When it comes to access to emergency care, Texas has plenty of room for improvement.
In fact, the American College of Emergency Physicians 2014 Report Card rated Texas an F for providing access to emergency care.
Fifteen rural hospitals have closed across Texas since 2013.
With many others on the brink of closure, we can only expect our state’s healthcare access crisis to worsen.
Couple that with our state’s budget shortfall this legislative session when compared to 2015 and the recipe is disastrous.
There is a relatively simple solution to this problem: Provide the free market the ability to accept Medicare and Medicaid, and freestanding emergency centers (often referred to as FECs) will become a permanent fix for rural access to care issues in Texas.
FECs are a more sustainable financial model than a full-service hospital.
Unfortunately, due to current legislative and regulatory restrictions, FECs are unable to provide their emergency care services in rural areas like West Texas, where access to care can mean the difference between life and death.
Currently, the Centers for Medicaid and Medicare Services does not consider non-hospital affiliated FECs as provider-based facilities.
Therefore, independent FECs do not receive reimbursement for care provided to Medicare/Medicaid patients, despite being required by law to treat all patients that walk in their doors.
Since treating patients without compensation is not financially sustainable for any healthcare provider, many independent FEC operators avoid locating in areas with high concentrations of Medicare/Medicaid patients.
Additionally, federal regulation restricts hospitals from opening FECs beyond 35 miles of their main hospital campus.
This regulation significantly impacts site location for hospital-owned FECs.
Until non-hospital FECs receive fair compensation and hospitals can open beyond the 35-mile restriction, it is unlikely that FEC operators will venture into rural, underserved areas where large percentages of the payer mix are Medicare/Medicaid.
A primary focus of the Texas Association of Freestanding Emergency Centers and its federal counterpart, the National Association of Freestanding Emergency Centers, will be to work with CMS to gain recognition for all types of FECs and protect their ability to be reimbursed appropriately.
This, combined with allowing hospitals to build FECs beyond 35 miles of the hospital campus, would allow FECs to expand into areas where a hospital would struggle.
This will have a substantial, positive impact on the overall healthcare structure and allow Texans access to efficient, life-saving care.
They called this solution the 24/7 Emergency Department model, which preserves patient access and redirects Medicare and Medicaid funds away from the failing hospital model to the efficient FEC approach.
The MedPAC reports reads “Under the 24/7 ED model, Medicare would pay the facility standard hospital outpatient rates plus a fixed payment to partially cover overhead services… This would help rural communities where the volume of services and the payer mix is insufficient to support a traditional hospital with an inpatient department.”
The FEC model is the best option for improving access to emergency care and saving lives in rural Texas.
Because the costs of operating a FEC are much less than a rural hospital, surrounding communities will have a crucial access point to emergency care.
Let’s embrace this innovative model of emergency care delivery by reducing regulations and passing legislation that allows for the smart growth of FECs to improve health and safety for all Texans.
Gerad Troutman MD, a board-certified emergency medicine physician in Amarillo, is the emergency medical director for Lubbock, Amarillo and Vernon. He is the cofounder and CEO of independent freestanding emergency centers in Amarillo and Wichita Falls.