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By 1987, the federal government repealed the national CON law because it restricted competition and limited the amount of available health services, rather than restrain healthcare costs.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need and a provider’s ability and willingness to meet that need, which is why more and more states are repealing their outdated CON statutes.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.
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.
The True Cost of Readiness
Emergency care is unlike any other form of medical care because of the responsibility to be prepared for the unknown at all times. Our freestanding emergency centers (FEC) must be ready for any injury or illness that comes through their door – something that requires a great deal of preparation and planning. This characteristic of emergency medical care may be undervalued and underappreciated by patients, because, often times, they do not understand all of the factors that are needed to provide emergency care.
So what does it take to provide emergency services?
Our doors are always open when you need us.
Freestanding emergency centers are required to be open 24/7, 365 days a year. Emergency medicine's top priority is being ready for every patient and is unique in that this delivery of care is unscheduled. In contrast, primary care physicians, minute clinics, and urgent care facilities have limited hours and often require scheduling appointments in advance. That means for late night injuries or holiday sicknesses, the emergency room may be a person’s only option for emergency care.
We have trained ER-physician and registered nurse (RN) on-site at all times.
Freestanding emergency centers are required to have a trained ER physician and registered nurse at all times. Urgent care facilities and similar alternatives are not required to have a physician available during all business hours. At times, a physician’s assistant will be the highest trained medical professional at an urgent care or minute clinic. Having the most experienced and qualified personnel is another important feature that enables FECs to provide the highest levels of service.
Our centers are equipped to handle serious emergencies.
Freestanding emergency centers are equipped to handle serious emergencies – heart attack, stroke, lacerations, or other medical emergencies – at a moment’s notice. To do so, freestanding emergency centers must maintain state of the art equipment, which enables staff to quickly diagnose and treat a medical emergency. FEC facilities have laboratory and radiology equipment, including CT scanners, ultrasounds, and x-ray machines. FECs are able to run tests and process results efficiently. They also have a stocked, Class F pharmacy on-site to quickly deliver needed medications to patients so they can get back to their daily lives. FECs stand ready for all levels of emergency at every hour of every day. FEC alternatives like primary care physicians, minute-clinics, and urgent care clinics are unable to treat patients with serious emergencies and are not required to house such complex medical equipment.
The value of convenient, quality emergency medical care.
Emergency care is the only form of healthcare required to be prepared for every level of patient at every hour of the day, regardless of their ability to pay. With the convenience and accessibility of freestanding emergency centers comes a cost of readiness. The cost associated with emergency care is linked to all of the traits previously mentioned that make freestanding emergency centers unique when compared to other healthcare facilities. The cost of maintaining readiness is something patients and insurance companies must recognize.
Although some patients might express concerns for shorter FEC visits that generate large bills for emergency care, it is important to understand that a speedy visit is one of the added benefits of visiting an FEC facility, and to consider all of the back end work that goes into making visits to freestanding emergency centers so efficient. FECs are willing and ready to treat any injury or illness at any time, which brings value to patients and allows freestanding emergency centers to stand out in terms of service and quality of care.
In the event of a medical emergency, know that you are in good hands at one of our freestanding emergency centers.
New East Jefferson General Hospital Partnership to Provide Additional Emergency Service in Community in 2017-2018
East Jefferson, LA (May 13, 2106) – East Jefferson General Hospital (EJGH) is pleased to announce it is partnering with Excel Med Alliance to open two new freestanding Emergency Departments (ED) in 2017-2018. These new facilities will provide ease of access to quality emergency care to the community.
The first ED is slated to open mid-2017 and will be located at the corner of Veterans Memorial Boulevard and Clearview Parkway in Metairie. The second location will open in Kenner in 2018.
At a freestanding ED, patients are seen by emergency physicians minutes after walking through the door, providing fast, comprehensive emergency care and treatment, resulting in improved patient satisfaction.
