Tuesday, August 13, 2013
National Public Radio aired an interesting story this morning about the proliferation of free-standing emergency rooms in places like strip malls, mostly in suburban locations with relatively affluent, well-insured residents. These places are equipped to handle life-threatening emergencies in much the same way as hospital-based ERs, and can charge the same high "facility fee" that a full-service hospital charges to reimburse the costs of maintaining expensive equipment and services. Consumers are likely to confuse them with urgent care centers, and often show up at the free-standing ER for a problem that could be treated appropriately and more cheaply in an urgent care center or a doctor's office. So rather than easing the problem of inappropriate use of the hospital ER for non-life-threatening problems, these facilities make it easier for well-heeled people to misuse the ER, a problem that had been more prevalent amongst the poor and uninsured in the past. And if there is a true emergency and the patient needs to be admitted to a hospital as an inpatient, there is the ambulance ride from the free-standing ER to the hospital to pay for. Not exactly the way to hold down health-care costs.
Another interesting wrinkle on free-standing ERs is that they are not subject to the Emergency Medical Treatment and Labor Act (EMTALA), which prevents hospitals that treat Medicare patients from dumping poor and uninsured patients out of their ERs and into public hospitals without stabilizing or treating them. So if a poor or uninsured patients shows up in the freestanding ER, she has entered a time-warp back to the early 1980's, when such patient dumping was widespread and not prohibited by federal law. If this trend of free-standing ERs continues, it may be time to revisit EMTALA.