Bryan's first free-standing emergency room recently opened for business, marking the fourth such facility to become licensed in Brazos County since December 2014.
Dr. Michael Nguyen, executive director of the new Physicians Premier Emergency Room, located at 2411 Boonville Road, said opening a free-standing ER in Bryan made sense because "this place is growing" and suggested the new location could alleviate some of the crowding at hospital-based ERs.
Free-standing ERs are physically separate from -- and not affiliated with -- hospitals. Such health care facilities have been proliferating across Texas since state legislators passed a law in 2009 allowing the establishment of emergency rooms independent of hospitals. College Station has three such businesses -- CapRock ER and the Signature Care and Neighbors emergency centers. Bryan's second facility -- another CapRock -- is under construction off Briarcrest Drive.
The new Physicians Premier has 11 beds -- two trauma bays, six exam rooms and others to observe patients -- X-ray and CAT scan machines onsite, as well as a lab and a pharmacy.
"We're giving patients the same quality of care, in my mind," Nguyen said of the Physicians Premier relative to hospital-based ERs. "We essentially can do anything a hospital ER can do, other than an MRI."
Jack Buckley, Jr. an executive in residence at Texas A&M University's School of Public Health, said free-standing ERs give choice to those seeking speedier options when deciding on emergency heath care.
"They don't want to have to wait. They want to drive in and drive out real quickly," Buckley said.
Free-standing ERs may look similar to urgent care centers, but they bill at much higher rates than facilities that aren't open around the clock.
"We're open 24 hours a day and staffed 24 hours a day. We incur a cost that urgent cares don't have," Nguyen said, adding that "there's a lot of profit to be involved in these free-standing ERs" because "you can bill at a better rate than urgent cares."
Free-standing ERs bill at emergency room, not urgent care, rates, resulting in a much more expensive bill than if a patient were to go to an urgent care center.
Dr. Robert Morrow, president of the Houston and Southeast Texas office of Blue Cross Blue Shield of Texas, said free-standing ERs "significantly increase the cost of care."
Morrow said most free-standing ERs are considered out-of-network, putting a financial burden on patients who likely would not face as large a bill if they were to go to an urgent care facility.
"It's important for people to understand not only the clinical, but also the financial implications of where they go for care," Morrow said, adding that 70 percent of out-of-network claims came from free-standing ERs.
Dr. Andy Wilson, managing partner of CapRock ER, challenged the idea that network status mattered in emergency situations.
"We accept whatever the insurance decides to pay us," Wilson said, adding that he has not heard of a single instance in which a free-standing ER has charged a patient for the difference between cost of care and what their insurance was willing to pay.
Wilson said state and federal law dictates that insurance providers must provide full in-network benefits for emergency care services.
Morrow said free-standing facilities can look similar to urgent care centers, potentially leading some customers to not understand they're seeking treatment from an ER. And keeping urgent care facilities open all night isn't likely to happen.
"No one will ever open a 24-hour urgent care, because there's not enough money in it," said Dr. Nich Beer, an emergency physician at Baylor Scott and White in College Station, one of three Brazos County hospitals with major emergency rooms. The others are CHI St. Joseph, which has an ER at its main location in Bryan and another next to its urgent care facility in College Station's medical district, and the College Station Medical Center off Rock Prairie Road. The Med and Baylor Scott & White both can handle critically injured and ill patients, but St. Joe's has the highest-level trauma center in the region, a designation given by the state that requires a certification process.
Beer called free-standing ERs "luxury emergency medicine," given that their locations are in more affluent areas where patients are more likely to have insurance. Free-standing ERs are not allowed to take government-funded insurance like Medicare, Medicaid or Tricare, since they're not affiliated with a hospital network.
Murray Cote, an associate professor at A&M's School of Public Health, said free-standing facilities "tend to be associated with fairly densely populated, fairly high income levels," since there's a "built-in demand" there that allows them to make more money. As a result, he said, they're not located in areas that need more health care options, like rural environments.
Beer said free-standing ERs' ability to recommend uninsured patients either go to an urgent care or a hospital-based ER hurts the big facilities in the end. Beer said hospital-based ERs lose the "guaranteed income" from patients with private insurance seeking emergency medicine, since they can go to one of the free-standing ERs, which often offer lesser wait times than their hospital counterparts.
Buckley said that he believes that as of now, free-standing ERs are "probably helping hospitals a little bit" because they relieve some of their workloads, but they also could be hurting hospitals since they're "taking that paying group of patients away" who subsidize patients with government-funded health insurance or who couldn't afford to pay their bills in full.
Beer said that free-standing ERs can offer a service -- and that certain free-standing facilities bother him more than others -- but that they are a "free-market solution to a non-free-market problem," since patients do not have a choice in when they get sick and because it's unrealistic to expect them to be informed consumers due to the knowledge gap between health care providers and those seeking medical care. Patients in need of emergency medical attention don't have the ability to compare prices and choose the best option for their services, since their problems are by, definition, in need of immediate recourse.
Nguyen said he will screen potential patients at Physicians Premier before treating them. If they are suffering from an affliction that doesn't require immediate medical attention, Nguyen said he'll recommend they go to an urgent care center during normal business hours, to spare them the emergency room pricing.
And any patients who have government-funded insurance will have to either go to a hospital or ER, or pay out-of-pocket for medical care, since Physicians Premier, which is owned by doctors, isn't approved to be reimbursed for Medicare, Medicaid and Tricare plans.
"We're not here to take advantage of patients," said Nguyen, a 1998 graduate of Texas A&M's College of Medicine. He says "we're here" for those who do want to be treated after urgent cares are closed for the night.
"Many emergencies are not conveniently during 8-5 hours," he said.