The rapid growth of freestanding emergency rooms—as well as consumer outrage over controversial billing practices—continues to draw the attention of researchers and legislators around the country. Most typically found in affluent neighborhoods, some freestanding emergency centers can be hard to distinguish from lower cost urgent care centers, setting expectations for some patients that they’ll receive an urgent care-size bill. When the cost more closely resembles the cost of a trip to the ED, patients cry “foul.” Researchers at Brigham and Women’s Hospital in Boston found the number of stand-alone emergency departments grew from 222 in 2009 to 360 across 30 states as of March 2015. The data show there is limited financial incentive for many of the stand-alone centers to open in rural areas that are home to poorer populations. The problem is that such areas are also most likely to see closure of community hospitals, leaving many without adequate access to emergency rooms. Jeremiah Schuur, MD, lead author of the Brigham and Women’s study, noted “It is important for policymakers to know that this is a service that’s locating to serve one part of the population and not everyone.” On the flip side, this all adds up to a potential opportunity for urgent care operators to step in and fill the gap by opening new locations in underserved areas.

Freestanding ERs Criticized for Billing—and Cherry-Picking Wealthy Patients
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