AUSTIN (KXAN) — Austin hospitals said with RSV, COVID-19 and flu all hitting at the same time, they’re seeing a growing number of patients in emergency rooms.
Dell Children’s is now asking parents with non-emergency cases to take their kids to a pediatrician or urgent care instead of the ER, if possible.
With the holidays approaching, it will make non-emergency medical care harder to find — that’s only expected to get worse.
Jacqueline Martin found herself in that situation over Thanksgiving. She said she woke up Black Friday struggling to breathe and that her “heart was just beating at a tremendous rate.”
Martin said she called her cardiologist but was unable to get in touch with them because it was a holiday. It left her with only one option: an emergency room.
“I also knew that the local hospital was really full with people with the flu, COVID and that RSV virus, and I thought, oh my gosh, I’ll be sitting in a waiting room forever and ever,” Martin said.
The former president of the Texas Medical Association and an ER nurse in Houston said that’s happening across the state. Emergency rooms are seeing longer wait times and more patients.
“We’re seeing a lot of illnesses, seemingly more than usual for this time of year, which is probably having to do with people having been masked for the past two years,” Dr. Diana Fite said.
Hospital-based emergency rooms have asked people who are not experiencing a medical emergency to go to urgent care instead of the ER. But being unable to breathe would fall into the emergency category.
Martin said her husband previously didn’t use Vik Complete Care, a freestanding emergency room in Lakeway, because the couple has Medicare and would have to pay out of pocket. But several friends told Martin because of the pandemic that had changed. She drove a mile down the road and found they were right.
“I’m thinking, oh my goodness, there’s lots of seniors and likewise. And, you know, if that hospital was full, they don’t get their proper treatment right away. It’s a life-or-death situation for many people. And in my case, it could have been because I was diagnosed with blood clots in both my lungs,” she said.
Access to freestanding ERs in jeopardy for some
Freestanding emergency centers aren’t affiliated with or attached to a hospital, but as Robert Morris, the CEO of Complete Care, explained, the facilities, equipment and staff are held to the same standards as ERs attached to hospitals.
One major difference in access, however, is that until the pandemic hit in 2020, they weren’t recognized by the Centers for Medicare and Medicaid Services. It meant people with those insurances — like Martin and her husband — were unable to go to freestanding locations without paying out of pocket.
CMS issued a waiver in April 2020 that allows freestanding emergency centers to get Medicare reimbursement during the country’s Public Health Emergency, but when it ends, the care goes away.
Congress is working to make that change permanent. It’s also on the radars of Texas lawmakers like Rep. Jodey Arrington in Lubbock.
Arrington explained freestanding ERs are licensed by the state and have the same standards, provide the same level of care as hospital-based emergency rooms, “including state Emergency Medical Treatment and Labor Act (EMTALA) regulations on treating all patients.”
Morris also noted data shows freestanding ERs actually saved the Medicare program roughly 20% in “lower emergency care payments for patients of similar acuity.”
“I would make an argument that it’s just a more focused level of care that we’re able to provide, and again, this is not a slam on the hospitals — I appreciate all the hospitals do — and that’s my background, but we focus on doing one thing and doing it really well and trying to do it really efficiently,” Morris said of that data.
The former Texas Medical Association president says even for people without Medicare, the cost of freestanding ERs is typically slightly less expensive, or just as expensive as an emergency room tied to a hospital.
Texas legislators have made several guardrails for the industry in terms of billing and transparency over the past few years. Now, Morris is hoping they’ll find a way to keep freestanding ERs on the list of facilities that can help Medicare patients.
“I can’t imagine what things would have looked like without free standings being an access point,” Morris said. He estimated freestanding ERs served hundreds of thousands of Medicare patients during the pandemic when emergency rooms and hospitals were all beyond capacity.
“What’s this going to look like if all the sudden you take away this access point? Right. So we just want to be able to continue to serve these beneficiaries and provide a good service to the community,” he said.
Morris also noted, like emergency rooms attached to hospitals, freestanding ERs are required to treat patients experiencing a life-threatening emergency despite the ability to pay.