Rep. Ruiz Co-Sponsors The Emergency Care Improvement Act (H.R. 1694)

The National Association of Freestanding Emergency Centers (NAFEC) is excited to announce that Rep. Raul Ruiz (D-CA) has signed on to co-sponsor H.R. 1694, the Emergency Care Improvement Act, a bill that would allow for permanent Medicare recognition of freestanding emergency centers (FECs). Rep. Ruiz is a Senior Democratic Member on the House Energy & Commerce Committee, a key health care Committee, and  a former emergency room doctor. His support for the bill comes as a direct result of NAFEC’s advocacy efforts and solidifies the recognized value of FECs in the health care system. NAFEC will continue to work with Congress to garner more bipartisan co-sponsors for and ultimate passage of this important piece of legislation.

NAFEC President Rob Morris commended the additional of Rep. Ruiz on the bill:

“We are proud that a fellow ER professional recognizes the importance of FECs and the value that they provide to patients. Granting permanent Medicare recognition of this sites of care would improve patient access, and strengthen the presence of emergency care in our communities. The Emergency Care Improvement act is a bipartisan piece of legislation that has the potential to save and improve the lives of many.”

Background on the Legislation:

1. FECs are fully licensed emergency departments that are staffed by both Emergency Medicine trained physicians and registered nurses who are on-site 24 hours a day, seven days a week and possess licensed pharmacies, clinical labs, and advanced imaging services. FECs are state-licensed and adhere to the same standards and provide the same level of care as Hospital Based Emergency Rooms (HBER), including state Emergency Medical Treatment and Labor Act (EMTALA) regulations on treating all patients.

2. To expand provider capacity during the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) issued a waiver in April 2020 to allow FECs to enroll as Medicare-certified hospitals and receive Medicare reimbursement for the duration of the Public Health Emergency.

3. Over 110 FECs, mostly located in Texas, enrolled and have been providing high-quality emergency services for all kinds of emergency conditions, at a significant savings to the Medicare program, to thousands of Medicare beneficiaries.

4. An actuarial study of Medicare claims data found that FECs did not increase overall utilization of emergency care services and actually saved Medicare programs 21.8% in lower emergency care payments for patients of similar acuity in hospital emergency departments.

NAFEC Comments on CMS's Federal Independent Dispute Resolution Operations Proposed Rule

Hyperlink to NAFEC’s comments HERE

NAFEC Comments on CMS's Proposed Rule on Administrative Fees

Hyperlink to our comments can be found HERE.

NAFEC Responds to Ways & Means Chairman Smith's RFI on Rural Health Care Access

Hyperlink to our comments can be found HERE

NAFEC Submits Testimony to Ways & Means Committee following September NSA Hearing

Hyperlink to our submitted testimony can be found HERE

NAFEC September 2023 Letter to CMS on NSA Implementation

Hyperlink to our letter can be found HERE

NAFEC September 2023 Letter to CMS on NSA Implementation

BREITBART EXCLUSIVE: House Bill Will Restore Vital Emergency Medical Coverage for Seniors, Says Rep. Arrington

View NAFEC’s comments by clicking HERE.

NAFEC Follow-Up Letter to CMS on No Surprises Act Implementation and IDR Process

Hyperlink to the letter can be found HERE.

NAFEC Shares Concerns and Recommendations with CMS on Insurers Abuse of NSA Implementation

Hyperlink to the letter can be found HERE.

Dobson Davanzo Study Finds FECs Save Medicare 20% While Not Increasing Utilization.

Hyperlink to the study can be found HERE.

