There are generally three options for acute medical care: the emergency room (ER), an urgent care clinic, or your primary care physician. Deciding which to use in an urgent medical situation can be complicated, especially when dealing with the complexities of geriatric care. A new provider model, touting better access to emergency care, has the potential to add even more confusion to your decision.
The Free-Standing Emergency Room
Be aware of a new class of medical facilities called freestanding emergency centers. Much like an urgent care or walk-in clinic, they are typically located in retail or neighborhood locations. The difference, however, is that they are actually full-service emergency rooms that are not physically attached to a hospital. They are open 24/7 and feature sophisticated, comprehensive medical equipment, similar to what is found in the emergency department of a hospital. Wait times are significantly shorter than at the ER, but the drawback is that these stand-alone facilities still charge ER prices. Regulations for these providers vary by state, but the best way to distinguish a standalone emergency room from an urgent care center is to look for the terms “emergency” and “ER” on signage, forms and paperwork. If you still are not sure, ask about their costs and billing practices.
Paying for a Free-Standing Emergency Room Visit
Freestanding emergency rooms (FERs) fall into two categories, hospital-based and independent. A hospital-based FER is located within 35 miles of its affiliated hospital and is held to the same Medicare Conditions of Participation and licensing standards as the main medical campus. Therefore, billing is submitted to private insurance companies, Medicaid, and Medicare part B under the same fee schedule as a traditional emergency room.
Independent, for-profit entities operating free-standing emergency rooms are not considered provider-based, therefore they are not required to meet the same federal regulations as a traditional hospital emergency department. The Centers for Medicare and Medicaid Services (CMS) does not recognize independently owned FERs as emergency departments, therefore they cannot bill Medicaid or Medicare. In many cases, patients must pay out of pocket for all or the majority of the services received at these facilities.
Where to Go for Medical Care
If your medical needs can be addressed by a primary care physician or an urgent care clinic, these providers will always be the less expensive source of treatment. If a senior is experiencing a true emergency, it may be in your best interest to head to the hospital emergency room rather than a freestanding ER facility. Although the wait time may be longer, the complex needs of older patients may be better served with access to the full capabilities of a hospital and its staff of nurses, specialists, and case managers.
Source: Centers for Medicare & Medicaid Services, https://www.cms.gov/