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Patients Find Convenience Is Costly At Freestanding Emergency Rooms

Laura Macia speaks with her son in front of the area where he fell off a hoverboard and broke his leg months earlier.
Julio Ochoa
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

Freestanding emergency rooms are popping up all around the Tampa Bay area -- nine have opened in the past three years alone.

Health care companies are using them to reach more consumers, appealing to patients with promises of easy access to hospital-level care. But patients and insurers are finding the convenience comes at a cost.

When Laura Macia's 12-year-old son crashed a hoverboard and broke his leg on New Year's Day, she and her husband scooped him up and headed for the closest hospital.

Being new to Tampa, they didn't know the area. So when they saw a sign for an emergency room, they pulled in. 

“We were like 'Oh, this must be it,'” Macia said. “We just like turned left and went in and it was like this small ER place. It was not a hospital.”

They had stumbled upon ER 24/7 in Temple Terrace, a freestanding emergency department run by HCA, a hospital corporation. The freestanding ER is one of more than a dozen facilities that have opened in the Tampa Bay area since 2008.

The facilities treat serious illness or injuries but many are not equipped to handle life-threatening conditions or accept ambulances. They advertise wait times that are shorter than hospital-based emergency rooms

But that wasn't what the Macia family found New Year's Day. After an initial consultation and some x-rays, they were left alone in an exam room. 

ER 24/7 in Temple Terrace is one of more than a dozen freestanding emergency rooms that have opened in the Tampa Bay area since 2008.
Credit Julio Ochoa / WUSF Public Media
The Florida Channel
ER 24/7 in Temple Terrace is one of more than a dozen freestanding emergency rooms that have opened in the Tampa Bay area since 2008.

“We waited there for about three hours,” Macia said. “He did have pain medication but the pain was still very, very high.”

Eventually, they put their son in a wheelchair and left.

They drove about 10 miles to St. Joseph's Children's hospital in Tampa where her son got x-rays, a diagnosis and a temporary cast in about 90 minutes.

Laura Macia said she expected a bill from the freestanding emergency department. But she was shocked at the price, compared to the hospital ER where her son actually received treatment.

Charges from the facility and the doctor totaled $4,000 -- compared to just over $2,000 at the hospital.  

“It was absurd, it was ridiculous, it made no sense,” she said. “I had two bills for services the same day, the same leg, the same kid. I'm like what's going on here?”

Macia requested itemized bills from both providers. She built a spreadsheet for a side-by-side comparison, complete with billing codes, which were identical for most services.

While there were big differences in how much doctors charged, the biggest expense on her son's bill at both facilities was for a line item called 'emergency services.'

At the hospital the bill for emergency services was $1,100. At ER 24/7 in Temple Terrace, it was more than $2,600.

“They can charge however much they want,” Macia said. “They can charge double for not providing the service. And they are getting paid.”

In response to questions, HCA officials released a statement that said the amount patients pay is based on their insurance. Since Macia had a high deductible plan, she was responsible for the entire bill.

“I was furious,” Macia said. “I'm like, I'm going to be paying for a service we did not receive. It was a terrible experience from start to finish.”

Patients are not the only ones alarmed by the costs. Health insurers like UnitedHealth Group also are noticing claims at these freestanding emergency rooms surge across the country. Thats' why the insurer decided to research the issue in Texas.

It found the average charge for treating common conditions at freestanding emergency departments was 22 times higher than the same treatment at a physician's office and 19 times more than an urgent care center, according to Lambert van der Walde, a senior vice president at UnitedHealth Group.

“When we looked at shifting the site of care in Texas from Freestanding EDs to physician offices and urgent care centers it would result in a savings of over $3,000 per visit,” van der Walde said.

About 20 states have laws that regulate freestanding emergency rooms. California prohibits them altogether. Florida allows companies to open the facilities as long as they are associated with a hospital that has an emergency department.

In the past few years, companies have been opening more and more of them. In 2015, Florida had 24 freestanding emergency rooms. Today, there are 61. 

UnitedHealth Group's study also found that most of the freestanding ERs are being built in affluent areas where people can easily access other providers, Van der Walde said.

“I think sometimes Freestanding EDs are intended to compete with a local hospital,” he said.

That seems like the case in the Tampa Bay area, where some freestanding emergency rooms are opening within a few miles of competing hospitals.

Some freestanding emergency rooms are opening within a few miles of hospitals.
Credit Julio Ochoa / WUSF Public Media
The Florida Channel
Some freestanding emergency rooms are opening within a few miles of hospitals.

For Example ER 24/7 in Riverview opened in May just 2.5 miles north of St. Joseph’s Hospital – South. 

And in North Pinellas County, two freestanding ERs appear to be going head to head against each other. In 2016, HCA opened ER 24/7 in Palm Harbor. About a month after that, AdventHealth - another hospital chain - opened a freestanding emergency room about a mile away on the same road. 

From the street, both facilities might be confused for urgent care centers, which focus on treating minor illnesses. The most noticeable difference is the big red “emergency” signs on the outside of free-standing ERs.

Still, some people seem to confuse the two types of facilities, van der Walde said. 

UnitedHealth's study found that most people who use freestanding emergency departments are there for conditions that can be treated for much cheaper elsewhere, such as a walk-in clinic. 

“We determined that the five most frequent diagnosis were fever, bronchitis, sore throat, upper respiratory infection and cough,” van der Walde said.

Tampa resident Ron Varghese learned how much the facilities charge after he brought his daughter, who was having trouble breathing, to Citrus Park ER, another HCA-owned freestanding emergency department.

Varghese said he looked for an urgent care center first but because his daughter got sick at night, when there were fewer options.

His daughter's condition had improved by the time they arrived but a doctor recommended an electrocardiogram just to be safe. The test showed she was fine.

Varghese didn't think much of it when he got a bill for $2,000 from Citrus Park ER. He has a high deductible health insurance plan, so he was responsible for the entire bill.

“I paid it off pretty much immediately using my (Health Savings Account) card,” he said.

Then he got a second bill -- this one, from the doctor who treated his daughter -- for $1,200.

He didn't realize these convenient facilities would have multiple charges for one visit.

Varghese's bill would have been the same if he had gone to one of its hospital-based emergency rooms, HCA said. The company released a statement in response to questions and again pointed out that high-deductible plans leave patients with most of the cost burden.

But Varghese is left wondering how much more he would have paid had his daughter's condition been more serious.

“If this happens for a small thing as a breathing issue and an ECG what would it be if I had a broken leg?” he said.

Laura Macia and her son know the answer to that question.

She and Varghese both agree that they will never set foot in another freestanding emergency room. But with the rate at which these facilities are being built in Florida, they may have trouble avoiding them.

Copyright 2019 WUSF Public Media - WUSF 89.7

Julio Ochoa is editor of Health News Florida.
Julio Ochoa
Julio Ochoa is editor of Health News Florida.