Urgent Care Info

Free Standing ER's vs. Urgent Care
Written 02/21/2019

A bipartisan group of State Senators and Representatives, including local Democratic State Senator Nathan Johnson, filed legislation to allow the Texas Attorney General to address the unreasonable prices charged by freestanding emergency rooms.

Johnson joined author Senator Kirk Watson, D-Austin and Representative Dade Phelan, R-Beaumont in filing legislation similar to an existing law that allows the AG to stop price-gouging for goods and services during natural emergencies and disasters.

Freestanding ERs in the state represent 83 percent of all out-of-network emergency room services and end up costing Texans more than $3 billion a year in avoidable health care costs, which continues to drive up overall healthcare costs. Legislators take issue with the fact that these facilities look like urgent care centers but charge emergency care prices, and often attract patients with only minor issues. Freestanding ERs charge 20 times what urgent care centers and primary care doctors charge for common conditions like fever, sore throat, and cough, and often more than hospital ERs.

A study from AARP showed that 77 percent of freestanding ERs confuse patients by saying they “take” or “accept” insurance even though they are out of network for all the major plans, that nearly 30 percent of them claimed they were in-network for Blue Cross Blue Shield of Texas when there weren’t, and that 30 percent of their websites don’t follow state network transparency laws.

The bill, known as SB 866 and HB 1941 in the senate and house respectively, would protect Texans from exorbitant charges in an emergency, make prices “unconscionable” if they are more than 200 percent over the average hospital charge for the same service, and allow the state to take action to stop freestanding ERs via restraining order against the facility if unconscionable prices. The penalty for overcharging the elderly could be up to $250,000.

A second bill from Republican Representative Tom Oliverson from Cypress would prohibit freestanding emergency rooms from using health plan logos, prohibit the words “take” and “accept” for patient’s insurance unless they are in-network, and would require facility and observation fees to the patient before anything is done.

“Time and again, Texans get confused by misleading advertising and frustrated by exorbitant prices when they seek care from independent freestanding ERs. These facilities have demonstrated a pattern of withholding important information from patients regarding their network status or the prices they will charge for their services,” said Dudensing via release. “Rep. Oliverson’s legislation would ensure Texans have the information they need to better care for themselves and their families without breaking their bank accounts.”

“Many freestanding ERs in Texas mislead consumers, and Texas patients are paying the price with some of the most expensive ER costs in the nation,” said TAHP CEO Jamie Dudensing via release. “TAHP supports protecting Texans from these outrageous prices and holding these bad actors accountable for price-gouging and deceptive advertising.”

Emergency Rooms vs. Urgent Care

While The American College of Emergency Physicians report that 92% of emergency visits are from 'very sick people who need care within one minute to two hours,' and the National Hospital Ambulatory Medical Care Survey estimates that one-third to one-half of all ER visits are for non-urgent care. In fact, the top three reasons for ER visits in 2007 were for superficial injuries and contusions, sprains and strains, and upper respiratory infections. (The CDC defines non-urgent as 'needing care in two to 24 hours.)

The main reason that so many emergency room visits are for non-urgent care is that hospital Emergency Departments are required by federal law to provide care to all patients, regardless of their ability to pay. Since they cannot be turned away, patients without health insurance or the necessary funds to pay out-of-pocket costs, often utilize emergency rooms as their main health care provider. This puts Emergency Rooms under tremendous strain, and limits their ability to move quickly to attend to health emergencies.

Emergency room costs are difficult to quantify and are most often unknown to a patient when he or she walks, or is wheeled, in the door. Other than knowing the standard co-pay amount for those who have private medical insurance, which can be several hundred dollars, it is impossible to determine how much the final ER bill will be until it is received in the mail a few weeks after treatment.

Urgent care centers are freestanding, walk-in medical facilities that provide care on a no-appointment basis and are often open for extended hours, including nights and weekends. Urgent care centers are a cost-effective alternative to emergency rooms for the treatment of non-life-threatening medical situations. Some centers provide basic laboratory and x-ray services, and most can run diagnostic tests and dispense prescriptions.

These care centers have existed in the United States for more than 30 years, and today there are approximately 8,800 facilities nationwide. They accommodate an average of 342 patients per week.