The vast majority of free-standing emergency department (FSED) visits are for non-emergency care, and treating those common conditions cost an average of $3,217 — 22 times more than at a physician office ($146) and 19 times ($167) more than at an urgent care center, UnitedHealth Group reported in a new study of Texas facilities.
UnitedHealth, the largest U.S. private payer, said shifting regular care from FSEDs to physicians offices and urgent care centers in Texas would cut health costs by 95%. That would mean a savings of more than $3,000 per visit.
There were at least 566 FSEDs in the country in 2016, which was a 42% increase from the previous year and a 155% increase from 2008. Texas alone has 266 FSEDs that account for more than a quarter of ED visits in Texas.
Free-standing ERs have sprung up in certain areas in the U.S., namely Texas. While there are 266 FSEDs in that state, the rest of the country only has 300 such facilities. UnitedHealth said the growth of FSEDs comes from a combination of consumer demand and high profit potential.
However, the report argues that these facilities aren't filling an urgent care need. The most common diagnoses in Texas FSEDs are for fever, acute bronchitis and a sore throat. All of those ailments can been treated in a lower-cost physician's office settings.
UnitedHealth echoed earlier criticisms of FSEDs — namely, they serve affluent communities that already have access to providers. The payer added that FSEDs often don't offer services for critical conditions, such as trauma or stroke. They usually don't have an operating room on site or receive ambulances.
In other words, FSEDs aren't helping poor areas, contributing to an area's emergency care or provider shortage. That finding echoes a 2017 Health Affairs report that said Texas FSEDs open in wealthier locations that have high rates of insured people. That report suggested policymakers should scrutinize where FSEDs pop up "to prevent the exacerbation of disparities involving the medically underserved."
UnitedHealth stands to gain business from its proposal to shift care to lower-cost facilities. The payer acquired MedExpress, an urgent care provider in 2015. MedExpress has more than 250 locations across the country and continues to expand.