Freestanding Emergency Departments are growing in popularity. What are they, and what factors should people consider when deciding where to go for care?
Most people have had to visit an emergency room or urgent care center for immediate medical care. A cut that might need stitches; shortness of breath; a cold and fever that keep getting worse: these could all require a visit to the doctor right now. But which doctor? The one at the urgent care center, or the ER? And what about Free-Standing Emergency Departments?
The choice hinges on two key factors: first, the capacity of the location to treat the issue the patient is experiencing. And second, how they will bill insurance. Understanding the factors before an emergency comes up can save precious time as well as money in the moment.
Sometimes it’s clear that the issue can wait for an appointment with a primary care provider; for example, with a bothersome muscle ache or strain, ongoing gastrointestinal issues like heartburn, or a sore throat that’s persistent but unaccompanied by fever. Waiting to make a PCP appointment can save money and means talking with a provider you know and who knows you.
But other times, it’s clear that someone needs immediate medical attention, or the issue is ambiguous enough that the person wants to get care right away. In these cases, there are three main kinds of options for care.
- Urgent Care Facilities are walk-in clinics, usually open 10-12 hours/day and on weekends. They’re often located in retail areas.
- Freestanding Emergency Departments (FSEDs), or Freestanding Emergency Rooms, are not attached to a hospital, but otherwise function like an ER. Most are open 24/7. Like Urgent Care centers, they’re often located in high-traffic retail areas.
- Emergency Rooms (ER) are located within hospitals and are open 24/7.
Medical Capacity at Each Type of Location
The locations and hours of these three options differ, and so do the medical staff and equipment capacity. In short, urgent care facilities are equipped to handle non-life threatening conditions and injuries. If the person is in immediate danger, it’s important to call 911. The person will be transported to an ER or, less often, a FSED.
Urgent care centers are not necessarily staffed by physicians, but will have nurses and nurse practitioners on staff. They’re not required to have the same life-saving emergency equipment as ERs. Urgent care facilities are well-equipped to treat mild to moderate illnesses and injuries, including urinary tract infections, strep throat, pink eye, mild to moderate cuts or sprains, and mild to moderate cold symptoms that could be COVID, RSV, or flu. People who don’t have PCPs may also use urgent care centers as their preventative care providers, and some urgent care centers are leaning in this model.
FSEDs, in contrast, are staffed by qualified emergency physicians, just like a regular ER, and they have all the same equipment. In an emergency, either facility will be able to treat severe allergic reactions, serious injuries, chest pains, and other life-threatening conditions.
The benefits of an FSED over an ER vary based on timing and location; an FSED will always be better if it’s closer, and sometimes they have shorter wait times than ERs. A benefit of ERs is that, if a person requires hospitalization after initial treatment, they’re already at the hospital for an extended stay, whereas a person treated at an FSED will need to be transported to a hospital in an ambulance. Keep in mind that urgent care centers also have relationships with hospitals and will be able to transfer a patient in need of ER care to the nearest ER or, in some cases, FSED.
How Will They Bill Insurance?
Cost is the other major factor. Urgent care centers are more affordable, in general; the insured patients may only be charged a co-pay for treatment and prescriptions filled at the center.
Freestanding Emergency Departments, since they have all the staff and amenities of standard ERs, have a similar pricing structure. FSEDs started in the 1970s as a trend in rural areas where hospitals are few and far between. More recently, they’re becoming common in urban areas, too. States are still catching up with the trend, and regulation of FSEDs–from staffing to service to hours of operation–still differs from state to state. Similarly, pricing at FSEDs differs depending on location, your insurance, and type of treatment.
There’s probably no financial incentive to go to the nearest FSED over the nearest ER, unless the FSED is in-network with your insurance provider, and the hospital isn’t. It’s a good idea to know which FSEDs and ERs in your vicinity take your insurance, before an emergency strikes. If you’re traveling, the situation may not permit time to do this research–but if possible, try to call either your insurer or the facility to find out if they’re in-network before being admitted.
Many FSEDs are owned by hospitals in that region, in which case they most likely are in the same networks as that hospital system. Others are privately owned, and their network status will vary. It’s important to know that these private FSEDs aren’t eligible to accept Medicare or Medicaid on their own; but, increasingly, they’re partnering with hospitals or even building out their own hospitals in order to meet Centers for Medicaid and Medicare Services requirements.
If you’re located far from the nearest ER, or if ER wait times are out of control in your area, the increasing prevalence of FSEDs could be good news in your neighborhood.
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