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New Models Of Emergency Care Create Questions

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Wendy Rigby
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Texas Public Radio

First, it was urgent care clinics popping up all over San Antonio. Now, the growing demand for convenient, fast access to more serious care has sparked a boom in the construction of emergency centers. San Antonio is already home to 15 independent emergency departments (ones that are not affiliated with a hospital) and more are being built.

This is the story of one woman’s experience, and information you should know before using a freestanding emergency room. 

  

Franny Church, 77, of San Antonio woke up one morning to find she was bleeding profusely, the result of an unexplained rupture in her colon. Her husband put her in the car to drive her to a hospital. When he passed a closer emergency center, he stopped.

"She was rightfully scared," said granddaughter Katy Shock.

"She’s still bleeding," Shock explained. "And then the guy asks, ‘Well what kind of insurance do you have?’ and my grandfather was like ‘Well, we have Medicare.’ And they’re like, ‘Oh, we don’t accept Medicare.’ And without asking any more questions, they sent them away."

Shock says the emergency department did not offer her grandmother any kind of preliminary care. "They didn’t triage her. They didn’t call an ambulance," Shock added. "They needed help."

That day, Church ended up at Methodist Hospital where she was admitted in critical condition, staying in the ICU for several days.

There are two big questions raised by Church’s experience: What should you expect when you go to an emergency center?  And, in this case, were there laws the emergency center was required to follow? 

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Credit Wendy Rigby / Texas Public Radio
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Texas Public Radio
New freestanding emergency centers are cropping up all over San Antonio, especially on the north side of the city.

  

 

"You’re not even allowed to talk about your type of insurance when a patient walks in the door," explained Brad Shields, Executive Director of the Texas Association of Freestanding Emergency Centers.

He says laws require that anyone who comes through the door of any emergency medical facility with a critical health problem must be treated, or at least stabilized and transferred.

"The state and federal law require all emergency rooms to see and treat and stabilize every patient regardless of their ability to pay or regardless of their type of insurance," Shields stated.

We asked for an interview with the parent company of Elite Care 24/7 Emergency Center on Bandera Road where Church’s family says she was turned away. The owners refused comment after discovering the family has filed a complaint and an investigation of the incident is underway by the Joint Commission on Accreditation of Healthcare Organizations.

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Credit Wendy Rigby / Texas Public Radio
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Texas Public Radio
Part of the appeal of freestanding emergency centers is that they are conveniently located in neighborhoods.

  

Now that second issue: what you should know about freestanding emergency centers. As it stands now, these centers don’t get reimbursed by Medicaid or Medicare, something the centers’ lobbyists are busy trying to change.  So if you receive care there, and your insurance doesn’t pay, you could be on the hook for a big bill.

Franny Church’s family says people need to know that. "There are many more people like my grandmother that are going to see the word emergency on a building and they’re going to stop. And they’re wasting precious minutes," Shock said. "I think my grandparents felt discriminated against because they have Medicare."

Texas has the most freestanding emergency departments of any state, more than 200, regulated under a 2009 bill passed by the legislature that requires licensing. The law says a board-certified emergency physician must be on site 24 hours a day.

The freestanding emergency centers do offer convenient locations. And they may help cut down on wait times and costs because they’re smaller and cheaper to run than traditional hospital-based ERs.

If the Centers for Medicare and Medicaid Services decides to reimburse for care at these facilities, they could fill an important niche in rural areas where some hospitals are foundering and closing down.

But for all patients it’s important to know who they will treat, and how you’ll be billed.