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</o:shapelayout></xml><![endif]--></head><body lang=EN-US link="#0563C1" vlink="#954F72"><div class=WordSection1><p class=MsoNormal><span style='font-size:9.0pt;font-family:"Arial",sans-serif'> <img width=623 height=151 style='width:6.4895in;height:1.5729in' id="_x0000_i1048" src="cid:image002.jpg@01D2D247.7E3CCAF0" alt="Description: Description: Description: Description: CAL/AAEM: California Chapter of the American Academy of Emergency Medicine"><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:9.0pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><div style='margin-left:15.0pt;margin-top:7.5pt;margin-right:15.0pt;margin-bottom:7.5pt' id=content><div style='border-top:solid #7F7F7F 1.0pt;border-left:none;border-bottom:solid #7F7F7F 1.0pt;border-right:none;padding:4.0pt 0in 4.0pt 0in'><p class=MsoNormal><b><span style='font-size:11.0pt;font-family:"Arial",sans-serif;color:#7F7F7F;mso-style-textfill-fill-color:#7F7F7F;mso-style-textfill-fill-alpha:100.0%'>February 7, 2018</span></b><b><span style='font-size:11.0pt;font-family:"Arial",sans-serif;color:#7F7F7F'><o:p></o:p></span></b></p></div><div style='margin-top:11.25pt;margin-bottom:11.25pt'><p class=MsoNormal><b><span style='font-size:12.5pt;font-family:"Arial",sans-serif;color:#DF0009'><o:p> </o:p></span></b></p><p class=MsoNormal><b><span style='font-size:12.5pt;font-family:"Arial",sans-serif;color:red'>Standalone ERs may have grown too fast in Texas, but other states continue to embrace them</span></b><b><span style='font-size:12.5pt;font-family:"Arial",sans-serif;color:#DF0009'> <o:p></o:p></span></b></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif;color:#0070C0'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif;color:#0070C0'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif;color:#0000CC'><a href="https://www.fiercehealthcare.com/healthcare/stand-alone-ers-may-have-grown-too-fast-texas-but-other-states-continue-to-embrace-them?mkt_tok=eyJpIjoiWVRWaU1Ea3pNamt4WkRNMCIsInQiOiJCVXV5VXVaNXI1cTJaamg2Y21EY3VEMUFBZ3plY2FQYkQydm9WWWRaNXlobWV3a0VxcWQ2MEpyZVwvZTVvSDdscjh0c0pkc0NCbjV0OUYzODI1UEJjVjBTSmx5bW1zTFE2RUo3WlR6ZnQzcjVrazVTYzFaTnpxdURtS0pZa3JcL05RIn0%3D&mrkid=905528"><span style='color:#0000CC'>Fierce Healthcare</span><span style='font-family:"Times New Roman",serif;color:#0000CC'><o:p></o:p></span></a></span></p><p class=MsoNormal style='margin-right:15.7pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:15.7pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>By Ilene MacDonald<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p></div><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Free-standing emergency rooms began to pop up in Texas eight years ago, but now economists say the business model grew too fast and may not always be the lower-cost option for patients.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>These standalone facilities are licensed by the state to provide 24-hour emergency services to patients and exploded in The Lone Star State after the passage of a law in 2009 that allowed the establishment of ERs independent of hospitals. Texas had only a handful of free-standing ERs in 2000. Now there are more than 200 across the state.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>And they have been a windfall for the state, which has earned $3.1 million in revenue just by issuing two-year licenses, according to the Dallas Morning News. But the cost of care, while still lower than a traditional hospital emergency room, has also increased, the publication reports. The mean cost of a visit at a free-standing ER was $2,199 in 2015, the article notes, compared to $2,259 at a hospital ER.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Research also finds that the facilities tend to open in more affluent, populated areas, and not where they may help the most, in rural communities.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Another problem: State licensing laws vary. For example, a rural community in Missouri wanted to explore the model, but then learned the state currently doesn’t allow free-standing facilities, St Louis Public Radio reports. Further complicating the issue, it’s against federal law for independent free-standing emergency centers, not affiliated with a hospital, to accept Medicaid or Medicare. That means patients must pay out of pocket or find another facility affiliated with a hospital.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>This became an issue in Aransas County, Texas, last year when the only hospital in the area had to shut down due to damage from Hurricane Harvey, KRISTV reports. Code 3 Emergency Room in Rockport was inundated with patients for a month after the storm. And in some cases, physicians weren't paid for the care they provided. If a patient’s life is at risk, even if the patient is on Medicare or Medicaid, Texas law requires Code 3 ER physicians to provide care, according to the media outlet. <o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>"We take care of them, we stabilize them, we call a helicopter. They get paid for it, but we don't, for doing all the care up to it including calling the helicopter," Justin Hensley, M.D., medical director of Code 3 Emergency Room, told the publication, adding that physicians are working with members of Congress to try to get disaster funds to treat patients with Medicaid and Medicare.