“These will be fully functional emergency departments, staffed 24/7 by an experienced, highly qualified staff, led by board-certified emergency medicine physicians,” notes Dr. Mark Peters, President and CEO of EJGH. “Focusing on creating new care access points for the community is part of East Jefferson’s efforts to bring quality care closer to our patients.”
About East Jefferson General Hospital
East Jefferson General Hospital is a publicly-owned, not-for-profit community hospital located in Metairie, Louisiana. This service district hospital, formed in 1965, receives no tax support from Jefferson Parish. The 420-bed hospital is accredited by the Joint Commission on Accreditation of Healthcare Organizations and Louisiana’s only four-time designated Nurse Magnet hospital. For more information on East Jefferson General Hospital, visit online at www.ejgh.org.
About Excel Med Alliance, LLC
Excel Med Alliance (EMA), founded by physicians, is the culmination of expertise from both the hospital-based and free-standing emergency medicine environments. Led by physicians John DiPasquale and Nick McLain, EMA is committed to high quality emergency care while providing the best overall experience for patients. EMA affiliates are Leading Edge Medical Associates and Excel ER, where you can visit online at lema-em.com or excel24er.com.
State Barriers For Freestanding Emergency Centers Bad For Consumers, Bad For Healthcare
Freestanding emergency centers have expanded across the country at a rapid pace because they offer quick, convenient access to emergency care in a comfortable delivery setting. However, as the demand for FEC services increases, some state legislators are attempting to stop the growth of FECs through overregulation and anticompetitive legislation.
In Rhode Island, following the state’s licensing of two Neighbors Emergency Center applications for freestanding emergency centers, Senator Joshua Miller filed S2696 requiring all future freestanding emergency center proposals to be subject to a Health Department “certificate of need” review. This measure would require future FEC facilities to demonstrate that their medical services would not be harmful to existing hospitals and other medical facilities by offering duplicative services. If passed, this legislation would effectively discourage competition and halt any future development of freestanding emergency centers in Rhode Island.
Additionally, Colorado Representative Elizabeth McCann introduced HB 1374, which would have has increased transparency requirements for independent freestanding emergency centers, but not for hospital ERs. Furthermore, HB 1374 conflicts with the prudent layperson standard, which was created to protect patients that present at an emergency room. The bill did not pass, however there was a motion to develop a study that will examine whether or not legislation calling for a “certificate of need,” similar to Rhode Island’s, would be beneficial for the state.
NAFEC opposes states enacting harmful legislation and creating barriers to entry for freestanding emergency centers. This approach is not only anticompetitive, it hurts consumers in that state by limiting access to emergency care.
While we understand that supporters of this legislation are concerned with how the growth of freestanding emergency centers will affect existing hospital emergency rooms, it is also important to note that emergency room visits are on the rise following the Affordable Care Act. This has increased pressure being placed on traditional hospital ERs, creating long wait times and a rushed treatment process for patients. Freestanding emergency centers help to alleviate the pressure placed on traditional hospital ERs and provide a welcomed alternative for consumers who want quality emergency care without the wait or the hassle.
With a trend of rural hospital closures occurring across the country, many states are looking to FECs as a potential solution to a shortage of access to emergency care and are opening their doors to this innovative model. Yet, in states like Rhode Island and Colorado, legislatures are choosing to take a step backward and limit the emergency healthcare options available to their constituents.
FECs are a natural progression in healthcare delivery that leads to higher efficiency and increased satisfaction for both patients and physicians. With a number of states already embracing the freestanding emergency room model, more states should break down barriers and allow these facilities to provide community based emergency services to greatly improve healthcare quality. NAFEC hopes to work with state legislators and address their concerns in a way that promotes responsible growth of freestanding emergency centers in their state.
Applying Medicare/Medicaid to FEC-Administered Care
The creation of the freestanding emergency center (FEC) industry in Texas sparked the rapid growth of FEC facilities across the state and now across the country. Initially, FEC operators owned only a few facilities in major markets with high demand for emergency care. Currently, however, we are seeing FEC operators expand into more rural areas, which tend to have higher rates of Medicare/Medicaid patients. This begs the question, how does Medicare and Medicaid apply to FECs?
