The Impact of Conversion From an Urgent Care Center to a Freestanding Emergency Department on Patient Population, Conditions Managed, and Reimbursement



      Freestanding emergency departments (FSEDs), EDs not attached to acute care hospitals, are expanding. One key question is whether FSEDs are more similar to higher-cost hospital-based EDs or to lower-cost urgent care centers (UCCs).


      Our aim was to determine whether there was a change in patient population, conditions managed, and reimbursement among three facilities that converted from a UCC to an FSED.


      Using insurance claims from Blue Cross Blue Shield of Texas, we compared outcomes of interest for three facilities that converted from a UCC to an FSED for 1 year before and after conversion.


      There was no significant change in age, sex, and comorbidities among patients treated after conversion. Conditions were similar after conversion, though there was a small increase in visits for potentially more severe conditions. For example, the most common diagnoses before and after conversion were upper respiratory infections (42.8% of UCC visits, 26.0% of FSED visits), while chest pain increased from rank 30 to 10 (0.5% of UCC visits, 2.3% of FSED visits). Yearly number of visits decreased after conversion, while median reimbursement per visit increased (facility A: $148 to $2,153; facility B: $137 to $1,466; and facility C: $131 to $1,925) and total revenue increased (facility A: $1,389,590 to $1,486,203; facility B: $896,591 to $4,294,636; and facility C: $637,585 to $8,429,828).


      After three UCCs converted to FSEDs, patient volume decreased and reimbursement per visit increased, despite no change in patient characteristics and little change in conditions managed. These case studies suggest that some FSEDs are similar to UCCs in patient mix and conditions treated.


      To read this article in full you will need to make a payment


        • Schuur J.D.
        • Venkatesh A.K.
        The growing role of emergency departments in hospital admissions.
        N Engl J Med. 2012; 367: 391-393
      1. Regulation of freestanding emergency medical care facilities.
        (Available at:)
        • Gutierrez C.
        • Lindor R.A.
        • Baker O.
        • Cutler D.
        • Schuur J.D.
        State regulation of freestanding emergency departments varies widely, affecting location, growth, and services provided.
        Health Aff. 2016; 35: 1857-1866
        • Schuur J.D.
        • Baker O.
        • Freshman J.
        • Wilson M.
        • Cutler D.M.
        Where do freestanding emergency departments choose to locate? A national inventory and geographic analysis in three states.
        Ann Emerg Med. 2017; 69: 383-392.e5
        • Ho V.
        • Metcalfe L.
        • Dark C.
        • et al.
        Comparing utilization and costs of care in freestanding emergency departments, hospital emergency departments, and urgent care centers.
        Ann Emerg Med. 2017; 70: 846-857.e3
      2. HCUP-US Tools & Software Page. Clinical Classifications Software (CCS) for ICD-9-CM.
        (Available at:)
        • Hsia R.Y.
        • Antwi Y.A.
        Variation in charges for emergency department visits across California.
        Ann Emerg Med. 2014; 64: 120-126.e4
        • Kliff S.
        Emergency rooms are monopolies. Patients pay the price. Vox.
        (Available at:)
      3. How freestanding emergency departments help patients. NEJM Catalyst.
        (Available at:)
      4. Freestanding emergency department growth creates backlash.
        (Available at:)
        Date: 2013
        Date accessed: October 17, 2018
      5. Increases in cost-sharing payments have far outpaced wage growth. Peterson-Kaiser Health System Tracker.
        (Available at:)
      6. Understanding the hybrid ER & Urgent care model: how it works.
        (Available at:)
        • AIS Health
        Enrollment Statistics and market share 2017.
        (Available at:)