What is The Texas Association of Freestanding Emergency Centers (TAFEC)?

What is The Texas Association of Freestanding Emergency Centers (TAFEC)?

Freestanding Emergency Centers are a relatively new concept in Texas, having been established in 2009. This form of healthcare differs from other healthcare providers due the type and quality of healthcare offered. There are many freestanding emergency centers spread all over Texas. To maintain high quality standards and present a unified voice, the freestanding emergency centers formed the Texas Association of Freestanding Emergency Centers (TAFEC). Bellaire ER explores the formation and functions of TAFEC.

Formation

The freestanding emergency care industry was established in 2009 under House Bill 1357. However, there were few freestanding ERs in Texas that operated individually before the bill was passed. Each of these ERs set their own regulations about operating times and the quality of care.
After the recognition of the freestanding ERs by law, there was a need to standardize their practices. It is due to this need that TAFEC was formed. The association became the first statewide representation for FECs in the United States.

Aim

TAFEC looks to provide a unified voice from the freestanding emergency centers. This way, the industry can present its views clearly and have a central point of representation. This unification helps the industry pay an important role during the creation of laws and regulations affecting the freestanding emergency centers.

TAFEC is also involved in creating awareness on freestanding emergency centers all over Texas. Through their awareness mandate, TAFEC aims to inform residents about the benefits of FECs and how to use them.

TAFEC also helps to maintain high quality standards for all its members. This includes high quality service to patients in minimum wait times.

Advocacy

TAFEC has been involved in many advocacy roles to create fair regulation for the FEC industry.
Health insurance transparency is one of the items under TAFEC’s legislative agenda. TAFEC is pushing for legislation that will require insurance companies to be transparent about how they calculate the rates paid to out-of-network healthcare providers.

The problem of surprise medical costs has plagued consumers who visit FECs. People are often presented with huge medical bills especially when they visit out-of-network FECs. This is because some insurance companies only cover a small portion of the bill and thus the patient is left to cater for the rest out-of-pocket.

With a transparent calculation mechanism, the insurers will have to be consistent in their payments to healthcare providers and the law can institute penalties for any insurance company that underpays.

Keeping in its role to provide fair regulation in the industry, TAFEC is looking to eliminate surprise medical bills through legislation. They hope to create a law that standardizes the reimbursement rates from the insurance providers. This way, patients will not be presented with surprise medical bills as they’ll already know how much their insurance covers.

Apart from the transparency of insurance companies, TAFEC also aims to promote the transparency of FECs. FECs in Texas were plagued with the problem of people confusing them with urgent care centers. This led to the passage of the Senate Bill 425 that mandated FECs to provide clear signage and information on the difference in cost and quality of care between them and urgent care centers.

The bill requires the FECs to post notices that inform patients that the facility is a freestanding emergency center and that billing is similar to a hospital based emergency center. The notices also inform the patients that their medical insurer might not cover their costs and that the physician attending to them might bill separately from the hospital.

These notices have to be placed in areas where they are clearly visible such as the entrances, treatment rooms, payment locations, and on the FECs website.

The bill helped to reduce complaints by patients who were met with surprise bills to the Texas Department of State Health Services.

In keeping with the need for transparency, TAFEC also has a section on its website that informs patients on which healthcare facility can serve them best. The section primarily aims to distinguish between urgent care and emergency centers. Illnesses and injuries such as flu symptoms, sprains, cuts, and allergies are best treated at an urgent care. Emergency rooms should be accessed for true emergencies such as heart attacks, stroke, chest pain, and severe burns.

TAFEC also has a lot of materials on other subjects such as FEC billing and Texas medical statutes. All this information is meant to help patients make the right decision when visiting a healthcare center. It also helps them access quality healthcare in times of an emergency since they know that that the insurers are supposed to pay for the emergency services at in-network rates.

Membership

TAFEC has 30 members who run 220 FECs across Texas. The FECs are located in more than 100 communities all over Texas. All the facilities operated by each member have to join if the parent company decides to join the association. These facilities also have to pay separate dues.

How emergency rooms charge?

Every time you walk to an emergency room, you are required to complete very long forms providing information about your health insurance and funding means. A copy of your insurance card is then filed together with the filed form before treatment begins. Do you know what happens afterwards though?

There is a common misconception that emergency rooms services come at a higher cost that those offered in traditional hospital facilities. This however, is far from the truth because the services are offered at an almost or even lower rate when you factor other charges which are levied in hospitals but are non-existent in emergency rooms. The reason why most people often complain about the cost of emergency rooms, is the fact that they don’t understand the billing system of emergency rooms. Why is it that most people feel that the amount of money billed against them after receiving emergency services is higher than what it should be? What would happen if you had no insurance cover and received medical care in an emergency room? Are there some unknown surprise bills which are added without your information? How do emergency rooms charge? Here is a quick guide in how the billing system of emergency rooms works;

Emergency services are mandatory to all with or without insurance

The first important fact that we have to point out about emergency rooms, is the fact that everyone is expected to be given emergency treatment whether or not he/she has insurance. Some people are given treatment even if they can’t afford it. This prompts emergency rooms to set up gross charges to be quite high in-order for them to compensate the payment of the less privileged.

Insurance service provider bargain with the emergency rooms on the amount of money payable

The other important thing you should know, is the fact that the hospital and the issuer of your insurance do bargain to come to terms on the amount of money payable for your emergency room treatment. The amounts of money quoted on your bills are not what insurance companies end up paying to the emergency rooms. They pay way less than you can imagine. Depending on the proficiency of the insurance company brokers, the charges can be cut down by more than 60%. It all depends with their contract negotiation skills and ability to convince the emergency room financial departments.