Because FECs were mostly concentrated in Texas and Colorado early on, the Centers for Medicare & Medicaid Services (CMS) has not yet recognized non-hospital freestanding emergency centers as a viable option for receiving emergency care in the US. Therefore, those FEC facilities do not receive reimbursement for care provided to Medicare/Medicaid patients.
So what does this mean for patients?
FECs are legally obligated to offer a medical screening to all patients that walk in their doors, regardless of their health insurance or ability to pay. In the event of a medical emergency, all patients will be stabilized and treated with the highest quality of care.
From a business perspective, treating patients without any expectation of compensation for your services is not ideal. Each year FECs administer millions of dollars in free emergency medical care to Medicare/Medicaid patients. For this reason, many FEC operators avoid locating in geographic areas with high concentrations of Medicare/Medicaid patients. But the reality is that until FECs receive fair compensation for treating these patients, it’s not likely FECs will venture into these rural areas, which are typically the areas most in need of increased access to emergency medical care.
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 for this association will be securing CMS recognition and reimbursement for FECs, which will have a substantial, positive impact on the overall healthcare structure and how patients receive treatment.
Sponsor Highlight: Presidio Health
The rapidly growing Freestanding Emergency Center and Urgent Care market demands a fresh approach to providing excellent patient care, and starts when your customer walks through the front door. Presidio understands this requirement for excellence and has built an integrated technology platform of services that manage each unique patient experience from arrival to final bill payment, including bed-side, mobile registration and discharge payment capture with convenient payment options from credit card, eCheck and financing, payment plan program options. In addition to our concierge patient services, our revenue management technologies and services dramatically improve clinical documentation, physician productivity and facility revenue capture. By maintaining a consistent “flow” of all revenue processes, we facilitate efficient and effective operations that maximize efficiency and profits.
Presidiohealth is a privately held corporation based in San Francisco, California founded by Douglas Evans, MD MPH, a practicing ER Physician, in 2004 to provide next generation Performance Management services to Emergency Departments, Freestanding ERs, Urgent Care centers and Physician groups across the United States. Presidiohealth combines years of deep experience in point of service and revenue management for emergency room facility and professional services and provides a high touch, turn-key suite of Performance Management services for Freestanding Emergency center and clients and their customers. In a rapidly growing and evolving industry, we are your full service, solutions oriented partner.
NAFEC Opposed Rhode Island's SB 2696
April 25, 2016
Senator Joshua Miller
Rhode Island Senate
82 Smith Street
Providence, RI 02903
Senator Miller,
On behalf of our members operating freestanding emergency centers across the country, the National Association of Freestanding Emergency Centers (NAFEC) OPPOSES SB 2696.
NAFEC represents the unique interests of freestanding emergency centers (FECs) delivering emergency medicine outside of the traditional hospital setting. NAFEC advocates for fair regulation and raises awareness of FECs as a high-quality, accessible, emergency medical care option.
NAFEC believes that existing statutory criteria are met when a facility in Rhode Island completes a rigorous license hearing process with the result being a license issued. NAFEC OPPOSES legislation as an attempt to go backwards by creating a new CON process. Many states have moved to abolish the CON process which favors existing entities, limits competition, provides a monopoly and eliminates patient choice. Free markets should be free and allowable.
The Antitrust Division of the U.S. Department of Justice and the U.S. Federal Trade Commission, in a joint statement, noted that CON laws “impede the efficient performance of health care markets” and “pose serious anticompetitive risks that usually outweigh their purported economic benefits”.
NAFEC believes that the current process works and questions whether adding the criteria parameter improves a process that was just proven to work.
Please do not hesitate to contact me with any questions or for further assistance.
