SAN ANTONIO – Emergency medicine has gone retail. Freestanding emergency rooms are popping up in strip malls right next to the neighborhood pizzeria.
Nearly six years after the state licensed the emergency departments, which are not attached to hospitals, the industry is seeing exponential growth. While there were 16 in 2010, there are now 180, with 16 in San Antonio.
So what are they? When should you go, and what should consumers know about the costs?
Fossil Creek Complete Care, which used to be an urgent care center, now operates an emergency department. It can do X-rays, ultrasounds and computerized tomography scans. The lab is fully equipped to run tests immediately. Doctors and nurses are emergency-trained. And they are open 24 hours a day, seven days a week. All of that is required by law.
They have the same capabilities as a hospital emergency room, according to Nursing Director Jeannie Berry.
"From minor to major injuries, major illnesses like congestive heart failure, chest pains, stroke, we can do all of that treatment here," she said.
There are limitations. People with the most extreme trauma needing surgery or specialists are transported by ambulance to a waiting hospital.
What freestanding ERs don't have are crowds and long waits.
"We live in a society where people want to have their needs addressed quickly, immediately," said Dr. Okem Okpara, with Austin Emergency Center. "We want faster Internet. We want faster cars, and people want to be seen faster."
Typically, patients see an emergency physician within 10 minutes of walking in the door, he said. It's a stark contrast to the hours of waiting in a congested hospital emergency room.
"We offer consumer convenience," Okpara said.
But convenience has come with concerns, confusion and costs.
"I got two bills in the mail. I was shocked," said John Havel, who once got a $1,800 bill for treatment for a scratchy throat.
What he had thought was an urgent care clinic was actually another San Antonio emergency department with a facility fee just like a hospital ER.
After numerous complaints statewide about surprise bills, the Legislature tried to cure consumer confusion by passing a law requiring better signage. The freestanding ERs must have a notice posted stating that it is an emergency room and charges rates comparable to a hospital ER.
"This really is a case of buyer beware," said Vivian Ho, Ph.D., health economist at Rice University's Baker Institute.
While she says the facilities can offer good medical services, she is critical of the business model. They do not take Medicaid or Medicare and tend to locate in more affluent parts of town where people are more likely to have private insurance. In San Antonio, the majority are on the far North Side.
"My concern is that people are going to use these facilities when there are other options that are more affordable," Ho said.
That will lead to higher costs for the insurance companies covering the ER visits.
"They, therefore, have to charge higher premiums, and so that raises the health insurance premiums of everyone in the market, whether they are going to a freestanding ER or not," Ho said.
Patients who have the sniffles, a cough or a cold should ideally go to their physician or an urgent care center, according to Okpara.
"But, as the last time I worked, I saw a patient who came into the ER an hour before their appointment with their primary care doctor because they didn't want to wait that extra hour, and people do that," Okpara said.
He said they are as transparent as possible with patients when they come in the door, informing them that they are in an emergency room.
At Fossil Creek, Berry said they also try to be upfront about billing and services.
"We want to treat everybody who comes through our door," she said. "We don't know that you're not having an emergency."
So when is an emergency room visit appropriate? The American College of Emergency Physicians offers this guidance:
- Chest pain
- Shortness of breath or difficulty breathing
- Severe bleeding or head trauma
- Change in mental status such as confusion or loss of consciousness
- Sudden dizziness, weakness or change in vision
- Severe or persistent vomiting or diarrhea
- Suicidal or homicidal feelings
- Abdominal pain
- Severe headaches
- Dehydration
As for when urgent care may better suit a patient's needs, the American College of Emergency Physicians offers this guidance:
- Minor burns
- Minor cuts requiring stitches
- Sprains and strains
- Coughs, colds, sore throats
- Ear aches
- Fever or flu-like symptoms
- Rash or other skin irritations
- Mild asthma
- Animal and insect bites
- Minor broken bones
- Flu shots and physicals for sports or school