Emergency room visits are part of insurance benefits the insured enjoy

Everyone who is covered by a health insurance receives emergency room benefits. Each and every health insurance I know of in America includes benefits for emergency room visits for all its subscribers. This doesn’t restrict you to a particular institution as well. You are free to visit an emergency room of choice at any one point when you are experiencing a medical condition that needs you to visit the ER.

Amount of money paid depends on the specific service received from the emergency room

When it comes to the charging itself, there are a few factors used to come up with the final cost of an emergency visit. An emergency room will charge you for every single service that you receive. Minor or insignificant as it may seem to you, an MRI scan will be included in your final bill. This is why you normally receive very many bills from separate departments especially in hospitals. Each Emergency room department in a hospital will separately provide a quotation of the amount of money they feel you are supposed to pay. This is normally because most departments in hospitals are separate legal entities and as such, each has its own bill attached. Standalone emergency rooms like Bellaire Emergency Room though normally have only two or three claims in the final bill for your visit because the whole institution works under single management. The only claim perhaps comes from the physician.

Severity of the condition also plays a role in determining the final amount of money you pay for the services

Besides being charged for every single service you receive in an emergency room, you will get a final bill corresponding to the severity of your medical condition and the complexity of the treatment you received. In Bellaire Emergency Room for example there are 5 levels of care. From level 1 to level 5. Level 1 care is meant for ‘minor’ problems like earache while level 5 care is meant for far complex issues like broken bones and trauma. The cost rises as you go up the treatment chain.

If you are in Texas and are in Houston and are looking for an emergency room that offers cheap and reliable services in the area, then look no further than Bellaire Emergency Room. Our emergency room is well-equipped with the latest medical facilities and you can therefore expect nothing short of the best treatment from us. We accept most of the insurances in the US and our charging/billing system is transparent. Visit us today for the best possible emergency room care in Houston.

How are emergency rooms funded in America?

I have realized a certain trend in the emergency rooms which has been bothering me for a long time now. I came to realize recently that the number of people receiving medical care from emergency rooms without insurance are more than those who are under insurance cover. This made me wonder how emergency rooms are able to sustain their services in America!

How are emergency rooms funded in America? This is a common question that I have come across in various medical platforms and social media pages. People are curious to know how the emergency rooms are funded considering that they sometimes give urgent care to the uninsured who can’t afford the services. In an effort to explain this, I want to take a look at the different types of emergency rooms available in America and how they conduct their business.

There are two main types of emergency rooms in America; freestanding emergency rooms and hospital emergency departments. Freestanding emergency rooms are facilities staffed by emergency services, are open 24 hours a day and are physically separated from the hospital. They may be owned by hospitals or be privately owned by individuals. Freestanding emergency rooms can further be broken down into either hospital outpatient department emergency center or independently owned freestanding emergency room. The main difference between the two subcategories is the fact that the former accepts Medicaid/Medicare payments while the latter does not. The latter are not bound by the federal legislation and regulations regarding operations such as EMTALA. This is not the case in all states though. Some states like Texas for example have passed legislations that impose rules and regulations similar to EMTALA on all the independently owned freestanding emergency departments.

The traditional hospital based emergency rooms on the other hand, operate normally and accept payment from Medicaid and Medicare. They are governed by federal rules and regulations such as EMTALA.

Financial implications for patients visiting the emergency rooms

There is no big difference between the cost of services offered in the freestanding emergency rooms and the hospital based emergency departments. The biggest difference as we have seen comes in when it comes to paying for the services that have been provided. The hospital based emergency rooms will readily treat Medicaid and Medicare as in network while their freestanding independently owned emergency rooms will not accept payment from such forms of payment.

Who funds the emergency rooms?

So, now that we have seen the main differences between the freestanding emergency rooms and hospital-based emergency rooms, it is time to go back to the main issue of who really funds these emergency rooms? How are they able to bridge the gap and financial void left behind when they offer services to the uninsured? This is what it is that normally happens especially in the hospital based emergency rooms;

Hospitals and physicians are normally forced to shoulder the financial burden for the uninsured by incurring billions of dollars in debt each year. This is a very common scenario in America. Actually of all the 140+ million reported emergency room visits, only about 40 million visits were made by insured people and the remaining 55% of the emergency care goes uncompensated. According to the Centers for Medicare & Medicaid Services Health, the accumulative bad debt or amount of money accrued by uninsured people receiving urgent medical care is in the neighborhood of $200 billion every single year. A study recently conducted by the American Medical Association showed that more than one-third of emergency physicians lose an average of $140,300 each year from EMTALA-related bad debt. So, how are emergency rooms still able to make profit with such figures? How do they make up for the lost funds?

In an effort to offset the bad debt, hospitals in the recent past shifted uncompensated care costs to insured patients to make up the difference. This basically meant that the insured patients were forced to help carry the burden of uninsured patients. This is however not applicable today. Owing to numerous complaints and lawsuits by insurance companies and individuals, cost shifting was done away with. It therefore is no longer is a viable option because managed care and other health plans have instituted strict price controls to their insurance plans. This means that there is very little leeway and margin for the emergency rooms to try and squeeze in some of the bad debt through cist shifting.


Things are not looking any good though. With projections that health care costs will double in the coming few years and the number of uninsured Americans not showing signs of reducing, emergency rooms and other medical service providers will have to keep bearing with the burden. The nation will have to keep providing for not just the disadvantaged in the society but for the uninsured as well.