Did Entry of Freestanding Emergency Departments in Texas Alleviate High Visit Volume in Hospital-Based Emergency Departments?

Background and Objective: Ever since the passage of the Texas Freestanding Emergency Medical Care Facility Licensing Act in 2009, freestanding emergency departments (EDs) have flourished in Texas. While freestanding EDs may provide timely emergency care for patients facing over-crowded hospital emergency rooms, the literature contains only limited case studies of the impact of freestanding EDs on access to emergency care. This study aims to measure the impact of entry of freestanding EDs on the volume of visits to nearby hospital-based emergency departments.

Methods: We use American Hospital Association hospital-based ED visit volume in 2010 and 2015 as the dependent variable of interest. Our main explanatory variables are the numbers of freestanding EDs and hospital EDs within certain distance bands, and a dummy variable for whether the hospital built its own satellite EDs in outlying areas. We estimated generalized linear models with Gamma-distributed dependent variables to investigate whether the entry of freestanding EDs helped relieve the burden of ED congestion in nearby hospitals and improve the efficiency of hospital ED services. The analyses control for multiple demographic characteristics and include hospital-level fixed effects.

Results: Preliminary results reveal that hospital ED visits are not significantly influenced by the entry of freestanding EDs nearby when taking all the competitors into consideration. The results remain the same with subset tests for hospital EDs in rural areas and urban areas. Setting up a hospital-affiliated freestanding ED slightly increases the overall number of ED visits, although the effect is imprecisely estimated. However, there are significant increases in hospital ED visits in the year 2015 compared to 2010. In conclusion, the entry of freestanding EDs doesn’t help reduce the visit volume in hospital EDs. We are conducting analyses of hospital ED wait times and drop-out rates to address the concerns for ED congestion. We will update this abstract before the conference to incorporate more findings.

Conclusion: Texas launched the licensing act for freestanding EDs in 2009, in an effort to relieve hospital emergency congestion and help patients access care in emergency service shortage areas. Our previous study showed that most of the freestanding EDs located in areas with high income and their presences did not reduce average waiting times in hospital EDs. We also noticed many hospitals built hospital-affiliated freestanding EDs to attract more patients, suggesting there are some financial incentives in these markets. We are concerned that the existing policy, instead of relieving the hospital burden, stimulates the demand for emergency services and increases healthcare spending in Texas. We will add data for the years between 2010 and 2015 and refine our measures of freestanding ED entry. We may modify this conclusion after we complete our full analysis.