Not sure if this is happening all over the country, but I've noticed in Houston, San Antonio, and College Station, in the nice parts of town especially, these "corner ER's" that are not attached to a full hospital or a strip center are popping up everywhere. What's going on the business end of these? Are they just huge cash flow centers? Do they charge more for their services since they're convenient, or because they can?

Good Bull Jones 17 said:

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Not sure if this is happening all over the country, but I've noticed in Houston, San Antonio, and College Station, in the nice parts of town especially, these "corner ER's" that are not attached to a full hospital or a strip center are popping up everywhere.

They are freestanding ERs and have been around since ~2010.

What's going on the business end of these?

They are identical to the ER you'd find attached to a hospital with onsite imaging, labs, and an ER or family medicine trained physician.

Are they just huge cash flow centers?

Depends on the volume and operations. Obviously, those seeing 30+ patients per day ("PPD") make a lot more than those that see 5 PPD.

Do they charge more for their services since they're convenient, or because they can?

Both.

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The only real difference between FSEDs and those attached to acute care hospitals is that FSEDs cannot accept Medicare/Medicaid/Tricare payments for services.

In 2009,Texas became the first state to allow free-standing ERs.

They offer nice, clean, efficient facilities that can take care of your problem with little wait time 24/7.

They charge "ER prices". Many patients don't understand the difference between an ER and an urgent care facility, so they are surprised to see that the fever they went in for winds up costing them $1500 when they get a bill a few weeks later.

DadAG10 said:

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If you go to one not in your network they will be very expensive.

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Same as a hospital, the difference being that most acute hospitals and ER staffing companies in hospitals are in -network, whereas FSEDs are not.


Under the ACA, if your visit is a true emergency, the chart is supposed to be billed and paid at in-network rates. Most of those issues are people that use FSEDs for things that are more appropriate for an urgent care - like a sore throat or skin abrasion or the flu.

I try my hardest to never go to an ER but my body does some strange stuff (and likes to have random blood clots that cause strokes).

Went to the ER at the hospital and spent 10 hours there (8 hours waiting). Went to the same hospital network stand alone ER and was seen in 5 minutes and spent the same two hours being treated there.

I don't know how they make a profit but unless I'm dying I'm going to the stand alone ER and will pay for the ambulance transfer if I'm more serious than I think.

Since they don't accept the government insurance (medicare, Medicade, Tricare) and I think they frown on people without insurance the volume of people is a lot less.

If I think I'm having a stoke or an episode I can have a scan and blood work done quickly compared to some hospital ERs.

My sister tripped and thought she twisted her ankle but her foot ankle and leg started swelling. Since the swelling was abnormal we went to the stand alone ER and she got an x-ray ans checked out to make sure she didn't break anything.

You also have something called hospital outpatient departments (HOPDs).

These are a type of FSED, but operate under a hospital's ER license as an "off campus extension" of their on-campus ER. As such, they are billed out the same as their parent hospital under the hospital's billing and collection agreements and network participation agreements.

These typically take CMS payments (medicare, medicaid, tricare) and are in-network the same as their acute hospital owner. These are owned by hospitals in some form or fashion, usually as a wholly owned subsidiary or as a joint-venture with an FSED developer.

They are everywhere here in the Austin area.

If the freestanding ED is part of hospital system they can accept Medicaid/Medicare.

It's all about convenience for the shopper and profits for the store. We know an emergency room doctor who started opening up these things here. He's his own boss, is knocking them naked financially and we don't have to go sit and wait forever in the regular "gun and knife show" emergency room.

Go America! Getting'er done since 1776!

The Wonderer said:

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You also have something called hospital outpatient departments (HOPDs).

These are a type of FSED, but operate under a hospital's ER license as an "off campus extension" of their on-campus ER. As such, they are billed out the same as their parent hospital under the hospital's billing and collection agreements and network participation agreements.

These typically take CMS payments (medicare, medicaid, tricare) and are in-network the same as their acute hospital owner. These are owned by hospitals in some form or fashion, usually as a wholly owned subsidiary or as a joint-venture with an FSED developer.

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All dallas First choices got converted to an HOPD if they were open prior to 12/31/16.

FriendlyAg said:

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The Wonderer said:

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You also have something called hospital outpatient departments (HOPDs).

These are a type of FSED, but operate under a hospital's ER license as an "off campus extension" of their on-campus ER. As such, they are billed out the same as their parent hospital under the hospital's billing and collection agreements and network participation agreements.

These typically take CMS payments (medicare, medicaid, tricare) and are in-network the same as their acute hospital owner. These are owned by hospitals in some form or fashion, usually as a wholly owned subsidiary or as a joint-venture with an FSED developer.

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All dallas First choices got converted to an HOPD if they were open prior to 12/31/16.

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Yeah, they entered into a massive joint venture with Texas Health Resources to convert 27 facilities with THR retaining majority interest. As some of you may know, THR owns 24 hospitals in the DFW marketplace include Dallas Presby.

