Freestanding ERs may freeze out poor, minorities

The freestanding emergency room mode is taking healthcare delivery by storm, but concerns linger about their effect on care access, according to a new study published in the Annals of Emergency Medicine.

These stand-alone facilities are physicially separate from acute care hospitals but are available 24/7 for emergency care, and offer many of the same services as traditional emergency departments, including on-site advanced diagnostic imaging and laboratory testing.

Researchers from Boston's Brigham and Women’s Hospital assembled a national database of freestanding ERs, determining that 360 existed across 30 states as of spring 2015, up from 222 in 2009. They found growth of the ERs is concentrated in high-income areas with growing populations, more traditional ERs, a higher proportion of privately insured patients and a lower proportion of Medicaid beneficiaries.

Ohio, Texas and Colorado led the other states for number of freestanding ERs, and in Texas and Ohio specifically, freestanding ERs were concentrated in ZIP codes with more privately-insured patients, according to the research. Texas’ freestanding ERs are more likely to be in ZIP codes with fewer Hispanics and higher annual spending.

Therefore, researchers concluded that although the model is on the rise, the facilities grow in areas that need the least help with care access.

“In the states with the most freestanding EDs, it seems less likely that they will expand access to underserved populations,” corresponding author Jeremiah Schuur, M.D., vice chair, Clinical Affairs, Department of Emergency Medicine, Brigham and Women's Hospital, said in a statement, “as they are preferentially located in areas where people had more available health services, higher rates of private health insurance, lower rates of Medicaid and higher median incomes."

The findings echo concerns voiced last year by the Medicare Payment Advisory Commission (MedPAC), which noted that two-thirds of Houston’s for-profit freestanding ERs are in ZIP codes with an average income higher than $53,000, FierceHealthcare previously reported

- read the study abstract
- here’s the statement