The Emergency Clinic at the Pearl is located at 2015 Broadway St.
Freestanding emergency centers throughout Texas have requested permission from the state to provide some nonemergency care during the coronavirus pandemic. Credit: Bonnie Arbittier / San Antonio Report

Freestanding emergency centers throughout Texas have requested permission from the state to provide some non-emergency care during the coronavirus pandemic to help alleviate stress on hospital systems. 

In a recent letter, the Texas Association of Freestanding Emergency Centers (TAFEC) asked the Health and Human Services Commission (HHSC) to waive or change two rules related to the operation of freestanding emergency centers.

The association asked that freestanding ERs be allowed to relieve overcrowding in hospitals by allowing them to provide non-emergency services, including imaging and radiology, for outpatients unrelated to a medical emergency and to charge less for coronavirus testing at their facilities, said TAEFC Executive Director Brad Shields, who noted that such ERs are already set up to provide those services.

Currently, if a patient goes to a freestanding emergency center for a coronavirus test, the visit will be billed as an emergency room visit, which is typically more expensive than a visit to a doctor’s office or urgent care facility, and patients can only be tested if they show severe symptoms. 

Freestanding emergency centers differ from urgent care facilities in that they treat conditions that place a person’s health in serious jeopardy, including severe pain and psychiatric disturbances, according to the HHSC. Urgent care facilities such as Texas MedClinic can bill for COVID-19-related services because they are legally able to provide services at the outpatient level.  

Dr. Edward Wright, a founding physician of Prestige Emergency Room, said that his three locations have turned away thousands of people seeking COVID-19 testing because freestanding emergency centers are “required by law only to evaluate patients that have an emergency complaint.”

“It’s very frustrating for us, too, because we’re sitting here with plenty of capacity to do the testing folks need … but an unintended consequence of that law has left us with this without the ability to actually help them,” Wright said.

Because the federal coronavirus relief legislation requires that coronavirus tests be offered at no cost to patients, allowing testing to be done at freestanding ERs would increase access to testing for patients, Wright said.

The freestanding ER group also wants the state to waive the current reporting provision that requires such facilities to file an incident report if they keep a patient for more than 23 hours, Shields said, so the facility can provide ongoing care and keep patients out of hospitals during the coronavirus pandemic. 

Allowing a patient to stay at a freestanding emergency center for longer than 23 hours would “reduce hospital admissions, preserve hospital beds, and keep non-COVID-19 patients out of hospitals where they might increase their chances of exposure,” Shields said.

The Southwest Texas Regional Advisory Council (STRAC), a network of hospitals and first responders that is coordinating the San Antonio area’s coronavirus response, is already referring patients to freestanding ERs to alleviate the strain on area hospitals, Shields said.

But while freestanding emergency facilities are included in STRAC’s COVID-19 plans, they are unable to bill accordingly or keep patients for the necessary amount of time, Shields said. 

The freestanding ER association has sought a change to allow outpatient services since the 2019 Texas legislative session, when Rep.James White (R-Hillister) authored House Bill 1278, which would have allowed freestanding emergency medical care facilities to offer outpatient acute care services regardless of whether there was a current health care crisis. 

The bill made it out of the House Public Health Committee but then stalled, Shields said. If the legislation had become law, freestanding emergency centers “would have been able to operate and offer outpatient acute care during this pandemic.”

Wright said that while it is important now to increase access to coronavirus testing, allowing freestanding emergency centers to provide outpatient services will be even more crucial once a COVID-19 vaccine becomes available. Having additional facilities, especially ones with extended hours, able to administer vaccines will be key.

Because many freestanding emergency centers are open 24 hours, it increases access for care to people who have scheduling constraints, Wright said. 

Roseanna Garza reports on health and bioscience for the San Antonio Report.