Where do Freestanding Emergency Departments fit in Mississippi’s healthcare system?
Thursday, December 6th, 2018
Freestanding Emergency Departments (FSEDs) are walk-in medical facilities providing emergency care at a physically separate location from a hospital. These clinics are very similar to hospital emergency departments (EDs) because they can handle all of the same trauma and surgical services, but they often lack trauma level verification by the American College of Surgeons, do not receive patients via ambulance diversion or transfer, do not have overnight beds or intensive care capabilities, lack inpatient referral or admissions capabilities, and are generally unprepared to handle volume influxes of patients. FSEDs have recently become a popular option in some states because they are not subject to the same restrictions as hospitals, can be located almost anywhere, and can be owned by a hospital, investment funds, venture capital firms, or non-healthcare entities, depending on state laws. Currently, the majority of states allow for some form of FSED, including Mississppi.
Lukens, J (2016). Free Standing Emergency Departments: An Alternative Model for Rural Communities. https://www.ruralhealthinfo.org/rural-monitor/freestanding-emergency-departments/. Adapted from “State of the Nation: Policy for Owning and Operating a Freestanding Emergency Department,” Journal of Free-Standing Emergency Medicine, August 2015.
FSEDs offer an alternative to having to go to a hospital ED which has increased their popularity. FSEDs distinguish themselves from hospital EDs by having less wait time, typically 60-90 minutes, by locating in upscale retail locations, and offer physicians and nurses that are not overwhelmed by patient load to the degree of a hospital. In Dallas and Houston, the median income associated with FSED locations was $15-20k higher than the metro area. Additionally, FSEDs in Seattle, Dallas, and Houston all show correlations between FSED locations and a less diverse population. The added convenience of FSEDs also comes at a cost, FSEDs typically cost 10 times higher than urgent care facilities and significantly higher than at a hospital EDs. Additionally, FSED billing practices often charge a ED “facility fee” and do not bill insurance so the consumer gets stuck with a high bill.
Some FSEDs have been working with different models that would allow FSEDs to not be solely reserved as boutique healthcare. For example, a facility called WestHealth in Minnesota prices minor and emergency conditions separately to reduce costs to patients. Some FSEDs claim that a lack of regulation allows them to control their overhead expenses in such a way that they could offer potential pricing models that would be more agreeable for insurance companies to contract with them. Other models, like in Mississippi, require that FSEDs be hospital-owned and located in rural areas in order to provide emergency care in rural areas that have suffered hospital closures. The financial viability of rural FSEDs is still largely unknown. Additional research needs to be done in Mississippi to figure out whether FSEDs are right for the state’s healthcare market and whether FSEDs are financially viable alternatives to hospitals in rural areas.