Sincerely,
Brad Shields
NAFEC Executive Director
Freestanding Emergency Centers: A Free-Market Solution to Emergency Healthcare Services
Freestanding emergency centers (FECs) could transform emergency healthcare services in the United States. Due to overcrowded waiting rooms, long wait times, inefficient processes and below-average customer service, emergency room visits are often unpleasant; however, with the use of FECs, that can change. State officials should consider this private-sector alternative to help resolve some of these widespread hospital emergency room inefficiencies.
According to the Texas Association of Freestanding Emergency Centers (TAFEC), FECs offer 24/7 care, have ER physicians on-site at all times, provide round-the-clock lab imaging services with instant results, and stock medications not required for urgent care centers. They also contain full CT scan and radiology services, cardiopulmonary monitoring, nebulizer treatments, and airway management, intravenous fluids and medications, and overnight observation capacity.
Architectural and equipment requirements mandate the work space be large enough and pleasing while providing comfort and ease for patient care. FECs require all necessary technology ER departments in the hospitals have to ensure the highest quality of care is provided to patients.
There are three forms of FECs throughout the United States. The first is the hospital outpatient department (HOPD), which is an affiliate of a larger hospital or health system and functions as a satellite office. (They are not attached to the actual hospital.) According to statute, a hospital affiliate must be within 35 miles of the hospital. This is the most common model and is in place in 40 states. The second type is the independent FEC that is unaffiliated with a hospital and is usually physician-owned. The third type is a joint-venture partnership between an FEC and a hospital. This form allows for the navigation of legislative and regulatory barriers of entry and provides flexibility in partnering with a more established health system.
Freestanding emergency care centers need to work closely with hospitals in their communities if their patients suffer a medical emergency such as a stroke. In this case, the center will facilitate the hospital transfer for admission to receive treatment. Among all urgent and emergency care providers, freestanding ERs receive the highest satisfaction scores from patients, physicians and staff. The American College of Emergency Room Physicians states that only eight percent of emergency patients have non-urgent conditions, and two-thirds of emergency visits occur after business hours or when the doctor’s office is closed. All FECs can meet these needs while reducing hospital crowding and letting hospital ERs focus on taking care of the most pressing issues.
FECs also offer higher-trained professionals than traditional urgent care centers, including emergency room (ER) doctors that have completed full residencies in emergency medicine and who are board certified in emergency medicine (A.B.E.M.). ER doctors are trained to work within pediatric and adult emergency settings, and experience both fields during their training. Because FECs can bill for similar rates to hospital emergency rooms and comply with the federal requirements of the Emergency Medical Treatment and Labor Act (EMTALA), they must provide care to all patients, regardless of health insurance or ability to pay.
Unlike in a traditional hospital setting, FEC facilities offer adaptability and flexibility for patients, translating into true quality care. They typically include eight to twelve beds, allowing physicians to see patients quickly and provide the necessary care in the smaller environment. The smaller facility also allows doctors to spend more time with each patient. Patients are closely monitored, instead of immediately admitted to the hospital when diagnosed with a complication.
FECs originated in Texas, where over 200 centers are currently in operation. According to Modern Healthcare, the number of emergency department visits is increasing, and between the FECs and hospital visits, emergency care for patients can be significantly improved.
Moving a step closer to increasing the number of FECs, there is a focus on Ohio, where Adeptus, a significant Texas healthcare operator that owns the First Choice chain of freestanding emergency rooms, has purchased property and filed plans with the local government to propose a 24-bed full-service hospital in Columbus. Lawmakers in California have also started to allow FECs in their state. They are considering allowing Saddleback Memorial Medical Center in Laguna Hills to operate an FEC in Orange County, in case San Clemente’s hospital shuts down.
FECs can be a viable free market solution designed to improve access to quality emergency care. By providing hospital-level capacity, it makes them a hugely improved option for their patients. With Texas and Ohio already embracing the FEC model, more states should break down barriers and allow freestanding emergency centers to provide community based and private emergency services to greatly improve quality of healthcare.
