The Pitfalls of Free Standing Emergency Rooms

~ By Ken Cohen, MD, FACP ~

We have all become familiar with the fact that our healthcare system costs several times more than those of other advanced nations and yet provides us with inferior health outcomes. A great sadness that contributes to this truth is the profit motive in healthcare. Nowhere in medicine is the example clearer than in the proliferation of free standing emergency rooms. These are typically built in affluent neighborhoods, and often in the “backyard” of competing hospital systems. They look similar to urgent care centers by virtue of their appearance and location, yet patients receive bills in the thousands of dollars when accessing these facilities, most often for simple urgent care problems. Unfortunately, the prices charged by these facilities are not transparent and patients are not told that they will receive these large bills. These centers are so lucrative, that often less than ten patients need to be seen in a twenty four hour period to generate a profit. As a result, not only are hospital systems building them, but there are also private companies building them in our area as well.

Most urgent care problems fall into the categories of respiratory infections, skin and urinary infections, sprains, strains, minor fractures, and minor gastrointestinal problems. These are all easily handled at urgent care centers. Think for a moment about the medical conditions for which an emergency room is truly needed. These are usually serious conditions such as heart attacks, strokes, serious breathing problems, surgical emergencies, and other conditions which fortunately occur much less frequently. When these patients wind up at a free standing emergency room, they then require transfer to the hospital. This process may delay the high level care which is needed. The main beneficiary of these free standing ER’s is the hospital which has now “captured” the patient into their healthcare system by transferring them to their hospital. With hospital systems tripping over themselves to capture market share, there are now over 20 free standing emergency rooms in the Denver metro area. Some of these centers are now functioning as combined urgent care centers and emergency rooms under one roof. The caveat is, however, that the emergency center and not the patient decide whether they are billed urgent care versus emergency room costs.

This means that you could be billed $200 or $3,000 and not know this at the time you are receiving the service.

With the cost of our healthcare system spiraling towards 20% of our GDP, almost one in five dollars spent in this country goes to healthcare. We cannot afford this. The solution is for us to focus on and support those healthcare services that provide us true value in terms of improving our health. Free standing emergency rooms, unfortunately, do not fall into this category.

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