It’s a Good Time to Take Another Look at the Price of ‘Convenience’ in Freestanding EDs

Hospitals in some U.S. cities are getting slammed with COVID-19 patients, leaving some patients to consider what their best option might be when they need immediate care. Many know urgent care is the best bet. Before the term COVID-19 even existed, however, operators of freestanding emergency rooms touted their own ability to see patients with a broad array of injuries and illnesses faster than would be likely in conventional emergency rooms. It’s a claim that matches one of the core attributes of urgent care. The problem is that the care is considerably more expensive in freestanding EDs. A new study published in Academic Emergency Medicine confirms that such facilities do, indeed, increase access to immediate care but that they also increase healthcare spending and fail to reduce visits to hospital EDs in the markets where patients have a choice. The researchers included data from Arizona, Florida, North Carolina, and Texas in Blue Cross Blue Shield Axis; a limited data set of deidentified insurance data claims; and lists of licensed freestanding EDs to examine total spending on emergency care, out‐of‐pocket spending, utilization, and price per visit from January 2013 to December 2017. In Texas, Florida, and North Carolina, there was a 3.6% increase in provider reimbursement for each beneficiary; there was no change in spending in Arizona. Emergency visits per 100 enrollees increased less than 1% in Texas, Florida, and Arizona (there was no change in North Carolina). Out-of-pocket spending increased in three of the four states, as well. Consequently, the authors concluded that freestanding EDs “have increased local market spending on emergency care in three of four states’ markets where they have entered.”