View the original story here.
Legislative Update: Colorado House Bill 16-1374
Earlier this month, NAFEC board members traveled to Colorado to testify in opposition to HB 16-1374 before the Senate Health, Insurance and Environment Committee.
In its current state, HB 16-1374 requires freestanding emergency rooms to post notices throughout the facility indicating that the facility is an emergency room and provides emergency services to treat emergency medical conditions. In addition, the bill would require freestanding emergency rooms to inform a patient after they’ve had their initial medical examination of the following:
- The patient is at a freestanding emergency room, which will charge at emergency room rates;
- The physician providing medical care could bill the patient separately from the center; and
- For non-emergency medical conditions, the patient may wish to confer with his or her primary care physician or other primary care provider.
As an organization that represents the spectrum of freestanding emergency rooms, NAFEC supports transparency, protecting consumers, and delivering healthcare in an efficient way. However, House Bill 16-1347 has unintended consequences that unfairly disadvantage independent FECs. For this reason NAFEC does not support the bill in its current form, but we are hopeful that the bill can be amended to achieve it’s underlying objective of protecting consumers without creating an unleveled playing field.
NAFEC will continue to monitor this bill and provide updates on any amendments made as they become available.
NAFEC Preparing for Upcoming National Health Care Policy Battles
Preparation is everything when it comes to getting the best results possible in a legislative or regulatory policymaking setting in Washington, D.C. While a quick read of the major newspapers or casually watching cable news might lead you to believe that Congress and the White House are at a standstill on healthcare policy development, it would be a mistake to believe nothing is happening or that there isn’t a need to get ready now for the upcoming fight.
2017 promises to be one of the busiest legislative years in nearly a decade. Even with the unpredictability of the upcoming elections, there is the certainty that we will have a new U.S. President and a number of new members of Congress.
In preparation for the opportunity to legislate on a number of major policy areas including healthcare reform, tax reform, and poverty, Speaker of the U.S. House, Paul Ryan (R-Wis.) has created working groups, led by current Congressional committee chairs, to develop policy proposals for use leading up to the elections in November and then during the new Congress, which will convene in 2017.
In a recent speech designed to address the strained situation on the presidential campaign trail, Ryan referred to these efforts and to the idea of focusing on policy development in an election year as being essential to showing leadership and focusing on the future.
“As leaders, we have an obligation to put our best ideas forward, no matter the consequences. With so much at stake, the American people deserve a clear picture of what we believe,” Ryan said. “This is the basic concept behind the policy agenda that House Republicans are building right now.”
In addition to Ryan’s efforts there are behind the scenes meetings being conducted across the aisle among Democrats and on the other side of the Capitol in the Senate by leaders from both political parties. Of course, the various think tanks and healthcare-oriented lobby groups around Washington, D.C. are all working on their own plans for the new president and next Congress.
The Medicare Payment Advisory Commission (MedPAC), a nonpartisan legislative branch agency that provides analysis and policy advice to the U.S. Congress, will continue to be busy in 2016. As will the Medicaid and CHIP Payment and Access Commission (MACPAC), which makes recommendations to Congress, the Department of Health and Human Services, and the states.
Finally, the presidential candidates and their campaigns are already developing proposals they will want to push if they are elected in November. Knowing that the first year of a new administration presents the best opportunity for major legislative accomplishments, the new president will want to hit the ground running even before the 115th Congress is convened in 2017.
The National Association of Freestanding Emergency Centers (NAFEC) will be taking a leadership role at the federal level and is already making its views known on Capitol Hill and across Washington, D.C. Working with Lucas | Compton, a bipartisan legislative and regulatory advocacy and advisory firm in Washington, D.C., NAFEC is laying the groundwork for guaranteeing that freestanding emergency centers are a vital part of the healthcare delivery system into the 21st Century.
