On a normal night just outside the southern city limit of Lubbock, a father had a situation on his hands. His rambunctious and fearless young daughter, Ava, just broke her leg and he had a decision to make.
In a Facebook post, Michael Nelson wrote that the thought of waiting in the University Medical Center Emergency Room for hours that night did not seem practical.
He decided to take his daughter to one of the standalone ER centers new to the Lubbock area. While the center delivered on a short wait time and excellent care, Nelson wrote there was one hang-up with his experience.
“The downside was when we got word from our insurance a couple of weeks later that they would not cover the visit as an ER visit since they didn’t recognize the facility as an emergency room,” Nelson wrote. “They denied us payment on the claim above what just a usual doc-in-the box would charge.”
Nelson wrote that after everything they had done at the ER center, from x-rays to the cast itself, he owed about $2,000. He explained the ER center made it clear to him that he would be billed as if he was in an emergency room and not just a doctor’s clinic.
“So for me, the issue wasn’t the ER facility itself, as I said the care was excellent,” Nelson wrote. “But my insurance company’s refusal to recognize it as such.”
While the insurance could be one hang up for potential patients, the care could be a source of concern as well.
John-William Knight, Lubbock resident and Texas Tech University graduate student, said his experience with a standalone ER center, Emergency Room Centers of America, ended up being more complicated than he anticipated.
Knight went to ERCA after getting a nail and some wood stuck in his leg while trying to hop a fence. He said he was hoping they could disinfect and treat the wound quickly.
He said they took good care of him and there was hardly any wait time, but that was the beginning of a journey that would lead him to the hospital.
On the first visit, he said they cleaned his wound and gave him antibiotics, but after about three days, his leg had swollen to twice its normal size and he made the decision to return.
“I go in there (the second time) and they said, ‘Ok we’re going change the antibiotics again and if that doesn’t help, you need to go to the hospital,’” Knight said. “Two or three days later, I was in the hospital.”
Knight said once he was in the hospital, they discovered an intense MRSA infection in the wound on his leg.
He said the traditional hospital had more time to diagnose the issue, but he thinks it could have been detected earlier. He said a different physician saw him each time he went to ERCA, which he believes contributed to the problem.
He said he would go to a standalone ER in the future for minor emergency situations, but for anything more serious, he would seek a more traditional hospital setting.
Ryan Lewis, M.D., chief executive officer and co-owner of the newly opened Star ER center, said it is important to know what you are getting when going to one of these facilities.
Lewis said the differences between freestanding ER centers and more traditional ER settings are minimal. Some laboratory tests are sent elsewhere, and most standalone ERs do not have operating rooms and other testing facilities.
While most standalone ER centers boast advantages like short wait times and quality care, Lewis said Star ER adds to those advantages by being the first freestanding ER center in Lubbock to be fully staffed by physicians that are residency trained and board certified in emergency medicine.
When patients come to Star ER, Lewis argues they are getting a specialized and dedicated emergency medicine experience.
“We have the ability to focus on emergency medicine and we don’t have to worry about every department in a hospital or in another facility,” Lewis said. “We can focus one hundred percent on emergency medicine.”
Bryson Bowman, M.D., chief operations officer and co-owner of Star ER, said the facility is able to focus on each patient because of the lower traffic they receive.
“We have all worked at high volume, hospital-based emergency departments where you see four patients an hour and two or three of those are really sick and you just don’t have the time to spend with each one,” Bowman said. “A lot of people get put off by ER doctors just simply because they only saw them for 90 seconds and the reason is because down the hall somebody was dying.”
Lewis said another problem traditional hospitals deal with is being responsible for a region.
“Many times with these larger hospital facilities, they’re taking so many transfers from the other smaller hospitals that all the beds get taken up with people that are transferred in that have already been seen and are just waiting on a bed upstairs,” Lewis said. “What does that do to the local community? They get stuck waiting in the waiting room.”
Freestanding ER centers also bill patients differently. Lewis said he wants people to understand that they charge emergency center rates, but in many cases they are equal to or sometimes less than hospitals’.
For many, the biggest deterrence for choosing one of these facilities is insurance coverage. The government currently does not recognize privately owned emergency centers the same as traditional hospital emergency rooms, which limits what insurance they can accept, according to the American College of Emergency Physician.
“It is not a matter of us wanting to or not wanting to take Medicare and Medicaid,” Lewis said. “They don’t recognize us, so we can’t.”
He said they are upfront with patients about what insurance they do and do not accept. Although they cannot accept Medicare or Medicaid, they will not turn away a patient with a life-threatening situation and will accept a financial loss if necessary.
Star ER accepts all other insurance providers, according to Lewis. Being a licensed emergency care center in Texas, all insurers must pay in-network rates for emergency care, meaning patients with insurance should not pay the full visit amount.
Lewis said the ultimate reason for freestanding ERs is the need for specialized care.
“You have a primary doctor that you go to for everything else, you have a cardiologist, you have whatever specialist,” Lewis said. “Emergency medicine is absolutely no different.”
Some physicians are not as convinced that freestanding ERs are as effective for patient care as a traditional hospital setting.
Heart attacks, aneurysms, strokes or other life threatening conditions that require immediate care are best handled in an emergency room, according to the Texas Association of Freestanding Emergency Centers.
Christopher Piel, M.D., the medical director of the ER for University Medical Center, said going to a freestanding ER center for a life threatening issue could delay definitive care.
“If you come to a hospital-based emergency room with those types of issues, we identify them quickly,” Piel said. “And then we get you to the operating room. We get the cardiologist involved if it’s a heart attack and get you up to the Cath Lab. If you’re having a stroke we have the neurologist right here and a stroke team that helps intervene with your care.”
However, Piel said freestanding ERs can capably handle many emergencies, depending on the center. Piel said board certified physicians, like those at Star ER, are definitely qualified to perform emergency medicine.
“Some of the freestandings obviously don’t necessarily hire people that have been trained in emergency medicine or don’t have a lot of experience practicing emergency medicine,” Piel said. “So in that case, maybe the standard of care isn’t quite as good. It just depends on who they are staffing those facilities with.”
One of the arguments for freestanding ERs is their positive impact on patient volume in other emergency rooms, but Piel said this has little to no impact on a traditional ERs volume.
“I don’t think the volume of patients that they see takes any heat off of the volume of patients that we have in a traditional ER,” Piel said. “We are still incredibly busy.”
The location of standalone ERs is not a coincidence, Piel said. He thinks these facilities are being built in more affluent areas where the clientele can afford to pay for their care. Traditional ERs do not have the ability to choose that. This is a national trend, and was also questioned by the Dallas Morning News.
In Lubbock, there are no freestanding ERs east of Indiana Avenue or north of 50th Street, with the concentration of facilities in Southwest Lubbock.
Piel said freestanding ERs that do not accept Medicare or Medicaid may see fewer lower income patients, making it easier to make a profit.
“They’re popping up all over the state of Texas,” Piel said. “And they are there for money.”
While Piel believes the physicians at these standalone are good doctors and people, he said it is up to the general public and the legislators of Texas to decide if these facilities are best for public health.
“It is expensive care, no doubt it can be expensive,” Piel said. “People have to be educated for sure.”