Freestanding ER regulations vary broadly across state lines

Emergency room sign

Photo Credit: Getty/Nils Versemann

State regulation of freestanding emergency rooms varies widely, which can impact the types of services, quality and costs that they offer patients, a new analysis has found.

A team of researchers led by Catherine Gutierrez of Harvard Medical School examined data on 400 freestanding ERs located across the country as of December 2015, according to a study published in Health Affairs. They compared that data to state regulations on staffing, licensing and operation. The 400 facilities were located across 32 states, according to the study, and of those 17 had specific requirements for them.

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The analysis further found that 21 states had policies on freestanding ERs either independently or part of their hospital regulations, while 29 had no regulations that specifically mentioned freestanding emergency facilities.

New York and Washington regulated freestanding ERs on a case-by-case basis, according to the study, and California’s hospital regulations barred such facilities in the state. 

The policies were not universal across state lines, the researchers found, so requirements related to staffing, hospital-affiliation and potential services varied significantly. For example, physicians were required to be on-site during all hours of operation in 15 of the 32 states, and nurses were required at all times in 23 states.

Several states applied rules similar to those from the Emergency Medical Treatment and Labor Act (EMTALA) to freestanding ERs, and others listed specific equipment and services that such facilities must offer. Twelve states required pediatric equipment be available, and 13 states stipulated that such facilities must have a defibrillator.

Policies that oversee freestanding emergency departments can significantly impact options for patients, the researchers concluded.

“Efforts to standardize requirements for freestanding EDs’ operations across states may help patients choose the acute care site that is most appropriate for them and avoid unnecessary costs and treatment delays,” they wrote.