Media Highlights Freestanding ER's Essential Role During COVID-19

AUGUST 2021 — Freestanding Emergency Centers (FECs) across the nation have stepped up to serve a critical role throughout the Covid-19 pandemic. While FECs have helped treat both Covid-positive and non-Covid emergency patients and have reduced burdens on many hospital systems, facilities are facing additional challenges amid the most recent Covid-19 wave. The following recent media reports highlight some of these challenges as well as the important role FECs play in the health care industry:

• San Antonio, Texas television station KENS-5 spoke with the head of a major hospital's emergency department about how the recent surge in COVID patients in South Texas is affecting the hospital’s ability to admit patients, while reporting on how Freestanding ERs in the surrounding areas are filling the gap in patient care.

  “We’ve had first responders and EMS reach out to us to potentially drop off patients that are not as critical,” said Dr. Gerardo Ortiz, Chief Medical Officer and Medical Director of the Lonestar 24 Hour ER in New Braunfels.

  "Typically, if you have a patient in a freestanding ER that stays over 24 hours you have to report that to the state," Dr. Ortiz said. "We've had ICU patients that have stayed over 60 hours with us because you call San Antonio and Austin and they're number 80-something on the list for an ICU bed. We've had COVID patients with us that have been on oxygen for 20 hours”

• East Texas television station KETK reported on how a Longview Freestanding ER is having to take care of not only emergency care patients but ICU level patients, without staffing or funding support from the state of Texas — unlike their hospital counterparts. The Longview FEC also shared how they are relying on some of their ICU-trained nurses to do extra work and teach skills to their emergency room nurses to meet the demand of the current COVID-19 wave.

  The patients who can’t get into hospitals are going to free-standing ER’s, leaving staff to care for a level of patients they never have before. Other medical facilities like free-standing emergency rooms aren’t approved to receive help from the state right now but are also experiencing a staff shortage.

  “We’re having to take care of not only emergency care patients but also ICU level care patients,” said Jeffrey Beers, a physician at Hospitality Health ER.

• The Houston Chronicle reports hospital capacity issues are affecting smaller hospitals and Freestanding ERs when it comes to transferring patients out to receive a more critical and/or long-term level of care. One Houston area Freestanding ER explained how their facility has had to hold patients who need a hospital bed for days. The Chronicle also reports on how the transfer problem extends beyond COVID-19.

  For small facilities, what once was a routine transport to local hospitals has become a frantic process of cold calling and cajoling health care providers in hopes of securing an open bed. In the meantime, patients who must receive intensive care languish in places that are unable to provide it.

   By Thursday afternoon, 543 patients in the 25-county hospital region anchored by Houston were waiting for staffed hospital beds, according to the SouthEast Texas Regional Advisory Council; 62 more waited to be admitted to an ICU.

  More recent COVID-19 headlines from across Texas:

• Austin, Texas: Local ER staff requesting emergency COVID funding from state to address staffing shortage

• Houston, Texas: COVID patients overflowing into free-standing ERs as local hospitals are stretched thin

• San Antonio, Texas: Neighboring counties look to San Antonio for care as delta surge squeezes hospital capacity

• Lubbock, Texas: Star ER another option for people to go to for COVID-19

• Corpus Christi, Texas: "Its not enough"; local nurses call on the state for more medical personnel

• Corpus Christi, Texas: 'We’re tired, we’re exhausted, we’re overwhelmed': Local doctors look to the state for staffing help

• Corpus Christi, Texas: Corpus Christi region ICU beds full; COVID-19 cases in young population increasing

• Tyler, Texas: Freestanding ERs holding COVID patients for days due to lack of hospital beds

• Longview, Texas: East Texas doctor says healthcare system is being overwhelmed

NAFEC Members work through challenges as winter storm, COVID-19 impact Coastal Bend

February 23, 2021 - CORPUS CHRISTI, Texas — It's a fact that when a crisis hits, people here tend to respond in some pretty remarkable ways. First responders and medical personnel are at the top of the list. One local group who, since the pandemic and through our freeze crisis last week, has been giving 110-percent to help their neighbors. They are on the frontline of healthcare -- the TLC Clinic on Staples Street.

