AUSTIN, Texas – Oct. 13, 2016 – The rapid growth of freestanding emergency centers (FECs) in states like Texas is helping transform emergency care in the U.S., providing a delivery model focused on convenience, speed, and getting patients quality time with physicians. Despite this, misconceptions of these facilities and the services they provide persist.
In 2009, Texas became the first state to license independent FECs, and today there are more than 200 independent FECs and more than 100 hospital-affiliated FECs statewide. FECs are conveniently located in patient neighborhoods, which improves access to care and saves critical travel time that could mean life or death. In most cases, patients are seen by a physician within minutes of walking into the facility and are treated right away.
“The growth in popularity of FECs and their expansion across the state is a testament to the value these facilities bring to patients and to communities,” said Brad Shields, executive director, Texas Association of Freestanding Emergency Centers (TAFEC). “Our hope is to dispel some of the myths surrounding FECs and educate Texas consumers on the many benefits they provide.”
Here are the top five FEC myths as identified by TAFEC.
MYTH #1: “Freestanding Emergency Centers are not true emergency rooms.”
FACT: The Texas Department of State Health Services enforces very clear licensing rules to ensure FECs provide the same level of service and meet the same standards as hospital ERs. Like hospitals, FECs are required to have an emergency trained physician and registered nurse onsite at all times, must be open 24/7, 365 days a year, and must have available the clinical equipment necessary to quickly diagnose and treat emergencies.
MYTH #2: “Freestanding Emergency Centers purposely saddle patients with surprise medical bills (often referred to as balance billing).”
FACT: Based on patient satisfaction surveys and reviews, the vast majority of FEC patients are clearly well informed about FEC billing practices and have no complaints about their bills. However, when patients do get hit with unexpected out-of-pocket expenses, there are two primary causes: predatory underpayment by health insurers and confusion on the part of patients regarding the specifics of their own benefit plans.
Texas law requires insurance companies to reimburse health care providers at the “usual and customary rate” for emergency care. But because there is no definition of the term “usual and customary” or uniform guidelines for insurance companies to follow, insurers have determined their own arbitrary rates and unilaterally declared them to be “usual and customary.” While some insurers provide adequate reimbursement for services, others are reimbursing at a much lower percentage. This leaves FECs with few options. They can either accept the low reimbursement rate, appeal to the Texas Department of Insurance, or collect the remaining balance from the patient.
Second, because the Affordable Care Act (ACA) defines emergency care as an essential healthcare benefit, a person cannot be penalized for receiving emergency care at an FEC. The ACA incorporates prudent layperson laws, which make the patient the final arbiter of whether he or she is suffering a medical emergency, and requires insurance providers to pay at the in-network benefit level for emergency care when a patient reasonably believes his or her life is in danger. However, many health plans do not comply with these regulations, do not defer to patients’ decisions about their own condition, and therefore pay at much lower out-of-network rates.
Surprise billing also can stem from a patient’s lack of understanding of his or her own insurance plan, leaving a large amount owed by the patient in order to meet higher deductibles as designated in his or her plan. For this reason, TAFEC proactively spends time and resources to educate the public on health insurance.
MYTH #3: “Unlike hospital ERs, freestanding emergency centers are not required to treat all patients.”
FACT: FECs provide critical access to care for any patient that walks through their door, regardless of insurance or ability to pay. This includes Medicare, Medicaid, and uninsured patients. Just like a hospital-based ER, FECs are legally required to administer medical screenings and stabilize all patients at their facility. FECs provide millions of dollars in uncompensated care annually, serving as an important resource to their local communities.
MYTH #4: “Freestanding emergency centers price gouge consumers by intentionally misleading them into thinking they are at an urgent care facility.”
FACT: FECs provide high quality emergency care for medical emergencies, and do not hide behind the guise of an urgent care or “doc-in-a-box” in order to price gouge patients. Furthermore, the Texas Legislature has created clear guidelines for FEC operators and comprehensive regulations to ensure FECs provide the same levels of service as hospital-based ERs. Each FEC facility has signage – both external and internal – prominently displaying the word “Emergency,” postings outlining the available levels of services, and billing disclosures that patients are required to sign acknowledging they are in an emergency room setting. It is also important to note that only licensed emergency care facilities are allowed to use the word “emergency” in their name or marketing material.
MYTH #5: “Freestanding emergency centers increase the cost of healthcare.”
FACT: According to a 2010 University of Michigan study, the average cost of an admitted patient is $35,000 per case. Preliminary research suggests that FECs may help to reduce inpatient admission rates. By treating patients in an FEC setting and transferring only patients in need of inpatient care, FECs can improve overall efficiency and help save on healthcare costs. FECs have no financial incentive to push patients into hospital admissions, and so can serve as unbiased gateways into the healthcare system.
About TAFEC
The Texas Association of Freestanding Emergency Centers (TAFEC) is the first and only statewide association in the U.S. specifically created to represent freestanding emergency centers. TAFEC members work to ensure that all Texans have timely access to high-quality emergency medical care. As licensed, regulated, fully functioning ERs equipped to handle medical emergencies 24/7, our members provide expert care at convenient community locations with minimal waiting.
For more information, visit: www.tafec.org
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