As rural hospitals struggle to remain viable in a rapidly changing healthcare system, especially those in states that have not expanded Medicaid, some experts are looking to freestanding emergency departments (FSEDs) as part of the solution.
Such is the case in Richland, Ga., where the only hospital for miles, Stewart-Webster, closed its doors early last year. According to the Modern Healthcare article “When the tiny hospital can’t survive: freestanding EDs with primary care seen as new rural model,” not only did the closure leave Richland’s 1,500 residents with no inpatient or emergency care, people outside the small town also lost access to healthcare. The closest inpatient facility is more than 35 miles away for Richland residents.
To address the problem of rural areas with no emergency healthcare services, Georgia Governor Nathan Deal has proposed loosening standards for hospital licensing, essentially creating FSEDs that can stabilize patients and prepare them for transport to urban- or suburban-based facilities.
Experts disagree whether FSEDs offer a good solution for rural healthcare, and some experts doubt whether these facilities can be financially viable in rural areas that can’t support a full hospital. But what no one denies is that the number of FSEDs is growing quickly across the country.
According to the American College of Emergency Physicians (ACEP), there are two types of FSEDs: a hospital outpatient department (HOPD), also referred to as an off-site hospital-based or satellite emergency department (ED), and independent freestanding emergency centers (IFECs). And both types are proliferating.
Licensing and regulation for the two types of FSEDs varies, and according to ACEP, the Centers for Medicare and Medicaid Services (CMS) does not recognize IFECs as EDs. Therefore, CMS does not allow for Medicare or Medicaid payment for the technical component of services provided by IFECs. That technical component, or facility fee, is part of what drives the high cost of visiting a FSED for commercially-insured or self-pay patients. Also, most insurance plans have higher co-payments for emergency visits. According to an article in the Orlando Sentinel, Florida residents will pay about twice as much for a copay at a FSED as they would for a visit to their doctor’s office or an urgent care center.
Regardless of the type of FSED, ACEP advises any facility presenting itself as an ED should adhere to a few simple guidelines:
- be available to the public 24 hours a day, seven days a week, 365 days per year.
- be staffed by appropriately qualified emergency physicians.
- have adequate medical and nursing personnel qualified in emergency care to meet the written emergency procedures and needs anticipated by the facility.
- be staffed at all times by a registered nurse (RN) with a minimum requirement of current certification in advanced cardiac life support and pediatric advanced life support.
- have policy agreements and procedures in place to provide effective and efficient transfer to a higher level of care if needed (ie, cath labs, surgery, ICU).
There are at least two FSEDs in Indiana, both of which are part of larger hospital networks. The Chesterton Health and Emergency Center in Northwest Indiana is part of the Franciscan Alliance and the recently-opened emergency department at Anson in Zionsville is part of the Labanon-based Witham Health Services. St. Vincent Fishers originally offered a FSED, but after the facility opened in 2008, inpatient services have since been added.
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