In the last year their workload has quadrupled. "I stopped tracking hours," said Dr. Richard Kretschmann. "We all put in the extra hours and the extra effort." Dr. Kretschmann, Medical Director for Complete Care, can't even keep track. "I couldn't even come up with a number off the top of my head," Kretschmann said. There is one sure thing the doctor knows --"We take care of each other," Kretschmann said. "We take care of the community."

In fact, these folks are like a family, and it's because of that they were able to get through some of the toughest times in the past year. "What made it difficult is we went from seeing numbers of 20 and 30 a day to 150 a day," Emergency Physician Dr. Brian Rich said. "So what the staff had to do to overcome that and to be able to see that number of patients per day was extraordinary.”

While this story focuses on this one group of people, the efforts here tell a much bigger story about the true spirit of caring when times get tough.

"People were coming in, slipping and falling on ice, you know, just everything you could think of," said Ann Marie Mellows of TLC Complete Care. "Still needing COVID tests, and they were continuing to see patients and continuing to show up. Even with the temperatures, even without power. We didn't have water." Bellows said they have survived many challenges in the past, but last week's freeze was certainly the biggest.

"We had staff that just couldn't get out of their house," Bellows said. "They couldn't make it, and so we had staff members that were here, had worked a 12-hour shift, and they just stayed. They stayed and covered the next shift for the next girl, the next guy, the next doctor, the next nurse."

"Not one complaint," said Trish Brummett, director of nursing. "Staff stayed here, you know. They used the beds here to sleep. They brought their food in; but they dedicate their time away from their families to be here to help other families."

Borrowing from the old adage, the folks at the TLC Clinic said "the needs of the many truly outweigh the needs of the few." Especially during the most difficult of times, in the true spirit of the Coastal Bend.

Source: https://www.kiiitv.com/article/news/local/tlc-complete-care-staff-work-through-challenges-as-winter-storm-covid-19-impact-coastal-bend/503-78beed0a-2ffa-4806-a68b-a9478c39b2b0

FECs Step Up To Assist As Weather Cripples State Infrastructure

February 18, 2021 - AUSTIN, Texas - As severe weather cripples Texas’ infrastructure, many medical facilities have been left without power, water, phone, and internet service. Many healthcare workers and patients ready for discharge have been unable to get home. Some healthcare professionals have been unable to make it to work, forcing their colleagues to work days on end.

On Wednesday, four St. David’s healthcare facilities, St. David’s Medical Center, South Austin Medical Center, North Austin Medical Center, and Heart Hospital were under Austin’s boil water notice.

"We are working with our supply chain to provide water for our patients, staff, and hospital operations. We began supplementing our onsite water inventory last week, and supplies are continuing to arrive." read a statement from a hospital spokesperson. 

St. David’s Medical Center lost water, and the Heart Hospital had low water pressure Wednesday. Tuesday evening, the South Austin Medical Center lost water, and consequently heat. They transported 30 patients to other hospitals and brought in water trucks to aid their heating system.

A statement from a Baylor, Scott & White spokesperson Wednesday said the healthcare system had been experiencing water outages "over the past few days." Their Emergency Center in Cedar Park closed due to a "winter weather-related water leak." Patients were transferred to other hospitals.

Dr. Luke Padwick, founder and CEO of Austin Emergency Center, a group of six freestanding emergency rooms, told FOX 7 Austin all six facilities have lost power. "Everything you can imagine is, has gone down. But we have stayed open," he said. "one facility remained without power, and dependent on a generator." Padwick said some of his facilities have lost other critical resources such as internet, phone service, and most importantly, water.

"As a healthcare facility the basics of just flushing toilets is an issue," explained Kevin Herrington president of the Texas Association of Freestanding Emergency Centers. "We are a healthcare facility so cleanliness is the most important for infection control so the basics of washing your hands becomes a challenge," he explained.

