Standalone ERs could get money during COVID-19 crisis, but the neediest patients are less likely to benefit

Freestanding emergency centers in Texas could soon get federal taxpayer dollars to care for patients during the coronavirus pandemic as part of an effort to bring more medical care to rural, low-income and other underserved communities, The Dallas Morning News has learned.

But most of these residents are unlikely to benefit because few of the facilities are located in their neighborhoods, a News analysis found.

It’s also unclear whether the extra beds are needed, given that Dallas and other major Texas cities have not seen the hospital shortages that medical and government officials initially had feared.

Under the plan, pushed by a largely Republican bloc of the Texas congressional delegation along with three Democrats and the National Association of Freestanding Emergency Centers, the government would reimburse privately owned emergency centers to treat patients through the Medicare and Medicaid programs for the elderly and poor.

The arrangement would last as long as public emergency declarations related to the pandemic are in effect. The cost to taxpayers is not yet known.

The proponents said the move would add as many as 1,500 beds in facilities across Texas to treat patients. The centers’ operators, who have so far relied on privately insured or cash-paying patients to fund their business model, have said government assistance over the long term would allow them to move closer to patients in underserved areas.

The independent emergency centers, pioneered in Texas a decade ago as a medical market niche to provide faster access to care, have lobbied for government insurance reimbursements for years without success. The main hurdle: U.S. health regulations do not recognize the facilities as eligible because they are not connected to hospitals.

“For the purpose of this health care emergency, it would be a failure on the part of policymakers not to open up bed access that’s available to us at this time,’’ U.S. Rep. Jodey Arrington, R-Lubbock, who has led the effort, told The News.

The number of privately funded freestanding ERs in Texas has increased over the last 10 years — to 213 as of last year, far more than in any other state, federal officials said. Many have opened in affluent, predominantly white neighborhoods near hospitals instead of rural and low-income areas with limited care options, according to a News analysis.

The majority of centers, about 135, operate in neighborhoods above Texas’ median household income of $60,629, The News found. Only seven freestanding ERs are located in rural counties.

In Dallas County, the disparity is even greater. Of the 14 facilities in the county, nine are in neighborhoods with a median household income above $100,000. In southern Dallas, where many low-income residents live, there are no freestanding ERs for miles.

Rhonda Sandel, president of the Texas Association of Freestanding Emergency Centers and an operator of facilities in Houston, said many centers would launch operations in underserved regions if they received the federal recognition and funding they have sought since 2010.

“We want to be in these communities, but it makes zero economic sense,’’ she told The News. The facilities already treat many Medicare and Medicaid patients without reimbursement, including the elderly and disabled, she said. State law prohibits the centers from refusing treatment.

Several other states such as Colorado, Rhode Island and Delaware allow private independent ERs, according to research from the Centers for Medicare & Medicaid Services. But Texas oversees roughly 90% of all independents nationwide.

Concerns about a shortage of bed space due to the pandemic, however, have not been realized. Hospitals in Dallas and other metropolitan Texas areas have postponed elective surgeries and other procedures to keep space available.

Arrington said the emergency centers could provide backup beds in coming months if the virus sees a resurgence.

“Why not have the peace of mind in having that bed capacity as you venture into the uncertainty of the future?’’ Arrington said.

Like hospital-based ERs, independent centers are open 24 hours and can treat major ailments such as heart attacks and pneumonia. They also are required to staff registered nurses on site.

The independent ERs, however, lack the range of specialists that are available to major hospital ERs for more complex cases, researchers said. In recent years, Texas lawmakers and patients have criticized some freestanding centers for price gouging, triggering state laws to make cost information clearer to consumers.

The Texas Health and Human Services Commission licenses and inspects the centers but does not make detailed reports of safety surveys available to the public online as the federal Centers for Medicare & Medicaid Services does for hospitals and their ERs. The state also does not post comparative clinical data for freestanding ERs; the Centers for Medicare & Medicaid Services offers such information for other kinds of medical facilities.

Though the independent ERs are not currently regulated by the federal agency they would have to comply with the agency’s rules for as long as the temporary funding allows.

Medical researchers have struggled to find meaningful government data on the centers’ quality of care.

“I would argue if we’re going to open up freestanding emergency centers to government-insured patients, we need to get the same exact data that we’re getting for hospital ERs,” said Dr. Cedric Dark, an emergency room physician and assistant professor at Baylor College of Medicine in Houston.

Dark, whose own research has found in recent years that the centers are concentrated in more affluent neighborhoods near hospitals, said he is not sure whether providing government funding for the Texas centers would be that effective in combating the COVID-19 pandemic.

The physician said he hopes federal officials such as Seema Verma, who heads up the Centers for Medicare & Medicaid Services, would take a “more nuanced approach,’’ such as only funding independent centers serving populations that have a greater need for medical resources.

Seema Verma, chief of the Centers for Medicare & Medicaid Services(Centers for Medicare & Medicaid Services)

“If I were Seema Verma, I would probably say, yes, I will pay Medicare and Medicaid rates for freestanding [ERs] as long as you’re in an area that doesn’t already have a bunch of hospitals,’’ he said. “Where there is a true need for them to exist.’’

Verma recently called the proposal “a unique opportunity for Texas,’’ Arrington told The News, because no other state has so many of the facilities. A spokesman for her office did not respond to an interview request.

Arrington and a dozen other members of Congress backing the plan, including Texas Sen. Ted Cruz, won support from Gov. Greg Abbott and other state health leaders in a conference call two weeks ago, Arrington said.

The plan requires approval from the U.S. Department of Health and Human Services. Last week, agency leaders began drafting guidance for sending Medicare and Medicaid funding to the centers. Formal action is expected any day, according to an official with knowledge of the plan who was not authorized to speak publicly.

Brad Shields, director of the national association of freestanding emergency centers, said in a recent press statement that the facilities are ready to “relieve the pressure on the hospital system as soon as the federal government gives them the green light.’’

Shields noted that the centers contain ventilators and isolation rooms that often are necessary to separate patients suspected of having COVID-19 from other patients.

Sandel, head of the Texas association of emergency centers, emphasized that she hoped approval by the Centers for Medicare & Medicaid Services of short-term funding through the pandemic will translate into permanent recognition.

“We desire to do this year round, to be part of the safety net for the future,’’ she said.


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