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EMERGENCIES
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opportunity to establish these centers in prime locations to attract and testing that allows most basic diagnostic evaluations. In theory,
patients seeking greater convenience. they should function just like hospital-based emergency depart-
ments, including being involved in the city EMS plan. In reality,
Houston and Dallas-Fort Worth lead the state in numbers of what has been observed is that the patients who go to a FSEC are
free-standing centers. San Antonio is rapidly catching up to the not as sick as those who go to hospital-based emergency depart-
pace of growth, however. A mixture of hospital-owned and private ments, even if you adjust for the lack of EMS involvement in the
facilities continues to grow. To the extent that traditional hospital FSEC. Nationally, the percentage of patients presenting to a FSEC
emergency department visits are slightly declining in San Antonio that required admission is around 1 percent. In contrast, the na-
following many years of substantial increases in volume, it seems tionwide admission rate at hospital-based emergency departments
apparent that the growth of the free-standings is having its impact. varies widely but averages over 20 percent.
The financial viability of free-standing emergency centers is The physicians will likely be board-certified physicians whose
quite different for hospitals, private investors versus physicians. specialty is emergency medicine. In contrast to urgent-care centers
For the entity that collects the facility charge, the break-even is that are generally designed to handle minor medical situations,
about 10 to 15 patients per day. Whereas if physicians are able free-standing emergency centers offer the advantage of having fa-
only to charge for their professional services, i.e., not the facility cilities conveniently located that are well-positioned to provide
charges, they must treat 35 to 40 patients per day to break even. critical care to patients.
This difference in reimbursement for physicians can be even
greater for non-hospital-affiliated free-standing centers. The main The disadvantage for consumers or patients is cost. Generally free-
reason for this difference is the fact that Medicare will not reim- standing centers are much more expensive. This is due to the fact, as
burse non-hospital-affiliated centers for emergency department previously stated, that these centers may charge “facility” fees for
professional or facility fees. The physician may bill a Medicare pa- rooms, supplies and diagnostic tests that urgent-care clinics do not.
tient at an urgent-care rate only, and the facility may not charge The professional charges for the physician’s time also are slightly
anything for the use of the facility. On the other hand, a free- higher to the extent that the charges will be for emergency-level serv-
standing emergency department that is not affiliated with a hos- ices rather than urgent-care level services. The total amount for the
pital may charge facility charges and emergency-level fees to visit may be four to five times higher than a regular office visit.
commercially insured or self-pay patients.
Healthcare professionals consider the possibility of hitting a sat-
ADVANTAGES, DISADVANTAGES uration point in the case whereby too many free-standing emer-
From the consumer point of view, free-standing emergency cen- gency centers are added. No one really knows where or when this
could happen. In comparison to other industries, such as banking,
ters provide both advantages and disadvantages. The advantages health clubs and spas, it appears that the axiom that the three most
begin, obviously, with location. Prior to hospitals or entrepreneurs important things are location, location, location applies to free-
building a facility, much research is done on population, demo- standing emergency centers as well. Ultimately it will be the pa-
graphic groupings and traffic studies. The result is likely to be a tients, the ultimate consumers of healthcare services, who will
convenient location for a concentration of residents in San Anto- determine the success of these ventures.
nio communities.
Robert Frolichstein, MD, an emergency medicine
Another advantage is that free-standing emergency centers physician, is president of Greater San Antonio Emer-
(FSEC) are equipped to handle higher acuity of presenting medical gency Physicians, PA, and a BCMS member.
conditions or problems. They must be equipped with CT scans
18 San Antonio Medicine • March 2015