The six freestanding emergency rooms have not only stayed open through the extreme weather, but have started accepting EMS drop-offs, something Padwick says freestanding emergency rooms do not do in Travis County, and seldom do in the state.

"[The emergency room is] just taking that load of the sort of the, maybe moderate acuity patients that would be seen in the hospital ER’s and sent home. We’ve got quite a few of those from EMS that would have gone to the hospitals," he explained.

Freestanding emergency rooms are not similar to say, Urgent Care. They are not affiliated with a hospital but provide a very similar level of care. They do not perform surgery. Like all emergency rooms, they are designed to transfer patients in need of specialized care.

Dr. Natasha Kathura says that has been extremely challenging this week. "We’re having to increase our capacity to hold patients longer than we ever want to hold patients, delaying surgeries. Ambulance transfers are taking over eight hours for some 9-1-1 calls so things have been very difficult for us."

Source: https://www.fox7austin.com/news/hospitals-struggle-as-weather-cripples-states-infrastructure

Emergency Room Improvement Act (S. 3531) Will Boost Patient Access to ERs and Improve Care Options for Medicare and Medicaid

October 17, 2018 — Washington, D.C.— U.S.Senator Bill Cassidy, M.D. (R-LA), has introduced legislation to provide Medicare and Medicaid beneficiary access to emergency room care in multiple states where Freestanding Emergency Centers (FECs) operate.  The bill would improve patient access to emergency services in crowded urban areas as well as rural areas where access to hospitals is limited. The bill would be a value proposition for Medicare by offering emergency services at a discounted rate.

There are more than 500 Freestanding Emergency Centers across the United States and most were established after 2010. FECs offer high-quality emergency care to patients in fully licensed facilities. Just as hospital-based ERs operate 24/7 and have emergency-trained physicians on-site at all times, so do FECs.

Additionally, Freestanding Emergency Centers are:

• Fully equipped for all emergencies and provide around-the-clock lab and imaging services.

• FECs stock medications not required for urgent-care centers.

• FECs treat most emergent illnesses and conditions, including heart attack, stroke, and minor trauma.

•  FECs are licensed by the states where they operate and comply with state EMTALA requirements, which mandates treatment of all patients regardless of their ability to pay.

Regarding patients’ ability to pay, over the past decade, FECs have provided tens of millions of dollars in uncompensated care to patients with no insurance. In having recognition from the Centers for Medicare and Medicaid Services (CMS), FECs will now be able to widely promote their ability to accept Medicare and Medicaid, which will make clear to even more patients in both urban and rural areas that emergency care outside of a hospital is widely available to them.

FECs offer essential and more convenient patient care, cutting down on patient wait times and offer a solution to rural communities that may not have a hospital in the area. Additionally, with shorter wait times, and quicker attention to emergent conditions, fewer patients require hospitalization.

Although FECs are structurally the same as off-campus EDs (OCEDs)—because they are not affiliated with a hospital—they are not currently eligible to receive Medicare or Medicaid reimbursement. Hospital ownership should not dictate patient access to care. 

Dr. Cassidy recognized that the statute needed to be modernized in order to reflect the improved delivery of healthcare.

As a result, he filed S. 3531, the Emergency Care Improvement Act, whichwould provide Medicare and Medicaid recognition of Freestanding Emergency Centers so they can continue to serve Medicare and Medicaid patients and be partially compensated for the care provided. 

This legislative solution—endorsed by both the National Association of Freestanding Emergency Centers (NAFEC) and the American College of Emergency Physicians (ACEP)—would also help to enable expanded FEC growth in rural areas.

“I introduced this bill because it provides Medicare and Medicaid patients with better access to emergency medical care, reduces their out-of-pocket costs, while also saving taxpayers money,” said Dr. Cassidy.

As ACEP president Paul Kivela recently penned in a letter to Dr. Cassidy: “We think FECs can improve access to emergency care in all areas and we particularly appreciate your recognition of the unique issues affecting access to emergency medical services in rural communities, and relative adjustment of reimbursement for FECs in these geographic areas as part of the legislation.”

