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Commentary: Growth of freestanding ERs boosts local, state economies


I would like to address some misrepresentations in “Freestanding emergency rooms, medical costs threaten Texas,” a recent guest commentary by the Texas Association of Business.

Freestanding emergency centers, or FECs, are not driving up health care costs or threatening the Texas business climate. Quite the opposite.

FECs create an average of 30 to 40 jobs per center. There are 325 FECs in Texas. In 2015, more than 10,000 jobs were created from the very FECs that the Texas Association of Business claims threaten the health of the state.

Likewise, the positive financial impact FECs have on Texas cannot be ignored. In 2015, the FEC industry generated more than $40 million in tax revenue and fees to local and state governments. It’s ironic that an organization claiming to work to improve the Texas business landscape would attack an industry that undoubtedly strengthens our state’s economy and local job markets.

While the rising cost of health care is a legitimate concern, the Texas Association of Business’s assertion that FECs are to blame is misguided. The American College of Emergency Physicians estimates that emergency care amounts to just 2 percent of the nation’s health care expenditures.

The rising cost of health care in Texas is a direct effect of health insurance business practices and the Affordable Care Act.

The Kaiser Foundation reports that over the last five years, the percentage of covered workers facing a general annual deductible has grown from 74 percent to 83 percent, while the average single deductible amount increased from $991 to $1,478.

Covered workers’ average dollar contribution to family coverage has increased 78 percent since 2006. Even worse, while insurance rates increase, there has been a reduction in the offering of health insurance by firms with 10 to 49 workers over the same period, decreasing from 74 percent in 2011 to 66 percent in 2016.

These rising costs cannot be pinned on FECs, but rather insurance companies promoting high-deductible plans and shifting more costs to enrollees.

FECs charge equal to — or in many cases less than — hospital-based emergency rooms. The assertion that FECs price gouge or siphon money from Texas business is simply incorrect.

Also misleading is the statement that many FECs are considered out-of-network. While many FECs are not contracted with insurance companies, this does not mean claims are processed at out-of-network rates.

The Texas Department of Insurance requires that insurers pay emergency facilities “at the insured’s in-network benefit level” for all services. This is based on the “prudent layperson” standard – a generally accepted principle in health care that applies to emergency medicine. This standard was created to protect consumers from high medical costs that arise from emergency situations by allowing them to be charged at in-network rates.

However, insurers have been reluctant to apply this standard for care issued at FECs. By not providing usual and customary reimbursement rates, insurance providers violate the intent of the medical community and legislators who turned the prudent layperson standard into law. Despite the implication by the Texas Association of Business that fever, bronchitis and sore throats are not medical emergencies, reimbursement is based upon the presenting symptoms as interpreted by the patient, not the final diagnosis.

When compared to hospital-based emergency rooms, FEC patients wait considerably less time to be seen by medical staff. Research shows that longer wait times at emergency departments increase the risk of death and likelihood that a patient will be admitted for inpatient services.

Furthermore, studies have shown that FECs admit patients for inpatient services at a rate much lower than hospital-based emergency rooms. Researchers attribute this statistic to the overcrowding of hospital-based emergency rooms, which causes physicians to admit patients who do not require inpatient services. FECs reduce health care costs by allowing doctors to spend quality time with patients to accurately diagnose and provide treatment in an outpatient setting, which saves thousands of dollars per avoided admittance.

FECs have provided much needed access to quality care and contributed to the Texas economy. Patients, health care consumers, business owners and Texas Association of Business alike should unite to address skyrocketing health insurance costs, the overwhelming lack of transparency and lobbying efforts that ultimately hurt consumers.

Shields is the executive director of the Texas Association of Freestanding Emergency Centers.



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