NAFEC Response to Brigham and Women's Hospital Study

A recent study, conducted by Brigham and Women’s Hospital and published in the Annals of Emergency Medicine, has generated a lot of media attention towards the freestanding emergency center (FEC) industry. NAFEC believes there is a need for context so that readers understand the complicated political and regulatory landscape FECs must navigate with regard to these findings. 

Access to Emergency Care for All

Most importantly, NAFEC would like it to be clear that FECs provide critical access to care for ANY patient that walks in their door, regardless of their insurance or ability to pay. As with all emergency care providers, FECs are legally required to administer medical screenings and stabilize patients before discussing how a patient intends to pay for their care.

Despite what the study may lead one to believe, FECs often see and treat patients knowing that they will not receive any compensation for their services, similar to what traditional hospitals experience. For a given FEC provider, unpaid claims can amount to millions in lost revenue.

National CMS Recognition for all FECs

Because more than one-third of the freestanding facilities studied were independent FECs, it is important to explain the situation with regard to the Centers for Medicaid and Medicare Services (CMS). Currently, CMS has not yet recognized non-hospital freestanding emergency centers. Therefore, independent FEC facilities do not receive reimbursement for care provided to Medicare/Medicaid patients. Treating patients without compensation is not financially sustainable. For these reasons, many independent FEC operators avoid locating in areas with high concentrations of Medicare/Medicaid patients.

Additionally, federal regulation restricts hospitals from opening freestanding emergency centers (also known as hospital outpatient departments or HOPDs) beyond 35 miles from their main hospital campus. This regulation significantly impacts site location for hospital-owned freestanding emergency centers

Until non-hospital FECs receive fair compensation and hospitals are allowed to open beyond the 35-mile restriction, it is unlikely that FEC operators will venture into areas where large percentages of the payer mix are Medicare/Medicaid.

Here’s what we are already doing to address this issue:

The National Association of Freestanding Emergency Centers (NAFEC) is a newly formed association that advocates for growth and fair regulation of the FEC industry nationwide. A primary focus of NAFEC will be working with CMS to gain recognition for all types of FECs and protecting their ability to be reimbursed appropriately. Having CMS recognize all models of freestanding emergency centers, combined with allowing hospitals to build freestanding emergency centers beyond 35 miles of the hospital campus, would lead FECs to expand into more rural and underserved areas with higher concentrations of Medicare/Medicaid patients. This will have a substantial, positive impact on the overall healthcare structure and how patients receive treatment. 

Stifling State Regulations

In addition to federal limitations for FECs, some state governments have attempted to stifle and control the FEC industry through regulation. Such restrictions make it more difficult for FECs to enter new markets – markets where access to quality emergency care is limited like in Baton Rouge, Louisiana.

Here’s what we are already doing to address this issue:

One of NAFEC’s biggest challenges is to establish consistent regulations for hospital-affiliated and independent FECs, which is why CMS recognition of all FECs is so critical.

In states like Louisiana and Georgia, where residents are in desperate need of access to emergency care, NAFEC is advocating for state legislatures and regulating bodies to explore FECs as a viable option and allow responsible FEC growth in those states. NAFEC is collaborating with legislatures, state health departments, and other stakeholders to identify ways FECs can solve some of healthcare’s toughest challenges while working within the established healthcare system.

Relieving Pressure On Hospitals

Following the passage of the Affordable Care Act, the pressure placed on traditional hospital emergency rooms across the country has increased significantly. Patients wait for hours just to be seen by a physician and, when they are finally seen, they are treated as a number within a system focused on volume and turnover. This can lead to hospitals admitting patients who do not require in-patient services, thus increasing healthcare costs. In southern states that have not expanded Medicare/Medicaid, maintaining large regional hospitals can be expensive and recent trends indicate that many are closing in rural areas.

In contrast, FECs see patients quickly, spend time with them, and provide quality emergency care. This is why patients are so satisfied with the model. Having smaller, more agile facilities triaging patients and sending those in need of in-patient care to hospitals is more efficient than having patients travel from all over to a regional hospital, only to wait in long lines to see a physician. FECs have the potential to change the way we deliver emergency healthcare. Shifting to this “hub and spoke” model for emergency healthcare is beneficial because it can save money and produce better results for patients.

The relationship between FECs and traditional hospitals is not duplicative. The growth of the FEC industry will ultimately support the need for traditional hospitals with surgeons, specialists, and trauma capabilities, and that shift will involve collaboration and integration. Together, FECs and hospitals can improve the delivery of emergency care in terms of lowering costs, reducing wait times, and improving patient satisfaction.