more likely to be covered by Medicare or Medicaid or simply uninsured.  In other words, free-standing emergency rooms are more likely to exist near areas with better access to healthcare and the potential of higher reimbursement, and not the rural communities that need nearby emergency care.

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