If you are a NAFEC member or you are interested in learning more about NAFEC membership, we would welcome the opportunity to schedule a time to discuss with you in more detail the legislative and regulatory preparations currently underway and to provide an assessment of what awaits the nation and its healthcare delivery system over the next several years.
Travis Lucas, Senior Partner
Mike Chapman, Government Relations Director
Lucas | Compton LLC
Sponsor Highlight: Republic E.M.S.
Established in early 2008, Republic E.M.S. has become one of the most reliable, fastest growing, and highly sought after private ambulance services. We pride ourselves in being a premier ground ambulance service solely dedicated to catering to the needs of freestanding emergency centers throughout Texas and abroad.
Focusing on integrity and outstanding performance, all of our units are MICU-ready, equipped with state of the art diagnostic tools, and highly trained medics.
Republic’s staff is required to go through a rigorous hiring process, including but not limited to: drug screenings, background checks, continuing education courses, and more. Our medics participate in frequent mock codes, as well as our in-house AHA training to keep their BLS, ACLS, and PALS certification current.
Each unit in our fleet is staffed with a Paramedic and EMT. Within five years of service our ambulances are replaced with a new unit. Each unit is equipped with a vent, pump, and cardiac monitor. With multiple 24-hour units strategically placed thorough out our service areas, we are able to keep our response times below 30 minutes.
We believe quality is key, and will continue to grow with our partnered facilities as they break ground across the United States. This growth allows us to ensure every patient and facility receives the best ground ambulance care available.
While, it is a main priority to ensure our services offered are always above reproach, we also know our success is greatly dependent upon the success of the facilities we service. Therefore, it is our number one goal to create a unique partnership with the same marketing goals in mind for your facility. We have extended our training services to partner-facilities – frequently offering BLS, ACLS, PALS courses, as well as mock codes on-site at the facility.
To begin a partnership that truly has the success of your facility, staff, and patients in mind, contact Omar Dar, via e-mail at omar@republicems.com, or by calling (832)257-8333.
XtreMed Successfully Integrates Radiology Technology with T-System’s EDIS, Streamlining Care for Neighbors Emergency Center
HOUSTON – March 28, 2016 – XtreMed, a turnkey medical imaging provider today announced successful integration of their Harmonious Radiology Solution with T-System’s emergency department information system (EDIS) at Neighbors Emergency Center, one of the largest freestanding emergency center (FSEC) networks in the U.S.
Neighbors Emergency Center is projected to provide care to over 75,000 patients annually through its more than 20 center locations. With plans to open centers throughout the U.S. this year, Neighbors sought out technology providers who could support their exponential growth. Since the integration of the two technologies from XtreMed and T-System, Neighbors Emergency Center has reported optimized clinical workflow, efficiency and patient care.
“When it comes to the unique dynamics of emergency care, having radiology information available at your fingertips is incredibly valuable,” said Lauren Cotton, RN, CEN, MS, chief nursing officer at Neighbors Emergency Center. “Our clinical team can access a radiology image directly within T-System instead of having to work between two systems, which would have a tremendous negative impact on our workflow and efficiency.”
XtreMed and T-System worked to ensure the technologies were seamlessly integrated so that the images from the radiology equipment were sent automatically to T-System’s EDIS, EV™, and accessible at the point of care.
“Prior to the integration with T-System, we experienced difficulties when attempting to integrate with other EDIS providers. We found that most vendors were unable to provide the necessary support and communication for a successful integration,” said Houman Farzian, chief executive officer of XtreMed. “This has been a very successful working relationship and we’re proud to help streamline care for Neighbors through this technological integration with T-System.”
“We believe in providing clinicians with the tools they need to deliver the best care possible to patients,” said Robert Hitchcock, M.D., FACEP, chief strategy officer at T-System. “I believe this successful integration with XtreMed really shows the remarkable outcomes that can be achieved when healthcare technology vendors work together and remain focused on what’s best for the patient.”
