Freestanding Emergency Departments Preferentially Locate In Areas With Higher Household Income

Abstract

Freestanding emergency departments (EDs) are a relatively novel phenomenon, and the epicenter of this movement is in Texas. Limited evidence exists about the communities in which freestanding EDs locate or the possible reasons behind location choice. We estimated logistic regressions to determine whether freestanding EDs in 2016 were more likely to be in areas of high demand or in those that could yield high profits. When we compared Public Use Microdata Areas that contained freestanding EDs and those that did not, we found that areas with such EDs had significantly higher household incomes. This finding was driven by the location choices of independent freestanding emergency centers and not by those of hospital-affiliated satellite emergency centers.

Freestanding Emergency Department Entry and Market‐level Spending on Emergency Care

“…Of the four states we examined, Texas is the only state that allows independent FrEDs. Previous studies have noted potentially different incentives between independent and satellite FrEDs . Hospitals may open satellite FrEDs in the hopes of attracting more inpatient admissions, but in the three states with only satellite FrEDs, we observe different relationships between entry and out‐of‐pocket spending.…”

“…Our approach for identifying FrEDs in Texas was described previously . We relied on licensing data from the Texas Department of State Health Services, as well as Internet searches, e‐mails, and phone calls.…”

“…Developed by the Census Bureau, PUMAs are geographic units constructed by combining census tracts (or counties in sparsely populated areas) with geographical contiguity. Each PUMA must contain over 100,000 residents, and the majority of PUMAs contain 100,000 to 200,000 residents . For example, Texas has 212 PUMAs.…”

“…FrEDs may have entered in areas where such facilities existed, which would legitimately increase ED utilization. However, other studies suggest that FrEDs enter in high‐income, well‐insured neighborhoods, which are the same factors that attract both primary care physicians and urgent care clinics …”

Maybe It’s Time to Rethink Freestanding Emergency Departments

“…Freestanding EDs also have higher staffing costs with board‐certified emergency physicians, compared to urgent care centers, which are often staffed by nonboarded doctors or advanced practice providers. Data also show that freestanding EDs tend to preferentially locate in more affluent, richly populated areas and not in higher need, poorer communities , . However, this practice is similar to urgent care centers, which also locate in similar, wealthy areas …”