You will see this more and more as JVing with hospitals is the new thing to do in order to go after the CMS payments and stabilize PPD volume and bank more on the hospital names since FSEDs have been run through the mud in the media the last several years.

Bit of a thread hijack, but i don't think I have a good grasp on ER vs urgent care. My son was having some pretty severe abdominal pain on a Saturday evening. We went to the ER. It turned out to be minor, but would I have been better off going to an urgent care facility?

AW 1880 said:

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Bit of a thread hijack, but i don't think I have a good grasp on ER vs urgent care. My son was having some pretty severe abdominal pain on a Saturday evening. We went to the ER. It turned out to be minor, but would I have been better off going to an urgent care facility?

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And that is the problem, not many do which causes way too much confusion.

And Wonderer, not picking on you but, acronyms that come automatically for you are confusing as h*ll to 99% that aren't in your industry.

all of those acronyms have been explained earlier in the thread. I thought he did a good job of explaining what they were.

Some regulations just passed last week that are basically going to drive all the freestanding ER's without hospital affiliation out of business

They will just relabel as Urgent

histag10 said:

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AW 1880 said:

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Bit of a thread hijack, but i don't think I have a good grasp on ER vs urgent care. My son was having some pretty severe abdominal pain on a Saturday evening. We went to the ER. It turned out to be minor, but would I have been better off going to an urgent care facility?

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Maybe i'm wrong in my thinking, but I've always viewed an Urgent Care center as basically a walk-in clinic for things that you would typically go to your PCP for, but maybe they are booked up, its a holiday, odd hours, etc. ERs are Emergency Rooms that facilitate the not-so-norm things (broken bones, accidents, breathing issues, severe pain, etc "true" emergencies), basically, things that would need more than what your average 9-5 PCP office could take care of in a short visit.

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you arent correct. An urgent care facility can set bones, give stitches, and provide a lot of other services. I have recieved a total of at least 10 stitches from various urgent care places. All for the cost of my regular copay.

DallasAggie0 said:

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Some regulations just passed last week that are basically going to drive all the freestanding ER's without hospital affiliation out of business

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Which ones? Are you sure it's not that prior bill that had a deadline of early January 2017 to convert to HOPD?

The big thing here is getting government payments and being able to get higher reimbursement rates with insurance companies because you have a huge hospital chain that has weight behind you.

Duncan Idaho said:

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histag10 said:

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AW 1880 said:

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Bit of a thread hijack, but i don't think I have a good grasp on ER vs urgent care. My son was having some pretty severe abdominal pain on a Saturday evening. We went to the ER. It turned out to be minor, but would I have been better off going to an urgent care facility?

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Maybe i'm wrong in my thinking, but I've always viewed an Urgent Care center as basically a walk-in clinic for things that you would typically go to your PCP for, but maybe they are booked up, its a holiday, odd hours, etc. ERs are Emergency Rooms that facilitate the not-so-norm things (broken bones, accidents, breathing issues, severe pain, etc "true" emergencies), basically, things that would need more than what your average 9-5 PCP office could take care of in a short visit.

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you arent correct. An urgent care facility can set bones, give stitches, and provide a lot of other services. I have recieved a total of at least 10 stitches from various urgent care places. All for the cost of my regular copay.

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My PCP can do those things too, which is why I said its basically a walk in clinic for things your PCP can do. Honestly, I cant even remember the last time I went to the ER for stitches or a broken bone. I've always gone to my PCP's office, and they take care of it all.

histag10 said:

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Duncan Idaho said:

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histag10 said:

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AW 1880 said:

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Bit of a thread hijack, but i don't think I have a good grasp on ER vs urgent care. My son was having some pretty severe abdominal pain on a Saturday evening. We went to the ER. It turned out to be minor, but would I have been better off going to an urgent care facility?

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Maybe i'm wrong in my thinking, but I've always viewed an Urgent Care center as basically a walk-in clinic for things that you would typically go to your PCP for, but maybe they are booked up, its a holiday, odd hours, etc. ERs are Emergency Rooms that facilitate the not-so-norm things (broken bones, accidents, breathing issues, severe pain, etc "true" emergencies), basically, things that would need more than what your average 9-5 PCP office could take care of in a short visit.

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you arent correct. An urgent care facility can set bones, give stitches, and provide a lot of other services. I have recieved a total of at least 10 stitches from various urgent care places. All for the cost of my regular copay.

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My PCP can do those things too, which is why I said its basically a walk in clinic for things your PCP can do. Honestly, I cant even remember the last time I went to the ER for stitches or a broken bone. I've always gone to my PCP's office, and they take care of it all.

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Well then you went on and contradicted yourself in the next part of your post.