About XtreMed
XtreMed is a radiology and medical imaging solutions provider headquartered in Houston, Texas. Since the inception of the FSEC market, XtreMed has performed more than 250 modality installations and 20 complete radiology suite projects and currently provides technical support and modality maintenance for more than 40 FSECs nationwide. For more information about XtreMed visit www.x3med.com.
About Neighbors Emergency Center
Neighbors Health System operates Neighbors Emergency Center, a series of 24-hour freestanding emergency centers that have seen exponential growth in Texas since 2009. Neighbors Emergency Center believes in providing extraordinary care that is dedicated to making lives better every day, with an unfaltering vision to be The Best Neighbors Ever. This means providing unparalleled medical care driven by compassion, respect, and\ dedication and a focus on our patients, our culture, and the community.
Neighbors’ 20+ locations service many communities, including Houston, Austin, El Paso, Beaumont, and the Permian Basin, with plans for centers in areas that include South Texas and Colorado in 2016.
For additional information about Neighbors, please visit www.nec24.com.
About T-System
T-System Inc. advances episodic care with solutions proven to solve clinical, financial, operational and regulatory challenges for hospitals and urgent care clinics. About 40 percent of the nation’s emergency departments and urgent care centers use T-System solutions to provide an unmatched patient experience. Through gold-standard documentation, charge capture and coding solutions, T-System optimizes care delivery and financial outcomes for organizations across the United States. Follow @TSystem on Twitter, or become a T-System fan on Facebook.
###
View the full press release here.
Sponsor Highlight: XtreMed Enterprise
As an emergency doctor, your investment in the growth of FECs enabled you to escape the hospital emergency room’s bureaucratic red tape regime so you could freely practice your passion and take control of your career. The new-found freedom allowed you to perfect your profession while your patients benefit from your specialty.
At XtreMed, your RADIOLOGY NEEDS are our EMERGENCY and a turn-key project, free of headaches, is our specialty.
We are worthy of the title of NAFEC Champion Sponsor because we are the FEC experts. We have been there since the inception of the FEC market and have had the privilege of working with more than 40 FECs NATIONWIDE. We offer a HARMONIOUS radiology suite that allows you to take more control of your business because our experiences taught us what to expect, what questions to ask, and what you need.
As just part of our service suite, we perform and manage:
- Medical Capital Procurement and Consulting
- Architect and Medical Physicist Design (Shielding Survey, EPE)
- Legalities and permits involved with the radiology department (local state health departments, HIPAA, FDA)
- EMR integration
- Modality Application Training
- Service Contracts including 24/7 Technical Support
- Image Archiving Solutions (PACS)
The most iconic feature of an FEC is the patients’ MINIMUM wait time experience. XtreMed has this exact same policy. We understand what is an urgent necessity within the market. Our aspiration is for you to focus on the thing that matters most: saving lives. Your time is too important to waste worrying about which vendor to call to rescue your malfunctioning radiology equipment. Working with XtreMed’s RescueRad Technical Support team means you work with one fully-integrated company that has been able to maintain a 3.8-MINUTE AVERAGE RESPONSE TIME and GUARANTEES a 96% uptime for your entire radiology suite.
Our RescueRad agents are wide awake around-the-clock to ensure your equipment is operational, which allows you to fully direct your focus on patient care outcomes. We help preserve your peace of mind when you rest your radiology needs on our shoulders. Our XtreMed family was created to serve your harmonious radiology solutions and aid in your growth and success.
Please click here for more information.
NAFEC Board of Directors
On October 27, 2015, the National Association of Freestanding Emergency Centers (NAFEC) held its first ever membership meeting, where NAFEC members elected its initial board of directors. NAFEC is excited to introduce our board members, each of whom has significant experience working within the FEC industry. The board is honored to represent FECs across the country and will work to further the industry nationwide.
