By Kristyn Eldridge

Saving time is the magic ingredient of freestanding medical facilities. Several decades ago, demand for after-hours doctor visits gave rise to urgent care clinics, just as the soaring demand for hospital emergency service is now stimulating the growth of freestanding ERs to cut wait times. However, the "emergency" status of freestanding medical facilities outside of hospitals has remained cloudy. Various states have struggled with classifying and regulating freestanding emergency rooms.

Last year, the Texas Legislature established new requirements for freestanding emergency rooms. Under the new regulations, freestanding emergency rooms must now provide the following:

• Laboratory testing necessary for emergency situations
• Radiology services such as X-ray, CT scans and ultrasound
• Staffing by physicians and nurses trained in emergency medicine
• Provide for patient transfers between the freestanding ERs and other medical facilities

Starting September 1, 2012, Texas will require all freestanding emergency rooms to be open 24 hours a day, 7 days a week. After this date, only licensed emergency centers may use emergency terminology to advertise themselves.

Receptivity of New Regulations

Physicians throughout the state welcomed the passage of the new regulations (Title 25 Chap 13), especially those operating freestanding emergency rooms. "We supported the law," says Rick Covert, Chief Executive Officer of Dallas-based First Choice Emergency Room. "It's important that the public know they can come to us for an emergency just as they would go to a hospital."

Covert says the new regulations are a welcome affirmation of the way his ERs have always operated. "Our emergency physicians are board-certified and come from hospital emergency room backgrounds. They know how an ER should run," he says adding, "Our mission has always been to provide first rate emergency care without wait times."

Free Standing ERs – Governed by State Law

The difference between urgent care and emergency care is unclear in the public's mind. Some states have tried to clarify this differentiation. Illinois now forbids the use of the word "urgent" by any medical facility that is not an emergency center. And Delaware prohibits the term "urgent care" except for use by emergency centers.

Texas has not gone this far; confining itself simply to the standards freestanding emergency rooms must meet. Most freestanding ERs in the U.S have been created by hospitals, but Texas has been a leader in those created by physicians themselves. The American Hospital Association identified 191 hospital-owned and 31 physician-owned freestanding ERs existing in 2008, in 17 states.

Freestanding emergency rooms have been largely unregulated for years, but they have long pressed for regulation as a means to recognition. Many, like First Choice ERs 12 locations in the Dallas, Houston and Austin areas, long ago obtained accreditation by the Joint Commission, an independent medical certification body.

In 2004, Medicare and Medicaid recognized freestanding ERs for the first time, and in recent years Blue Cross Blue Shield led the country and other insurers by issuing requirements in Texas that would allow for payment.

ith iTriage, you can easily find ERs, freestanding ERs and urgent care centers located near you. Look for freestanding ERs in the emergency room section of iTriage. Search iTriage now.