Are standalone ERs only for the rich?

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Standalone emergency rooms (ERs) are increasingly popular nationwide, but in addition to backlash over high prices, the Medicare Payment Advisory Commission (MedPAC) panel recently expressed concerns about their proliferation in high-income neighborhoods specifically.

For example, in Houston, two out of three independent freestanding emergency centers run by for-profit organizations are located in ZIP codes with an average income higher than $53,000 a year, according to Zach Gaumer, senior analyst for MedPAC.

In testimony during the meeting's public portion, Texas Emergency Care CEO Rhonda Sandel said that allowing freestanding ERs to bill Medicare could increase their spread to lower-income and underserved areas, MedPageToday reported. More freestanding ERs, she said, could fill a vital community need, as they don't have restrictive hours like urgent care centers nor the long wait times of hospital emergency departments.  

The panel also noted a recent 30 percent spike in Medicare physician claims for level 5-severity ER visits, the highest possible level, between 2008 and 2013, as well as an 82 percent spike in level 5 outpatient claims over the same period. This increase, Gaumer speculated, may tie into the growth of standalone facilities. Commission Chairman Francis Crosson, M.D., also discussed the possibility of standalone ERs siphoning patients from community hospitals that depend on a steady supply of patients, according to MedPageToday.

Medicare claims data does not currently indicate whether emergency care was provided on or off a hospital campus; the commission agreed to recommend that the Centers for Medicare & Medicaid Services amend claim forms to enable tracking care type by site. MedPAC could also explore how, if at all, the growth of standalone ERs has affected beneficiaries' understanding of when they should seek emergency care and their out-of-pocket liability.

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