ER Now unable to accept Medicare, Medicaid

April 22--Because the federal government doesn't recognize freestanding emergency rooms as physician-based facilities, ER Now and other standalone ERs are unable to accept Medicare or Medicaid as forms of health insurance coverage.

Dr. Gerad Troutman, co-founder and chairman of Amarillo-based ER Now, said only three states in the country -- Texas, Colorado and Rhode Island -- provide licenses for freestanding emergency rooms at this time. He said from the federal government's point of view, when Medicare or Medicaid receives a bill from a medical provider, they check to see if it came from a provider-based facility, which include licensed general hospitals, surgical centers, doctor offices and more.

He said because freestanding ERs are in three of 50 states at this time, the federal government has yet to acknowledge bills from those facilities.

"It's not our choice," the Wichita Falls native said. "We would take it if we could."

By law, however, freestanding emergency rooms in Texas have to treat anyone who seeks care regardless of insurance or financial status.

Troutman said it's also important to note that if a patient has a secondary insurance policy to supplement Medicare, that secondary policy won't recognize freestanding emergency rooms as provider-based facilities because the primary insurance didn't recognize them as such.

Work is underway by the Austin-based National Association of Freestanding Emergency Centers to get the federal government to change how they view standalone ERs. Troutman said there are two camps of thought when it comes to the facility. The first is that some states contend that until the feds accept this form of emergency center as a provider-based facility, they won't license them.

The other group has to do with certificate of need laws in states that require medical facilities wanting to open or expand must prove there is a need in the community before the government will approve a license.

"Texas is very pro-business," he said. "We (the state) believe in the business environment and the market kind of establishing the business practices. Healthcare is a business as well."

According to the NAFEC website, certificate of need laws were created in the 1880s to regulate railroads and public utilities. The federal government in 1974 established certificate of need laws for hospital-related facilities to prevent costs from rising and an over-saturation of hospitals in the country.

Certificate of need laws were repealed in 1987, but there were still some limitations placed on medical facilities. The NAFEC said that studies showed that by limiting competition through the laws, it didn't do what it set out to do. The Federal Trade Commission acknowledged that in 2015.

"CON laws raise considerable competitive concerns and generally do not appear to achieve their alleged benefits for health care consumers," the FTC said.

Troutman said he believes there will be a change to the law eventually, but it takes time to change federal policy.

ER Now will open a new location in Wichita Falls this week. It is located next to The Plex on Southwest Parkway. It is a fully licensed emergency center that has to adhere to the same standards as hospital-based emergency rooms. Follow them on Facebook at ER Now-Wichita Falls.

Follow John Ingle on Twitter at @inglejohn1973.

___

(c)2017 the Times Record News (Wichita Fallas, Texas)

Visit the Times Record News (Wichita Fallas, Texas) at www.timesrecordnews.com

Distributed by Tribune Content Agency, LLC.