Freestanding Emergency Centers Could Help Ensure Access to Care in Rural Areas

Christina Mattina

Critical access hospitals in rural areas continue to be threatened by unsustainable operating costs, but a recent blog post on Health Affairs proposed an innovative solution to ensure access to care persists in these areas: freestanding emergency centers (FECs).

The problems faced by rural hospitals are severe, in part due to decreased reimbursement and low admission volumes, as 38% operate at a financial loss and many are at risk of closing. When these hospitals do shut their doors, their communities experience both economic effects from the loss of jobs and healthcare access obstacles arising from the scarcity of other care providers.

According to Jesse Pines, MD, and David Ernst, MD, FECs could fill the holes left by hospital closures in rural, underserved areas. Community residents would be able to access care at a full-service, around-the-clock emergency department without enduring a long and potentially dangerous journey to another care site, and administrators would be able to operate these centers at a more feasible cost.

“While rural communities may have insufficient demands for inpatient care to support a full hospital, FECs have a lower cost structure and higher patient volume,” the authors wrote.

FECs can be independently owned or operated as hospital outpatient departments under a larger health system. Pines and Ernst noted that this model has been successfully implemented by the Mid-Atlantic branch of Kaiser Permanente.

However, there are still some barriers preventing more widespread adoption of the FEC model. First, the centers are subject to certificate-of-need regulations in most states, which make it difficult to obtain permission for new construction. FECs also cannot be reimbursed by CMS because they are not operated under the license of a hospital, but some administrators have skirted this rule by building “micro-hospitals” with subsidiary FECs licensed underneath.

The authors concurred with the Medicare Payment Action Committee’s recommendation to Congress calling for CMS to support independent FECs through grants or stipends, and proposed that CMS develop a pilot that recognizes independent FECs in underserved areas. They also suggested that the funds designated for rural hospitals that have closed could be diverted to support new FECs to replace the hospitals.

Efforts to implement the FEC model on a national scale may not be easy, they acknowledged, but would certainly be worthwhile, especially for rural residents with few other options.

“While most recent health policy changes have been centered around improving access to coverage and reimbursement for high-quality care, the ever-growing crisis of poor access to care for rural populations has gone largely unaddressed,” the authors concluded. “We urge Congress and the new administration to prioritize rural health and address barriers to allowing the FEC model to become a viable solution in addressing the rural health care access crisis.”
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