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Hospital systems in other parts of the country, however, are committed to opening new free-standing facilities. For example, Florida Hospital plans to open two standalone ERs, each with 24 beds, in Orlando and Oviedo this year, Orlando Business Journal reports. And in Arizona, a new $8.5 million facility will open next week to provide care to Marana-area residents, the second such facility to pen in the Tuscon area, according to Tucson.com. Both facilities are owned and operated by Northwest Healthcare, which is part of Community Health Systems, so don’t have the same concerns as independent standalone ERs.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>“They are controversial in some of the other communities because those free-standing EDs are independent. They are not affiliated with a healthcare system, they don’t have contracts with insurance companies and so patients go there and the get gouged for these big bills,” Kevin Stockton, regional president and market CEO of Northwest Healthcare, told Tuscon. com.“We’re still in network. Patients coming to our ED, whether they are in a hospital or a free-standing one, it’s the same financial implications.”<o:p></o:p></span></p><p class=MsoNormal style='margin-right:15.75pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:15.75pt'><span style='font-size:11.0pt;font-family:"Calibri",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:15.75pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><strong><span style='font-family:"Arial",sans-serif'>Jeff Wells</span></strong><span style='font-family:"Arial",sans-serif'><br>Deputy Editor, CAL/AAEM News Service<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-bottom:12.0pt'><strong><span style='font-family:"Arial",sans-serif'>Brian Potts</span></strong><b><span style='font-family:"Arial",sans-serif'> MD, MBA</span></b><span style='font-family:"Arial",sans-serif'><br>Managing Editor, CAL/AAEM News Service</span><o:p></o:p></p></div><p class=MsoNormal style='margin-bottom:12.0pt;background:#D9D9D9'><span style='font-size:7.5pt;font-family:"Verdana",sans-serif'>Contact us at: <span style='color:#0000CC'><a href="mailto:calaaem.news.service1@gmail.com"><span style='color:#0000CC'>calaaem.news.service1@gmail.com</span></a></span><br><br>For more articles, visit our <span style='color:blue'><a href="http://www.calaaem.org/news_archives.php"><span style='color:blue'>archives</span></a></span>. <br><br></span><span style='font-size:9.0pt;font-family:"Arial",sans-serif'><a href="mailto:somcaaem@uci.edu"><span style='font-size:7.5pt;font-family:"Verdana",sans-serif;color:black;text-decoration:none'>To</span></a></span><span style='font-size:7.5pt;font-family:"Verdana",sans-serif;color:#0070C0'><a href="https://maillists.uci.edu/mailman/listinfo/calaaem"><span style='color:#0070C0;text-decoration:none'> </span><span style='color:blue'>unsubscribe</span></a></span><span style='font-size:7.5pt;font-family:"Verdana",sans-serif'> from this list, visit our mail server.<br><br>Copyright (C) 2015. The California Chapter of the American Academy of Emergency Medicine (CAL/AAEM).</span> <span style='font-size:7.5pt;font-family:"Verdana",sans-serif;color:#0000CC'><a href="http://www.calaaem.org"><span style='color:#0000CC'>http://www.calaaem.org</span></a></span><span style='font-size:7.5pt;font-family:"Verdana",sans-serif'>. All rights reserved.<br><br>CAL/AAEM, a nonprofit professional organization for emergency physicians, operates the CAL/AAEM News Service solely as an educational resource for physicians. Dissemination of an article by CAL/AAEM News Service does not imply endorsement, agreement, or recommendation by CAL/AAEM News Service, CAL/AAEM, or AAEM.<o:p></o:p></span></p><p class=MsoNormal style='background:#D9D9D9'><b><span style='font-size:7.5pt;font-family:"Verdana",sans-serif'>Follow CAL/AAEM on Facebook and Twitter:<o:p></o:p></span></b></p><p class=MsoNormal style='background:#D9D9D9'><span style='font-size:7.5pt;font-family:"Verdana",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='background:#D9D9D9'><a href="http://www.facebook.com/pages/CalAAEM/172577489479442?sk=wall&filter=12" target="_blank"><span style='color:black;text-decoration:none'><img border=0 width=28 height=28 style='width:.2916in;height:.2916in' id="_x0000_i1049" src="cid:image004.jpg@01D2D247.7E3CCAF0"></span></a> <a href="https://twitter.com/#!/CALAAEM"><span style='color:windowtext;text-decoration:none'><img border=0 width=30 height=30 style='width:.3125in;height:.3125in' id="_x0000_i1050" src="cid:image006.jpg@01D2D247.7E3CCAF0"></span></a> <a href="http://escholarship.org/uc/uciem_westjem"><span style='color:windowtext;text-decoration:none'><img border=0 width=112 height=30 style='width:1.1666in;height:.3125in' id="_x0000_i1051" src="cid:image008.jpg@01D2D247.7E3CCAF0"></span></a><o:p></o:p></p><p class=MsoNormal style='background:#D9D9D9'><span style='color:black'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri",sans-serif'><o:p> </o:p></span></p><table class=MsoNormalTable border=1 cellpadding=0 style='border:none;border-top:solid #D3D4DE 1.0pt'><tr><td width=55 style='width:41.25pt;border:none;padding:9.75pt .75pt .75pt .75pt'><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri",sans-serif'><o:p> </o:p></span></p></td><td width=470 style='width:352.5pt;border:none;padding:9.0pt .75pt .75pt .75pt'><p class=MsoNormal style='line-height:13.5pt'><span style='font-size:10.0pt;font-family:"Arial",sans-serif;color:#41424E'><o:p> </o:p></span></p></td></tr></table><div id=DAB4FAD8-2DD7-40BB-A1B8-4E2AA1F9FDF2><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri",sans-serif'><o:p> </o:p></span></p></div></div></body></html>