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.

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(5) comments

Michael Nguyen

I empathize with everyone who have had a bad experience at a Free Standing ER or hospital based ER. Patients encounter many negative experiences when cared for in an ER and I have dealt with all of them from Long waits, rushed staff/doctors, loud environments, crowded ERs, poor communication, and most of all billing issues that are never addressed.

We opened in Bryan because we believe this is a great opportunity to give patients a good ER experience in their most stressful times. Along with a quick and comforting ER experience, we have created an environment where your needs are met from Board Certified physicians and staff with extensive ER experience. We also are 100% physician owned and staffed only by physician owners with multiple Aggie physician owners.

We do not stop caring for you after you are discharged. We believe follow up care and any billing concerns have to be addressed. We took the painstaking steps of bringing all of our billings in house rather than hire a third party billing company.

This allows us to send patients ONLY one bill in a timely manner rather than multiple bills that you get from other ERs that can come after many months. Many times, this helps us to bill less that what you will find at other ERs. Also, this allows us to address any billing concerns that patients have quickly and we strive to make 100% of all billing complaints resolved to the patient's satisfaction.

We opened our site in Bryan to improve healthcare and accessibility to patients in the area. We do have to bill at standard ER rates as we are opened and staffed 24 hours a day/every day with full lab/medicine capability, CT scan, Xray, and Ultrasound. We have essentially everything you will find visiting a hospital based ER.

I am confident that anyone who visits our ER will continue to come back. I would be happy to give anyone a tour or answer any questions. Please call our ER at 979-775-0911 or email me at mnguyen@mdpremier.com and I would like to give you a personal tour.

Colton Candler

"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."

The article doesn't discuss Balance Billing. Balance billing is when the Free-Standing ER clinic bills the patient for the amount the insurance didn't pay. Balance billing has been outlawed in several states, but it should be outlawed in every state.

Recently I had an emergency and went to a Free-Standing Emergency center. I went there vs the hospital ER because the website for the Free-Standing ER center says "We accept all major insurance carriers, including Blue Cross/Blue Shield." Being in an emergency state of mind and having BCBS insurance, I read that statement as they must be in-network or at a minimum have some type of an agreement with BCBS. My interpretation was wrong and they have no agreement with BCBS. The Free-Standing ER billed BCBS a total of $3,000. BCBS is required to pay them the customary and usual in-network rate for the services performed, which was $1,000. Then I received a bill for $2,000, the remaining balance the insurance didn’t pay. These Free-Standing ER centers intentionally avoid being in-network because if they are out of network they can bill up to 10 times more. The website should disclose that while they accept the insurance, they are NOT IN-NETWORK.

Balance billing is wrong and the Free-Standing ER clinics should be required to disclose if the insurance carrier is in-network or not. The Free-Standing ER clinics argue that the usual and customary in-network rates don’t cover their operating costs and they have to charge up to 10 times the amount of the customary rates to keep the lights on. That argument just sounds like it’s a bad business model. Until they outlaw balance billing or become in-network with insurance carriers, avoid these ER clinics at all cost.

bcsguy

Buyer beware! My wife and I learned the hard way you certainly pay for the "convenience" of these facilities. Two years ago our little girl had a minor injury at home. It was after hours and we couldn't go to her normal doctor. One of the CS providers of this kind of care, referenced in this article, is constantly advertising so it came to mind easily as a quick alternative. My wife had to pay a $500 copay as soon as they entered. The physician saw our daughter for approximately five minutes. Not a shot or xray was administered. We were advised the remainder (after paying $500 already) would be billed to our health insurance. Within a week we received bills totaling close to another $2500. When I inquired they advised half was a facility fee and half for the physisican. We hadn't met our major medical deductible for the year it seemed. Major medical? As a previous commenter mentioned, I wish this article had been more in depth of the outcome even for those with health insurance. Everyone wonders why insurers are losing money hand over fist and having to increase rates. Here's one reason right here. It should be mandated a large warning should be in bright letters at the entrance to these facilities stating that by entering you could be subject to a $3000 bill. Be certain when I had an infection last year and couldn't get in to see my doctor at a convenient time, I went to an urgent care location run by a local hospital located right down the road. I even called ahead to confirm they were definitely not an ER. We've heard similar stories from other families in town. The state should really reconsider parts of the 2009 law in my opinion.

Brazos County Citizen

Informative article. I've wondered about the cost of these new, free-standing ERs compared to urgent care clinics and traditional hospital ERs. Now I know.

Gary Drost

Many retired military, like myself, only have Medicare and Tricare, which cover nearly all medical expenses, including ER costs. The free-standing ER's do not take either, so we would have to pay 100% of the cost of care at one of those ER's. A good friend on mine (retired Army) was suffering a heart attack and went to the nearest ER, CapRock at Tower Point. At the time, he was unaware that they dldn't accept Medicare or Tricare, so he had to pay 100% of the bill. He told me that had he known that he would have to pay the full amount, he would have gone one more mile down the road to the ER at either The Med or S&W. Would the extra 1-2 minutes to go down the road have made a difference to my friend's life? I don't know, and that was his decision. This article should be a warning to all who only have Medicare and Tricare to know your options and make informed choices when in need of emergency care.

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