ERs are Emergency Rooms that facilitate the not-so-norm things (broken bones, accidents, breathing issues, severe pain, etc "true" emergencies), basically, things that would need more than what your average 9-5 PCP office could take care of in a short visit.

there are some broken bones that a PCP and Urgent Care facility cannot handle, in fact, there are more types of breaks that they CANT handle than they CAN (*in most cases). I suppose I should have stated that. By accident, I mean you are in a traumatic accident that falls under the category of "emergency" (I thought that was pretty easily understood, but I guess not. I never thought of needing stitches as an "accident" that would necessitate the ER).

Interesting thread, as I have 2 of these being built about same distance from my house (different directions) I plan to stop in both when open and get a more detailed explanation and how it pertains to my insurance.

If it means paying a little more for an actual emergency and not having to wait behind all those people with non emergencies that show up at the ER because they can't be denied then I'm a fan.

I've always wondered, are FSER's regulated under EMTALA?

The ebola comment is unfair to many hospitals, because you can't expect the same luxury from what is a essentially a public facility. I'm not saying ERs do not charge an exorbitant amount of charges, but those facilities have trauma designations.

histag10 said:

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there are some broken bones that a PCP and Urgent Care facility cannot handle, in fact, there are more types of breaks that they CANT handle than they CAN (*in most cases). I suppose I should have stated that. By accident, I mean you are in a traumatic accident that falls under the category of "emergency" (I thought that was pretty easily understood, but I guess not. I never thought of needing stitches as an "accident" that would necessitate the ER).

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hmmmmm...

I guess some things can be explained better.

Quote:

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I thought he did a good job of explaining what they were.

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DadAG10 said:

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And Wonderer, not picking on you but, acronyms that come automatically for you are confusing as h*ll to 99% that aren't in your industry.

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FSED/FSER = Freestanding Emergency Department (FSED is the preferred industry term)

HOPD = Hospital Outpatient Department

UC = Urgent Care

ACA = Affordable Care Act/Obamacare

PCP = Primary Care Physician (your private family doctor if you have one)

Acuity = rating system for the level of trauma a patient (PT) is diagnosed (Dx) with on a scale of 1-5 (1=low, 5=high)

PPD = patients per day (volume measuring metric used for trend analysis and break-even factorization)

CMS = Centers for Medicaid & Medicare Services (the government entity that pays for medicare and medicaid subscribers

Tricare = military medical insurance (government entity payor)


Let me know if I missed any as I tried to remember to write out the actual term and put the acronym in parentheses following its usage...



I'm happy to answer any questions. I'll have to look back through the thread for some stuff that I'd like to respond to from an industry internal/operational standpoint.

Thanks!

Now can you look at my MRI?

histag10 said:

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AW 1880 said:

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Bit of a thread hijack, but i don't think I have a good grasp on ER vs urgent care. My son was having some pretty severe abdominal pain on a Saturday evening. We went to the ER. It turned out to be minor, but would I have been better off going to an urgent care facility?

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Maybe i'm wrong in my thinking, but I've always viewed an Urgent Care center as basically a walk-in clinic for things that you would typically go to your PCP for, but maybe they are booked up, its a holiday, odd hours, etc. ERs are Emergency Rooms that facilitate the not-so-norm things (broken bones, accidents, breathing issues, severe pain, etc "true" emergencies), basically, things that would need more than what your average 9-5 PCP office could take care of in a short visit.

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Some urgent cares take care of 99% of what free standing ER's typically do.

Others much less

Quote:

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Honestly, I cant even remember the last time I went to the ER for stitches or a broken bone.

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44 years old, and have never had either injury. What are you - an MMA sparring partner?

I had stiches once when I was 10. Unfortunately I'm sick as an adult because I developed autoimmune diseases.

94chem said:

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Quote:

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Honestly, I cant even remember the last time I went to the ER for stitches or a broken bone.

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44 years old, and have never had either injury. What are you - an MMA sparring partner?

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I havent had stitches in quite some time (minus c-section and other surgeries), but my husband has had stitches a few times in the past 2 or 3 years. We are also very active, and live in an "outdoor" type state, and have had the broken bones and sprains that come with that.

I also have a clumsy toddler.

The Wonderer said:

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Good Bull Jones 17 said:

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Not sure if this is happening all over the country, but I've noticed in Houston, San Antonio, and College Station, in the nice parts of town especially, these "corner ER's" that are not attached to a full hospital or a strip center are popping up everywhere.

They are freestanding ERs and have been around since ~2010.

What's going on the business end of these?

They are identical to the ER you'd find attached to a hospital with onsite imaging, labs, and an ER or family medicine trained physician.

Are they just huge cash flow centers?

Depends on the volume and operations. Obviously, those seeing 30+ patients per day ("PPD") make a lot more than those that see 5 PPD.

Do they charge more for their services since they're convenient, or because they can?

Both.

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The only real difference between FSEDs and those attached to acute care hospitals is that FSEDs cannot accept Medicare/Medicaid/Tricare payments for services.

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I work in employer benefits, so I hear from a lot of people who go to FSEDs for whatever reason. If the only real difference is FSEDs can't accept Medicare, then why to FSEDs always tend to send their real emergency cases to the real ER attached to their hospital?