Dobson-Davanzo, a highly respected health care consulting firm, performed an actuarial analysis of this proposal and found that it would save Medicare a net $28 million over 10 years, even after accounting for expected increased utilization. That analysis focused on the 5 states where FECs are now licensed (TX, RI, CO, SD, and AZ) and used MedPAC’s assumption on induced demand (5.5 percent) and conservative assumptions on growth and migration. These savings do not include fewer hospital admissions from FECs as documented in peer-reviewed literature.[1]

Brad Shields, Executive Director of NAFEC added, “This value-based bill would improve patient access to emergency care, particularly in towns far away from hospitals, while also offering savings and greater competition to the Medicare program. Dr. Cassidy’s patient-centered efforts will make a substantial difference in the lives of Americans where FECs exist, and especially, in Texas—where the need for and access to reliable emergency care has never been greater.”

###

About S. 3531

• Reimburse FECs:

  • 75 percent of Medicare’s hospital rate for FECs located in urban and suburban areas for higher acuity evaluation/management levels (99283-99285). Lower acuity patients typically seen by urgent care would not get facility payments

  • 95 percent of Medicare’s hospital rate for FECs located in rural, i.e. non-MSA areas for higher acuity evaluation/management levels (99283-99285) 

[1]When comparing FECs to hospital-based ERs, Simon et al observed a 20% lower admission rate for conditions such as chest pain, COPD, asthma and congestive heart failure. These savings were not quantified in the Dobson Davano analysis. (Simon El, et al. “Variation in hospital admission rates between tertiary care and two freestanding emergency departments,” American Journal of Emergency Medicine, 2017)

NAFEC Statement Regarding Adeptus Bankruptcy Announcement

Adeptus Bankruptcy Sparks Industry Response to Increase Insurance Oversight

Adeptus Health announced today that it and certain subsidiaries have filed voluntary petitions for relief under Chapter 11 of the United States Bankruptcy Code. This announcement comes after Adeptus was named in a class action lawsuit regarding the company’s billing practices, which were alleged to be excessive and deceptive. While Adeptus and First Choice are not active members of the National Association of Freestanding Emergency Centers (NAFEC), this event highlights several ongoing concerns for freestanding emergency center operators.

It is now the responsibility of our legal system to determine whether these accusations against Adeptus have merit. NAFEC expects its members to be transparent and honest with patients throughout their freestanding emergency center experience (including regarding the facility’s charges and billing), and to educate the communities in which our members operate about their capabilities and levels of service.

As is the case in any industry, the free market will ultimately determine the success of a business. In most industries, this means that some firms and market participants will not succeed or survive.  Conversely, these same market forces are responsible for the creation of the innovative freestanding emergency center model, and will ultimately lead to its evolution in delivering high quality emergency care to patients.

However, what many do not realize is that the amount a freestanding emergency center bills a patient is directly related to the amount insurance companies reimburse healthcare providers for their services rendered. Adeptus has cited chronic underpayment by insurance companies as a reason for its Chapter 11 filing. This comes as no surprise to freestanding emergency center operators, who offer vital access to emergency care, but face challenges to collect payment from insurers.

In response to this filing, NAFEC has taken aim at increasing oversight for Employee Retirement Income Security Act (ERISA) plans, which include federal and self-funded insurance plans. This will protect healthcare providers and ensure patients are not exposed to large out-of-pocket expenses.

When ERISA health plans do not pay healthcare providers adequately for their services, there is no formal entity regulating or providing oversight to these plans, meaning healthcare providers have limited options for recourse. This poor payer behavior certainly contributed to Adeptus’ bankruptcy filing, and must be addressed to prevent insurance companies from controlling the market and intentionally underpaying providers.

