Freestanding emergency departments are on the rise. But what are they?

You’ve heard of an emergency department and an urgent care center, but have you heard of a freestanding emergency department (FSED)?

When Darya Herscovici, now a resident physician at UMass Chan Medical School, worked as a senior research coordinator with Massachusetts General Hospital in Boston and Harvard University’s Emergency Medicine Network, she conducted research on FSEDs as an undergraduate student at UMass Amherst.

“I became really interested in freestanding emergency departments. It was really difficult to track them down,” she told Healthcare Brew. “So we decided to kind of dig a little deeper to more clearly define them.”

While only 1% of FSEDs were freestanding in 2001, that figure jumped to 11% in 2016, totaling 566 facilities nationwide.

The concept of FSEDs dates back to the 1970s, when these facilities provided emergency care to people in rural areas who didn’t have convenient access to hospitals. In 2001, there were only 50 FSEDs in the US—now there are about 745, according to 2018 research by the Emergency Medicine Network, which Herscovici worked on.

What’s a freestanding emergency department?

The name “freestanding emergency department” means just that. These are facilities where emergency medical care providers can work off-site from hospitals.

There are two types of these clinics, according to the American College of Emergency Physicians (ACEP): ones affiliated with hospitals and ones that are independent. They have various sizes—hospital-affiliated FSEDs tend to be larger—reimbursement options, and provide different services, according to 2016 research from Harvard University.

Hospital-affiliated FSEDs can integrate care between the hospital and the offsite department. Services are billed under the same National Provider Identifier as the hospital and must adhere to the same Centers for Medicare and Medicaid Services rules and regulations, according to ACEP.

Havard researchers also reported that owners of independent FSEDs can be doctors or investors, including private equity firms.

What makes them different from urgent care centers?

While FSEDs are becoming more popular, the line between them and urgent care clinics is blurry.

Take this June story from NPR, in which a man in Florida told NPR that he thought he had gone to an urgent care center, not a more expensive FSED. He had sought care at Parkland Health’s Urgent Care Emergency Center, and was charged $19,543 for two emergency room visits. In the end, he paid $1,000 out of pocket, according to NPR.

“I would say there definitely is some confusion,” Herscovici said, adding that the names of facilities can cause misunderstandings—like Parkland Health’s Urgent Care Emergency Center—in addition to some being “marketed as almost boutique care” and located more in affluent areas.

Jeffrey Elder, the associate chief medical officer for emergency management at LCMC Health in Louisiana, which operates two FSEDs, said these departments can be viewed the same as a hospital’s emergency department.

“It’s emergency physicians and pediatricians. They are a 24/7 operation. They have X-ray, they have CT scan—they have typically all the things that you would have in an emergency department,” Elder said. Patients are also billed for regular emergency department care, he added.

But urgent care centers are different, Elder said, as they’re not often available 24/7 and generally can’t offer the same extent of services as an FSED. Urgent care visits are also usually much cheaper, according to 2021 research from Harvard Medical School and the University of Pennsylvania, which found that emergency department visits are about 10x more expensive than urgent care.

How do hospitals benefit?

With these FSEDs serving as “an extension of the hospital,” Elder said, they tend to function the same as an on-site emergency department.

In addition, a 2019 study from ACEP showed that emergency departments are a central part of hospital care, with 70% of hospital admissions coming in through them. So the main benefit for patients to having FSEDs, according to Elder, is access.

For instance, LCMC is based in New Orleans, and one of its FSEDs, the Children’s Hospital Metairie Emergency Room, is situated at “one of the busiest intersections in the state,” Elder said.

“It’s just an easy place for people to be able to go with their child, if their child’s ill and they need to see a physician,” he said.

Herscovici said that, in addition to increasing access, having a FSED can help prevent oversaturation in hospital departments, like the Covid-19 spikes that led to crowded facilities. Then, if FSED patients need to be admitted or require follow-up, they’d already be in the hospital’s system.

“It’s a little bit more streamlined process to get them admitted [and] accepted over to the main hospital as an [emergency department] that’s connected directly to our hospital facilities already,” Elder said. “It gives more options for our patients to easily get into emergency care when they’re obviously having a bad day.”