ER Doc: “Let us help!”

Throughout the last month, we have seen the state of Texas mobilize to fight a pandemic. Closed and yet-to-be licensed medical facilities have been given the green light to get up and running. Ambulances are cleared to deliver patients to urgent care facilities. Dorms and sporting arenas can convert to become make-shift departments of a hospital. Nearly 9,000 ventilators have been counted as standing ready to help COVID-19 patients throughout the state. Texas is even moving toward reactivating retired doctors, importing out-of-state physicians, and putting nurses who have not completed their training to work. Almost everything possible is being considered in preparation for the coming wave of illness.

So why are more than 200 licensed Freestanding Emergency Centers, or FECs — staffed with thousands of emergency medicine doctors and nurses, equipped with ventilators, labs and pharmacies — not part of the current plan? Why not use our thousands of doctors and nurses who are actually qualified, present and willing to serve?

After years of hospital closures throughout the state, our facilities are among the only medical institutions left standing in some communities, but we are not yet being considered as part of the state’s pandemic response.

In fact, in recent days, we have seen even more facilities throughout the state close their doors. Several major health systems have recently shuttered emergency care facilities in order to consolidate personnel and equipment back into hospitals, an understandable decision.

Now we are hearing about many urgent care centers and primary care offices laying off employees and considering closures. However, that leaves communities across Texas with even fewer healthcare options at a time when we should be prepared to offer them more. FECs are ready and able to help bridge the gap, as soon as the state clears the way for them to do so.

Also, despite repeated appeals, FECs are still not allowed to serve elderly and vulnerable Texans dependent on Medicare and Medicaid. Those patients may have to drive long distances to receive emergency care or treatment during this public health emergency, a state of affairs that literally endangers their health for no reason other than the preservation of the bureaucratic status quo.

During this time when Texas is enlisting every appropriate medical resource, here are three ways the state can take advantage of existing staff, patient beds and ventilators, particularly in rural and underserved communities, as well as expand access to care for vulnerable Texans.

• Texas should work immediately with its federal partners to expand Centers for Medicare & Medicaid regulations to allow FECs to serve elderly and vulnerable Texans. FECs are currently not eligible for Medicare and Medicaid reimbursement because regulations have simply not caught up with our relatively new form of healthcare delivery.
• Second, allowing FECs to provide outpatient services — a lower level of care — would give Texans access to urgent care at a reduced rate and keep patients out of hospitals when they do not need to be there. This would be of enormous value in areas where FECs are the only medical resource available to patients. The state must clear the way for FECs to perform infection assessments, pharmacy services, lab work, radiology and imaging.
• Third, since hospital beds are at a premium, allow FECs to stabilize and continue to care for patients beyond the current 23-hour limit, keeping patients in safe and stable environments and alleviating hospital overcrowding.

Now is the time for our leaders to be patient-focused. Susceptible seniors, Medicaid patients and veterans should have the same access to care as privately insured patients, allowing large hospital emergency rooms and hospitals to continue delivering quality care while minimizing the spread of infection and mitigating the risk of overcrowding. Denying coverage and limiting use of safe, existing, licensed healthcare options during this time is bad public policy.

FECs are an essential part of the Texas public health infrastructure and are equipped and staffed to handle medical emergencies — like treatment for COVID-19, a heart attack, a stroke or a broken bone. We also want to be there for patients with less urgent needs. We are calling on the state of Texas to get our more than 200 facilities, 1,500 patient beds, hundreds of ventilators and thousands of courageous, committed healthcare professionals off the bench and onto the field.

Let us help our fellow Texans.

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The Texas Association of Freestanding Emergency Centers (TAFEC) is a member-based association representing freestanding emergency centers in Texas. The Association works with state leaders to ensure the fair regulation and growth of this industry, as well as raising public awareness of the industry and promoting an overall understanding of the unique benefits of freestanding emergency centers.