Rhonda Sandel – President
Rhonda began her career working as a registered nurse, before starting her first company, Sandel Legal Nurse Consultants. While consulting she met the physicians that ultimately founded Texas Emergency Care Center, joining their team as CEO. Rhonda has been instrumental in the growth of Texas Emergency Care Center and has overseen the opening and operation of four area locations since 2006. Rhonda continues to guide Texas Emergency Care Center in their day-to-day operations and expansion plans as the CEO.
In addition to her role at Texas Emergency Care Center, Rhonda has also served as president of the Texas Association for Freestanding Emergency Centers (TAFEC). With TAFEC, Rhonda was actively involved in the legislative process to develop licensing standards for freestanding emergency centers.
Maureen Fuhrmann – Secretary
Maureen Fuhrmann, Chief Business Development Officer for Neighbors Health System, Inc., received her bachelor’s degree in Nursing from Niagara University and earned a Master of Healthcare Administration from the University of Houston.
Prior to joining Neighbors Health System, Maureen held primary responsibility for all aspects of REMCO Emergency LLC, the management company that provided turnkey solutions for building, managing, and operating FECs.
Her 25 years of emergency healthcare experience played a key role in the development and design of freestanding emergency centers throughout Texas. She has been an active member of the Texas Association of Freestanding Emergency Centers since its inception, and is currently a member of its board of directors.
Graham Cherrington – Treasurer
Graham has over 10 years of healthcare industry experience, and recently served as Chief Operating Officer of WellNow Urgent Care.
Previously he was Executive Vice President of Operations for NovaMed, an operator of 37 outpatient surgery centers in 19 states. Prior to NovaMed, Graham was Senior Vice President of Operations for Matria Healthcare, Inc., a provider of disease management services to health plans and employers.
Graham began his career with Accenture, and PepsiCo. He received an MBA from the University of Florida and a BS in Business from the University of Illinois.
Swapan Dubey
Dr. Swapan Dubey attended The University of Texas at Austin and then medical school at the University of Texas Health Science Center in San Antonio. Dr. Dubey attended and completed a residency in Emergency Medicine at SUNY Stony Brook in 1999.
In 2010, Dr. Dubey co-founded SPHIER Emergency Room and has served as the President and CEO of SPHIER Emergency Room.
Dr. Dubey has been involved in organized medicine through the TMA, HCMS, and ACEP. Dr. Dubey is currently serving on the Board of Socioeconomics for Harris Count Medical Society. Dr. Dubey assisted in the formation of the Texas Association of Freestanding Emergency Centers and has served as President for the association.
Michael Falgiani
Dr. Michael Falgiani is the Medical Director of the UF Health Shands Emergency Center – Springhill. Dr. Falgiani graduated from the University of Oklahoma and attended residency at The University of Florida Shands Jacksonville.
Dr. Falgiani served as faculty for the University of Florida at Winter Haven Hospital Department of Emergency Medicine upon completion of his residency. Dr. Falgiani then moved to Kansas City, MO, where he worked in community emergency medicine for three years before returning to Florida.
Dr. Falgiani returned to academics in July 2010 when he became full-time faculty for the Department of Emergency Medicine at UF Gainesville. Dr. Falgiani has a wide range of clinical interests including hyperbaric medicine and diving related injuries. In August 2013 UF Health opened the first freestanding emergency center in Gainesville. Dr. Falgiani was instrumental in the development and planning of this facility and has served as the Medical Director since its opening.
Abe Longoria
Dr. Abel Longoria is board certified by the American Board of Emergency Medicine. He has been an active member of Greater Houston Emergency Physicians (GHEP) since 1998. In 2009, he was an integral part in GHEP opening its first FEC, Elite Care in Houston.
In addition to his Elite Care and GHEP duties, Abel is a charter member of the Texas Association of Freestanding Emergency Centers and has served on the board since its inception.
Abel also continues to be active in the pre-hospital arena. In this capacity, he had the honor of serving as the “Medical Director of Ground Zero” for the 14 days immediately after 9-11. His numerous years of pre-hospital care were recognized in 2008 when he was awarded the EMS Medical Director of the year for the Greater Houston Area.