Freestanding ERs: Do They Fill the Prescription?

In a world driven by convenience and customer service, it’s no wonder a person would seek out an alternative solution to the stereotypical, crowded hospital emergency room (ER) when available.  It’s not breaking news that more of America’s uninsured population is turning to the ER as a primary care provider, and, based on the statistics, there is no foreseen decrease in the number of ER visits in medical facilities around the country.

For the past few years, the concept and actual existence of stand-alone emergency care centers has flourished around the United States.  Just as ambulatory surgery centers have taken many of today’s most commonly performed surgical procedures out of traditional hospital operating rooms, freestanding ERs are successfully drawing patients to their prototype facility with the promise of shorter wait times and stellar customer service.

I don’t want to confuse these independent emergency facilities with their cousins, Urgent Care Centers, which became popular several years ago in an effort to provide family practice-like care, particularly in the evening hours and on weekends when most physicians’ offices are closed.    Freestanding emergency departments are actually adorned with the exact same technology found in any hospital ER, such as crash carts, a pharmacy area, laboratory equipment, electronic medical records systems, X-ray machines, and even CT scanners.  Freestanding emergency departments paint the same landscape as their hospital-based siblings.

However, critics express concern about these centers, particularly when it is medically necessary for a patient to have immediate access to an operating room or a cardiac catheterization lab after being diagnosed with a critical condition.  Hospital ERs are in fact the doorstep to the hospital when a patient is presented with life-threatening symptoms and conditions.

Proponents of the independent models emphasize there is enough patient business to go around and that, in some respects, it makes more sense for hospitals to tend to the critically ill patients and leave the less-critical scenarios for the freestanding ERs.

Furthermore, freestanding facilities are required to have transfer agreements in place to transfer and admit patients to hospitals when longer-term care and treatment is warranted.  It’s commonplace for an independent emergency facility to directly admit a patient to a nearby hospital, bypassing the sometimes cumbersome delay in a traditional ER room or holding area. Naturally there are also financial ramifications, such as the loss in potential revenue, for hospital organizations to consider when some of their routine business is migrating elsewhere.

Across the nation, there is already a presence of both hospital-owned and privately owned freestanding ERs, many of which are open 24 hours a day, 7 days a week.   Hours of operation and the type of testing that are available at freestanding ERs are regulated at the state level.   For example, Texas passed House Bill CSHB 1357, which places strict guidelines and requirements on stand-alone emergency centers located within the state.  This 2009 bill mandated coverage of services by commercial insurance providers, and it will also require all Texas freestanding departments to be in operation 24 hours, seven days a week no later than September 1 , 2012, to maintain their licensure and continue to the use the terms ER and emergency for marketing and advertising purposes.

So, tell me what you think, are freestanding emergency rooms just what the doctor ordered?  What type of experience have you had with these types of facilities?  How is your state addressing the regulation of these centers?  Please reply to this blog below or feel free to contact me directly at

Lori Webb, BAAS R.T. (R)
Lori Webb, BAAS R.T. (R), Clinical Analyst — Ms. Webb joined MD Buyline in 2008 and has an extensive 25-year background in radiology. She assists hospitals and healthcare facilities with purchasing considerations, product research and comparisons on analog and digital radiographic equipment and radiology IT systems, as well as radiology support items. Ms. Webb graduated from El Centro College with an associate degree in applied sciences (radiologic technology) and a Bachelor of Applied Arts and Sciences from Lamar University. She is registered by the American Registry of Radiologic Technologists.