NAFEC’s goal is to ensure healthcare providers are not faced with the dilemma of choosing to bill patients beyond what their insurance paid or accept substandard rates that ultimately lead to their demise. Federal dispute resolution reform appears promising, as Congress is expected to send jurisdiction of ERISA plans back to the states, where state entities would have the ability to regulate reimbursement. This increase in oversight would improve the overall healthcare system by ensuring healthcare providers receive sufficient payment for their services and protecting patients from exorbitant medical bills that result from insurance underpayment.

For more information, please contact:
Jarred Gammon
512.288.4054 (office)
804.387.2337 (cell)
jarred@influeneopinions.com

Certificate of Need: A Barrier to Access

Freestanding emergency centers’ (FECs) medical services meet the same requirements and accreditations as hospital ERs. They are conveniently located, offer little to no waits, and provide an unsurpassed quality of emergency care to patients. FECs’ reduced size and lower overhead and operational costs when compared to traditional hospitals allows them to provide their services in areas where hospitals cannot exist.

These are some of the many reasons why FECs are proliferating.

However, state-level certificate-of-need (CON) laws restrict the creation or expansion of FECs in 36 states. CON law mandates that those looking to open or expand a healthcare facility must obtain government approval by demonstrating that the community needs the proposed facility.

CON laws were originally devised in the 1880s to regulate railroads and other public utilities. Legislators believed these regulations would prevent ruinous competition and ensure the availability of services to everyone. In 1974, the federal government adopted hospital-related CON laws to prevent increased healthcare costs and the over-expansion of hospitals.

Unfortunately, wealthy and politically connected healthcare providers used their capital and influence to gain government certifications. Once certified, these providers proceeded to use their political clout to block competing providers from receiving certification.

By 1987, the federal government repealed the national CON law because it restricted competition and limited the amount of available health services, rather than restrain healthcare costs. In fact, multiple studies have shown that a lack of competition in healthcare actually drives up the costs to patients.

In 2015, the Federal Trade Commission stated, “CON laws raise considerable competitive concerns and generally do not appear to achieve their alleged benefits for health care consumers.”

Simply put, CON laws are used to impose an artificial order on the market, without regard to what consumers themselves want or need. Facilities and services should be available on the basis of patient need and a provider’s ability and willingness to meet that need, which is why more and more states are repealing their outdated CON statutes.

FECs have proven they are willing and able to meet the needs of their patients. FEC proliferation proves patients want FEC services. It’s time states allow for more competition and increase the availability of healthcare facilities, procedures, and providers by eliminating CON laws.

Sponsor Highlight: T System

T-System offers a suite solutions for the FSED market that are unique in the industry. T Sheets® and T-System’s EV™ (electronic version) provide efficient, complaint-driven bedside documentation that helps clinicians spend more time with patients and accurately reflect care and medical decision making for optimized reimbursement. FSEC Foundation™ is the only purpose-built integrated platform that provides FSECs with a full-suite of technology tools to drive clinical, operational and financial outcomes.

EV™ is an easy, efficient and effective ED information system (EDIS) and includes physician and nurse documentation, CPOE, patient tracking, clinical decision support, e-prescribing, reporting and more. Over 400 emergency departments and freestanding emergency centers have chosen EV to document patient care. T-System’s clinical experts maintain the system with the most up to date regulatory and clinical requirements.

T Sheets® support virtually every chief complaint from medicine to trauma to pediatrics, and alleviates the burden of emergency department documentation so that ER physicians and nurses can focus on patient care. 

FSEC Foundation™ is the first integrated enterprise technology platform specifically designed to serve the FSEC market. It includes a comprehensive suite of solutions, including patient registration, gold standard documentation, coding and more.   FSED Foundation integrates T-System’s best-of-breed EDIS and Presidiohealth’s suite of practice management tools to enhance the patient experience, improve workflow and drive clinical and financial outcomes for the FSEC market. This powerful platform seamlessly integrates with other solutions such as radiology, laboratory, billing and others supporting the unique needs of freestanding centers.

