Medicare Advisers Recommend Payment Cuts To Many Free-Standing ERs
The woman arrived at the emergency department gasping for air, her severe emphysema causing such shortness of breath that the physician who examined her immediately put her on a ventilator to help her breathe.
The patient lived across the street from that suburban Denver ER. The facility wasn’t physically located at a hospital, says Dr. David Friedenson, the physician who took care of her that day. But it was affiliated with a hospital several miles away — North Suburban Medical Center.
Free-standing emergency departments have been cropping up across the U.S. in recent years and now number more than 500, according to the Medicare Payment Advisory Commission, an agency that reports to Congress.
Often touted as more convenient, less crowded alternatives to hospitals, these ERs often attract suburban walk-in patients with good insurance whose medical problems are less acute than those who visit an emergency room that’s inside a hospital.
If a recent MedPAC proposal is adopted, however, some providers predict that the free-standing facilities could become scarcer.
Propelling the effort are concerns that MedPAC’s payment for services at these places is higher than it should be, since the patients who visit them are sometimes not as severely injured or ill as those at hospital-based ERs.
The proposal would reduce Medicare payment rates by 30 percent for some services at hospital-affiliated, free-standing emergency departments that are located within 6 miles of an emergency room within a hospital.
“There has been a growth in free-standing emergency departments in urban areas that does not seem to be addressing any particular access need for emergency care,” says James Mathews, executive director of MedPAC. The convenience of a neighborhood ER may even induce demand, he says, calling it an “if you build it, they will come” effect.
Emergency care is more expensive than a visit to a primary care doctor or urgent care center, in part because ERs have to be on standby 24/7, with expensive equipment and personnel ready to handle serious car accidents, gunshot wounds and other trauma cases.