Freestanding Emergency Centers seeking Medicare and Medicaid recognition

4:58 AM, Jan 03, 2019
9:31 AM, Jun 12, 2019

Freestanding Emergency Centers look much like urgent care clinics and so, many consumers have confused the two.

There is a big difference. While an urgent care clinic’s billing is usually similar to that at your doctor’s office, billing at a free-standing emergency room is like a trip to a hospital ER, complete with a facility fee.

“The way it is set up right now is the Texas Legislature has set up where insurance companies are to pay In-Network for any emergency care. So even though we are Out-Network, the laws have been set up so that the insurance companies see that as an In-Network charge. There are different co-pays as far as urgent care and ER, and we fall under ER co-pay and that does affect our patients,” said Physicians Premier Emergency Room Dr. Martin Grieme.

Freestanding ERs can also help relieve overcrowding at hospitals.

“That is kind of why freestanding emergency rooms kind of blossomed is that it is a big need in Texas. Texas gets an “F” on the ratings for access to care, and we are trying to provide a source that actually kind of goes at the problem and get a solution for it,” saidGrieme.

Physicians Premier is one of the 200 plus independent, freestanding emergency centers in Texas that aren’t affiliated with a hospital and aren’t recognized by the Centers for Medicare and Medicaid Services so people with that insurance may have to pay full price if they go there.

“We have to get a new law or new bill placed that inserts emergency rooms that is not in the four walls of a hospital. So we are trying to get that done. Senator Bill Cassidy from Louisiana has a couple of bills that he is going to introduce and hopefully with that and the push through Congress, we can get things kind of settled where we can actually take Medicare and Medicaid and actually bill for it,” said Grieme.

This bill would allow patients to feel comfortable accessing freestanding emergency centers and would impact rural healthcare access in Texas.

“I think the hurricane really spotlighted how valuable we are, and when Hurricane Harvey hit, we were open before several of the major hospitals, and we were able to see patients much sooner than most of the big hospitals. That gave us an advantage, and it gave us a niche that they realized, hey the emergency care, and what if there was a flood, and there were several places in Houston that were flooded out; people couldn’t get to the hospital, but the freestanding emergency room was accessible and people were able to be treated and seen there, and it was literally life-saving for a lot of folks,” said Grieme.

Senator Bill Cassidy, M.D., R-LA, has introduced a bill titled the “Emergency Care Improvement Act,” which would provide Medicare and Medicaid recognition of freestanding emergency centers and provide a certain level of reimbursement for these facilities.

  • Freestanding emergency centers in urban and suburban areas would be reimbursed at 75 percent of Medicare’s hospital rate, but lower-acuity patients typically seen by urgent care would not get facility payments.
  • Facilities located in rural areas would be reimbursed at 95 percent of Medicare’s hospital rate.

Facilities would also need to follow emergency care regulations, such as the Emergency Medical Treatment and Labor Act. It’s a federal law that ensures patient access to emergency services, regardless of ability to pay.

According to the Texas Association of Freestanding Emergency Centers’ analysis in 2016, the independent freestanding emergency department community in the state provided about $40 million of uncompensated care.

Lawmakers have also joined together in a bipartisan effort in Congress to fight surprise medical bills. They released draft legislation in September.

The Protecting Patients from Surprise Medical Bills Act would:

  • Ensure that a patient is only required to pay the cost-sharing amount required by their health plan and a provider can’t bill the patient for an additional payment
  • Require a patient to sign a written acknowledgement of a notification about a higher cost-sharing if they received a non-emergency service from an out-of-network healthcare provider or facility
  • Ensure that a health plan or out-of-network provider can’t bill a patient beyond their in-network cost-sharing in a situation where a patient receives a non-emergency service from an out-of-network provider in a facility that is in-network

Premier ER is a privately operated emergency center with capabilities usually found in hospital emergency rooms. The new facility will remain open and staffed with physicians 24 hours a day. Registered nurses, radiology technicians and support staffers also will work at the center.

Emergency room vs. urgent care

ER: For trauma, life-threatening conditions and emergency health care that can’t wait. An extremely high fever, chest pain, loss of vision, and difficulty breathing can all be signs of an emergency. ERs are open 24-hours.

Urgent care: Can fill in for your doctor for minor conditions that can’t wait, like flu cases, minor burns, sprains and fractures. Typically open longer hours than primary care, including evenings and weekends.

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