AL Freestanding Emergency Departments Will Increase Convenience

The 24,000-square-foot facility at the corner of Alabama Highway 150 and Interstate 459 will include all the equipment you would expect to find at a standard ER – except the hospital.

The building will contain 12 exam rooms, board-certified emergency physicians, CT scanners, X-ray machines, onsite labs and an ambulance bay. The Birmingham area is at the forefront of this trend, with two facilities set to open in Hoover this year. The second freestanding emergency department will be owned and operated by Brookwood Medical Center and is slated to open in late October near the intersection of U.S. 280 and Alabama 119.

"Basically, it is just like an ER in the hospital, it is just not attached to a hospital," said Keith Pennington, CEO of Medical West.

Those similarities also extend to the billing practices.

Freestanding emergency departments bill just like any other emergency room, so patients who turn to them for care will end up with bills for both the doctors' services and facility fees.

Texas has about 150 freestanding emergency rooms, and most of them opened after the state passed a law regulating the industry in 2009.

As the industry grew in that state, so did concerns about the cost of care, which can be several times higher in a freestanding emergency room than in an urgent care clinic. Facility fees can top $1,000, and the co-pay for using an emergency room is typically $150 for insured patients, which is much higher than the cost for urgent care.

About two-thirds of patients who use hospital emergency rooms could have gone to urgent care, according to a 2006 study by the Centers for Disease Control and Prevention. In Texas, customers have complained about confusion, and many have said they ended up in a freestanding emergency department when they thought they were going to an urgent care clinic.

Pennington said the clinic will fill a need in Hoover for emergency services.

Right now, patients in the area must drive long distances and battle heavy traffic to get to the nearest hospital. The new freestanding emergency room will provide the equipment and expertise to stabilize patients during an emergency, and treat conditions such as broken bones and severe nausea and dehydration that need emergency care, but not hospital admission.

Pennington said the hospital is trying to educate patients about the differences between freestanding emergency rooms and urgent care, so they can make the best choice. But all the education in the world won't prevent all patients with non-urgent health needs from ending up in an emergency room, he said.

"As you know, even in our hospitals, we get urgent care-type patients just because it's open twenty-four hours," he said.

In Texas, one insurance company fought back against the high charges from freestanding emergency departments, suing one of the biggest chains for charging improper facility fees. Leaders at Blue Cross Blue Shield of Alabama will be watching the costs, said spokeswoman Koko Mackin. She had some advice for consumers.

"For the consumer, a free-standing ER may be more convenient, but as with any ER visit there are higher out-of-pocket costs," she wrote in an e-mail. "Most copays for ER visits run one hundred fifty to three hundred dollars, while a copay for a physician office visit is twenty to fifty dollars."

Patients who do need emergency care and even admission to the hospital will be able to get that care more quickly at a freestanding emergency room, which can seamlessly transfer the patient to the affiliated hospital via ambulance or helicopter, said Dr. Conrad Brown, administrative director for emergency services at Brookwood Medical Center.

"If they come in with chest pain or stroke symptoms, the freestanding emergency department can save minutes and save lives," Brown said.

The number of patients who will need to be admitted to the hospital will probably be pretty low. One chain in Texas admitted only five percent of patients to the hospital, which is about one-third the rate for a regular ER, according to Kaiser Health News.

Vivian Ho, a health economist at Rice University, said she is concerned that freestanding emergency rooms will raise overall health costs. State laws typically require them to contain expensive equipment such as CT scanners.

"All of that is going to add on an extra layer of cost," she said.

The first freestanding emergency departments in Alabama are following the trend in other states by locating in affluent suburbs, Ho said. In addition to the two operated by Brookwood and Medical West, a  third freestanding emergency department in Hoover has also been approved for Princeton Baptist.

"They are opening in an area where it's hard to get into downtown Birmingham to get to the ER and where there are a large number of privately insured patients," she said.

All of the freestanding emergency departments in Alabama will have to abide by federal laws that require them to treat all patients, regardless of ability to pay. They will also take Medicare and Medicaid patients.

But at this point, it's unclear whether they will ever locate in rural areas that have experienced hospital closures.

Pennington at Medical West said the model might fill medical gaps in rural communities. Brown at Brookwood said it might be too difficult to partner with struggling rural hospitals.

If freestanding emergency departments prove to be as popular in Alabama as they are in Texas, they will almost certainly appear in other parts of the state. Ho said consumers should be aware of the costs of seeking treatment in such facilities, and have a plan in case of emergency.

"We urge consumers to look at the sign and see if it says urgent care or emergency care," Ho said. "Check your emergency plan before an emergency happens."