Insurance & Benefits

Blue Cross Insurance Data Reveals Texas’ Freestanding Emergency Department Charges

New research shows what many have already discovered: freestanding emergency departments may charge more than urgent care centers to fewer patients who have similar conditions.

The study looked at three urgent care centers that were converted to FSEDs in Texas using insurance claims from Blue Cross Blue Shield of Texas, based in Richardson. They show that patient volume went down between 29.5 and 94.8 percent, but reimbursement per patient increased between 970 and 1,369 percent. The study showed no significant difference in the age, gender, or conditions of patients managed by both the UCCs and FSEDs. Researchers did find a small uptick for more severe conditions such as chest pain, which was .5 percent of UCC visits and 2.3 percent of FSED visits.

“This study highlights some of the payment reimbursement structures that are not ideally suited to the patient or to our health care system as a whole. While this is a case study of three facilities and is not generalizable to all FSEDs, this study shines a light on these reimbursement structures and how they can potentially be used to increase revenue,” said Dr. Sabrina J. Poon, instructor of Emergency Medicine at Vanderbilt University Medical Center, via release.

The Journal of Emergency Medicine study describes FSEDs as emergency departments not attached to an acute care hospital, though they are at times affiliated with one. In 2009, Texas passed the Texas Freestanding Emergency Medical Care Facility Licensing Act, which allowed the facilities to be built in the state.Texas led the charge in allowing freestanding emergency rooms, which often pop up in wealthier neighborhoods.

“You have to look at why patients are going to FSEDs, as there are benefits. They are convenient, they are located in a place that is easy to get to, there is a shorter wait time, and the list of services or care provided is what patients are looking for. The question is, how can we provide this care in the most valuable way for both patients and the health care system?” said Poon via release.


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