T-System, Inc. has been specializing in emergency department documentation since 1996.   T-System has since expanded its focus to include the development of innovative solutions for the rapidly expanding episodic care market, including hospital-based emergency departments (EDs), freestanding emergency centers and urgent care centers. Today, our company continues to innovate by leveraging a strong team of industry experts who lead our clinically-driven services and documentation solutions as well as charge capture and coding solutions that serve 40 percent of the nation’s emergency departments, including over 130 free-standing emergency centers.

Freestanding emergency centers face unique challenges related to care delivery and financial outcomes. As the FSEC market matures and continues to rapidly expand, it’s critical that technology evolves to keep pace. As more and more patients choose to receive care at FSECs due to ease of access, convenience and satisfaction, technology must evolve to enhance the patient experience and drive high-quality, efficient care.  Our integrated platform can provide clinicians with visibility to key insights previously unavailable, enabling FSECs to quickly adapt, grow and scale as the industry evolves.

For more than 20 years, T-System has stayed true to our original purpose: to provide improved patient care through efficient bedside documentation and to optimize reimbursement by producing an accurate and complete medical record.  Clinical content and intuitive workflow are what make T Sheets and EV unique. Our approach is driven by two fundamental elements: compliance and quality. 

In the December 2015 Black Book EDIS survey, which included over 27,000 validated responses, T-System won Top Overall Ambulatory EHR EMR Vendor for Emergency Department. While we are proud of this honor, we are even happier that it means the patients who receive care from physicians and clinicians using EV have the benefit of a system that helps the clinician focus on THEM and not the documentation.

XtreMed in Action

XtreMed has provided concierge radiology services since the inception of the Freestanding Emergency Center (FEC) concept in 2008. Whatever is needed for your radiology suite – we make it headache-free for you.

As NAFEC’s inaugural Champion Sponsor, XtreMed successfully incorporates several aspects of your FEC project including working with the architects and physicists to design your facility and protect your staff and patients with proper shielding needs, managing your general construction company to ensure your radiology department meets your state’s regulations and your expectations.

XtreMed not only provides the latest modalities to fill your FEC, but we offer application training so your staff knows how to operate it, and we provide 24/7 remote and onsite technical support. Properly trained technologists equate to an efficient workflow while well-maintained modalities mean less downtime and longer lifespans.

The XtreMed umbrella covers solutions for: 

• Architectural Designers
• General Construction Companies
• Medical Physics (Shielding Survey, EPE)
• Equipment Procurement & Installation
• Project Management
• Modality Application Training
• EMR Integration
• Radiology Reading & Diagnosis
• 24/7 Warranty & Service Contracts
• Image Archiving Solutions (PACS)

What good is having all the latest technology at your fingertips if it does not work with your other modalities? XtreMed has business relationships in place to offer clients not only the most competitive financing for your modalities but the entire FEC complete coordination collection by providing services like Electronic Medical Record (EMR) integration, radiology reading and diagnosis services as well as image archiving solutions.

To learn more about what XtreMed can offer your FEC, please click here to watch us in action.

Download a PDF version here. 

X3MED.COM

NAFEC Response to Brigham and Women's Hospital Study

A recent study, conducted by Brigham and Women’s Hospital and published in the Annals of Emergency Medicine, has generated a lot of media attention towards the freestanding emergency center (FEC) industry. NAFEC believes there is a need for context so that readers understand the complicated political and regulatory landscape FECs must navigate with regard to these findings. 

Access to Emergency Care for All

Most importantly, NAFEC would like it to be clear that FECs provide critical access to care for ANY patient that walks in their door, regardless of their insurance or ability to pay. As with all emergency care providers, FECs are legally required to administer medical screenings and stabilize patients before discussing how a patient intends to pay for their care.

