|By Barry Shlachter, Fort Worth Star-Telegram|
|McClatchy-Tribune Information Services|
Where customers once lined up to rent Finding Nemo, they can now be whisked before a doctor before even finishing their paperwork. The gleaming new facility has the latest equipment, from a CT scanner to a portable X-ray. An in-house lab provides quick test results. There are free snacks and a
By locating in well-trafficked, convenient and often affluent areas where potential customers already shop, such free-standing medical centers provide an easy alternative to hospital ERs with their long waits and sometimes gritty settings. Nationally, they've doubled to more than 400 since 2009, according to
Yet there is a growing backlash to the lucrative medical facilities, where sprained ankles, stitches and other simple procedures can cost upward of
Since a 2010 licensing law took effect in
Like hospital ERs, the doctor- and investor-owned centers benefit from emergency room cases that could have been treated far more cheaply at a doctor's office or urgent care facility. Such cases represent 27.1 percent of ER cases, according to a 2010 study by the
There's enough profit in the expanding market segment to snare the interest of private equity investors and large hospital groups, which don't want to lose market share.
Although free-standing ERs architecturally resemble "doc in a box" or urgent-care clinics, some Texans are unaware they are entering an ER facility and end up using review sites like Yelp to express regret over charges that can turn out five or 10 times higher.
During a reporter's visit to the First Choice center in
When First Choice's parent corporation,
A respiratory therapist herself, Cseke initially asked if Elite accepted her insurance. She was told it did. But Cseke did not whether Elite was in her insurer's network of approved providers. Fewer than half of free-standing ERs, for example, have agreements with Blue Cross Blue Shield of
Her bill totaled
"I have worked in healthcare for 14 years and I didn't ask the right question," said Cseke, who has expressed her anger about her Elite Care experience on Facebook and Yelp. Elite Care said its CEO,
Cseke added, "I could have gone to the
Elite Care's website doesn't make it any easier for the patient. Its home page and two other pages say, "Acceptance of most medical insurance plans and all major debit and credit cards." But nowhere does it say that it isn't part of networks.
The insurance industry hasn't stood idly by.
Aetna has gone a step further.
It's suing two free-standing
"Our experience has been that the free-standing ERs were previously urgent care clinics," Aetna spokeswoman
"In our lawsuits, we have found that the free-standing ERs don't really treat emergency," Coplin said. "In fact for real emergencies they call 911 or get an ambulance for the patient to be transferred to an actual [hospital] ER. The arrangements between the free-standing ER and hospital is usually a sham with the only real interaction between the entities is a split of the facility fee that can now be charged."
The two firms being sued, operating as Trinity Health Care Network and ER Doc 24/7, have denied any fraud. In their response to Aetna's complaint, they said that their hospital links are legitimate and that besides,
Competing with rivals
Baylor seems to be filling in gaps between hospitals with 20,000- and 40,000-square foot ER centers as
"For the cost of an 80-bed hospital, we can build 10 ER centers," said Dr.
As with smaller rivals, Baylor promises an average wait of 15 minutes "door to doctor" and a total stay of one hour.
The group has centers in
Is there a risk of oversaturating the market with ERs?
"We haven't seen that proximity of a free-standing emergency room as a limiting factor yet," Wood said. "Obviously, more and more are being built and that might be something to consider."
Both Baylor and
Five years ago, the Texas Health Harris Methodist Outpatient Center Burleson was built as a hybrid facility, combining an ER with an outpatient, primary-care clinic so there's less risk of a patient being unnecessarily treated by emergency staff, said
Pleased with the results, the group is building another in the
"We found that consumers are frustrated by two things at free-standing emergency centers," Bujnowski went on. "The unexpected charge if they assumed they were going into a nonemergency facility. And a second co-pay if they have to transfer to a hospital ER for a very serious condition."
Critics of the doctor- and investor-owned ER centers recommend greater cost transparency to avoid sticker shock when the bill arrives.
Patients who aren't experiencing a life-threatening emergency should be told in advance that the facility is an ER, not an urgent-care center, said
For many families, the decision to go to a free-standing ER is driven by convenience.
"I see a mom bringing her kids in because she doesn't want to wait four or five days to see her primary care physician," First Choice spokeswoman
"If it's a case of a snotty nose, we will absolutely refer them to an urgent care. But if they say, 'I'm not feeling well,' they'll be treated."
Gibson and Hutchinson said First Choice is aware of the confusion between ER centers and urgent-care clinics and has become proactive in explaining the difference to the public by staffing booths at school and sports events, taking out TV commercials and speaking to the media.
"We tell them, 'This is not urgent care,' " Gibson said.
As for the increasingly fierce competition, she said: "I like it. It keeps us honest."
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