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Freestanding emergency departments (FSEDs) were introduced in the 1970s and were initially located in rural areas lacking hospital access. Since 2010, FSEDs have expanded, with over 500 sites in 45 states.1

Variability exists in the definition, association (eg, associated with a hospital/health system [termed a hospital-based FSED or off-campus ED] or independent [termed an independent FSED or independent freestanding emergency center]), location (sometimes determined by state regulations or reimbursement from the Centers for Medicare and Medicaid Services [CMS]), services provided, and hours of operation of FSEDs. Many FSEDs are in urban areas within communities with higher shares of privately insured patients and where medical care is readily accessible. To maintain crucial access to emergency care in rural areas and curtail rapid expansion of FSEDs in urban areas, CMS reimburses emergency services differently based on location.2 CMS recommendations do not apply to independent FSEDs, although state regulations may. A study published in 2015 reported that 21 states had policies addressing FSEDs, 29 states had no regulations, 2 states regulated them on a case-by-case basis, and 1 state essentially barred them.3 In New York State, FSEDs operate similarly to traditional hospital-based EDs (24/7 coverage, board-certified emergency medicine [EM] physicians, and EM nurses with certifications in advanced cardiac life support [ACLS] and pediatric advanced life support [PALS]).4

Issue Section:
Frontline Pharmacist
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