The Ever-Growing Issue with Freestanding Emergency Departments

It’s no secret that hospitals have been closing all over the country. Sometimes, closures are a result of mergers; other times, they shut down because of lack of funding, or because the cost to maintain them is simply too great. Rural areas bear the brunt of these closings, and Alabama in particular has not escaped unscathed.

Dr. Don Williamson with the Alabama Hospital Association told WBRC that “25 hospitals [in Alabama] are at risk of closing, but 15 are at an immediate risk. He said they are in rural parts of the state that are already under-represented in healthcare. But, Williamson said hospitals in urban areas are also at risk for closure.”

To address the needs of folks across Alabama who may not have access to emergency services at hospitals, AL.com reports, two hospitals are planning to build more freestanding emergency departments, or FEDs. The American College of Emergency Physicians defines freestanding emergency departments as licensed facilities that provide emergency care to the public. They are distinct and separate from hospital facilities. FEDs differ from “urgent care” centers, too, which may treat less severe illnesses and injuries.

The first freestanding emergency department was built in Alabama almost a decade ago. Once the two new freestanding departments are completed near Huntsville and Decatur, there will be a total of 10 in the state.

The differences between a freestanding emergency department and a hospital emergency department

There are several differences between a freestanding emergency department and a hospital emergency department, but two that are especially important.

1. The ownership can vary. A hospital emergency department is owned by the hospital, but a freestanding emergency department can be owned by hospitals, private organizations, or health systems.
2. Hospital emergency departments are more convenient for those who need to be admitted to the hospital. A person who visits the ER can be admitted immediately into surgery or an ICU, or any department. That is not the case with an FED. A person who needs additional care will likely need to be transferred to a true hospital via ambulance or medevac. (FEDs typically come equipped with helipads for this reason, just like hospitals do.)

The controversy about Alabama freestanding emergency departments

Given how dire the situation is in Alabama, some people think that freestanding emergency departments are the solution to the hospital crisis.

But Dr. Williamson completely disagrees. He told AL.com that freestanding emergency departments are not the proper solution because when rural hospitals close, it is very unlikely that they will be replaced by freestanding emergency departments. Instead, these freestanding facilities are more likely to be found in suburban and inner-city areas (as well as areas with higher incomes), which means those living in rural areas will have a much longer or inaccessible commute to them.

Another point that Williamson made was that freestanding emergency departments may seem like a good idea, but they must remain profitable. This is a real issue in the state of Alabama as many of the hospitals are closing because patients do not have insurance or cannot pay for the treatment they receive, which means that the hospitals are not making a profit. As he told WBRC:

Alabama has the lowest Medicare [reimbursement rates] in the country. We have, for 19 to 64-year-olds, an uninsurance rate of roughly 13 to 15%. So, hospitals are dealing almost 1 and 6 or 1 and 7 of the people who come to them, are unable to pay for their healthcare. Add the combination of the uninsured, low Medicare reimbursement rates, and low third party reimbursement rates, our revenue can’t keep up.

On top of all this, he explains, the nurses themselves are expensive. Alabama-based nurses can make more money in other states, which leaves hospitals reliant on traveling nurses, which costs a lot more. FEDs may find themselves in the same boat when it comes to hiring and retaining experienced nurses. In the end, the freestanding facilities may soon experience the same financial troubles that the hospitals have dealt with for a long time.

Why we’re also worried about FEDs

The issues Williamson discussed are valid; revenue intake, insurance woes, facility locations – all of these are genuine concerns. But what we can’t seem to shake is the sinking fear that even people who can access FEDs will not get the level of care they need, because we, as a nation, are sicker than ever.

The Centers for Disease Control and Prevention (CDC) says 6 in 10 American adults have a chronic disease, and 4 in 10 have at least two. We are still struggling from COVID-19 (more deaths than in any other developed country) and with the opioid epidemic. A lot of people pushed back non-emergency care over the past two years, and the effects have been disabling and deadly.

This matters, because an FED is useful if you’re having a heart attack or you’ve been assaulted, but it is not equipped to address and treat chronic conditions. That’s not what they’re there for. That’s what hospitals are for – but every time you close a hospital, you make it harder for folks in need to get care. That means when they do finally show up, their illnesses will be more severe and more advanced. That means longer stays and higher costs on an already overburdened system.

FEDs are a bandage over a hemorrhage. We’ve no doubt that the professionals who work there truly care about their patients, and want them to do well. They’re terrific facilities to have in addition to hospitals, not in lieu of them. And yet we cannot help but think that this is how they’ll be used.

Martin & Helms is based in Huntsville and serves clients in and around Decatur, Madison, Athens, and all of North Alabama. We care about our community, and are your advocates when you are injured. Call our office or submit our contact form to schedule a free consultation.