Despite what the study may lead one to believe, FECs often see and treat patients knowing that they will not receive any compensation for their services, similar to what traditional hospitals experience. For a given FEC provider, unpaid claims can amount to millions in lost revenue.

National CMS Recognition for all FECs

Because more than one-third of the freestanding facilities studied were independent FECs, it is important to explain the situation with regard to the Centers for Medicaid and Medicare Services (CMS). Currently, CMS has not yet recognized non-hospital freestanding emergency centers. Therefore, independent FEC facilities do not receive reimbursement for care provided to Medicare/Medicaid patients. Treating patients without compensation is not financially sustainable. For these reasons, many independent FEC operators avoid locating in areas with high concentrations of Medicare/Medicaid patients.

Additionally, federal regulation restricts hospitals from opening freestanding emergency centers (also known as hospital outpatient departments or HOPDs) beyond 35 miles from their main hospital campus. This regulation significantly impacts site location for hospital-owned freestanding emergency centers

Until non-hospital FECs receive fair compensation and hospitals are allowed to open beyond the 35-mile restriction, it is unlikely that FEC operators will venture into areas where large percentages of the payer mix are Medicare/Medicaid.

Here’s what we are already doing to address this issue:

The National Association of Freestanding Emergency Centers (NAFEC) is a newly formed association that advocates for growth and fair regulation of the FEC industry nationwide. A primary focus of NAFEC will be working with CMS to gain recognition for all types of FECs and protecting their ability to be reimbursed appropriately. Having CMS recognize all models of freestanding emergency centers, combined with allowing hospitals to build freestanding emergency centers beyond 35 miles of the hospital campus, would lead FECs to expand into more rural and underserved areas with higher concentrations of Medicare/Medicaid patients. This will have a substantial, positive impact on the overall healthcare structure and how patients receive treatment. 

Stifling State Regulations

In addition to federal limitations for FECs, some state governments have attempted to stifle and control the FEC industry through regulation. Such restrictions make it more difficult for FECs to enter new markets – markets where access to quality emergency care is limited like in Baton Rouge, Louisiana.

Here’s what we are already doing to address this issue:

One of NAFEC’s biggest challenges is to establish consistent regulations for hospital-affiliated and independent FECs, which is why CMS recognition of all FECs is so critical.

In states like Louisiana and Georgia, where residents are in desperate need of access to emergency care, NAFEC is advocating for state legislatures and regulating bodies to explore FECs as a viable option and allow responsible FEC growth in those states. NAFEC is collaborating with legislatures, state health departments, and other stakeholders to identify ways FECs can solve some of healthcare’s toughest challenges while working within the established healthcare system.

Relieving Pressure On Hospitals

Following the passage of the Affordable Care Act, the pressure placed on traditional hospital emergency rooms across the country has increased significantly. Patients wait for hours just to be seen by a physician and, when they are finally seen, they are treated as a number within a system focused on volume and turnover. This can lead to hospitals admitting patients who do not require in-patient services, thus increasing healthcare costs. In southern states that have not expanded Medicare/Medicaid, maintaining large regional hospitals can be expensive and recent trends indicate that many are closing in rural areas.

In contrast, FECs see patients quickly, spend time with them, and provide quality emergency care. This is why patients are so satisfied with the model. Having smaller, more agile facilities triaging patients and sending those in need of in-patient care to hospitals is more efficient than having patients travel from all over to a regional hospital, only to wait in long lines to see a physician. FECs have the potential to change the way we deliver emergency healthcare. Shifting to this “hub and spoke” model for emergency healthcare is beneficial because it can save money and produce better results for patients.

The relationship between FECs and traditional hospitals is not duplicative. The growth of the FEC industry will ultimately support the need for traditional hospitals with surgeons, specialists, and trauma capabilities, and that shift will involve collaboration and integration. Together, FECs and hospitals can improve the delivery of emergency care in terms of lowering costs, reducing wait times, and improving patient satisfaction.