Free-standing emergency departments in Texas' largest cities have not alleviated emergency room congestion or improved patient wait times in nearby hospitals, according to a new paper by experts at Rice University.
That finding contradicts arguments made by proponents of free-standing EDs, who have claimed the proliferation of stand-alone emergency rooms would speed care in overcrowded hospitals, said the authors.
But unlike in Texas' biggest cities, the research indicates that in smaller communities, free-standing emergency rooms can indeed reduce wait times.
The researchers reached their conclusion by studying data from the American Hospital Association annual survey, the American Community Survey and free-standing ED licensing data from the Texas Department of State Health Services from 2010 to 2016.
They looked at how the entry of more free-standing EDs in local markets impacted the flow of patients in nearby hospital EDs, finding the free-standing centers didn't affect the number of patient visits to hospital EDs, ED wait time, length of visit for discharge patients or the rate of patients who left without being seen or treated.
But in areas outside of the four major metropolitan areas in Texas -- Houston, Dallas, San Antonio and Austin -- the authors found that if a hospital opened satellite free-standing EDs in the community, wait times in the hospital's ED and length of stay in the ED both fell.
The results imply that free-standing EDs are increasing the utilization of emergency care, and don't function s the "perfect substitute" for a hospital ED, particularly in major metropolitan areas.
The authors said it hasn't yet been shown whether the additional care is ultimately beneficial to patients. They support a recent move by the Centers for Medicare and Medicaid Services to lower reimbursement rates for free-standing EDs within six miles of a hospital ED.
Among private health plan enrollees in recent years, there has been a substantial shift from emergency departments to urgent care centers when it comes to patients receiving care for low-acuity conditions, Brigham and Women's Hospital research found last year.
Treatment for new health problems, or acute care visits, encompass over one-third of all ambulatory care delivered in the U.S. Given the high costs of emergency departments, many insurance plans have created incentives to encourage patients to receive that care elsewhere.