| Perspectives on Texas

Texas and the rest of the country are confronting the many challenges of our changing health care system — changes accelerated by last November’s election.

The elderly population in Texas is growing. While our overall population continues to grow by leaps and bounds, it is also aging significantly. According to data from the U.S. Census Bureau 2010 and Texas State Data Center at the University of Texas at San Antonio, the number of people in Texas age 60 and above is expected to more than triple between 2010 and 2050. Because seniors require the most care, that translates into increased costs to the overall system.

Texans have limited access to emergency care. Historically, Texas ranks among the worst states in this category, according to the American College of Emergency Physicians, which gave the state an ‘F’ grade for access to care on its 2014 Report Card. Only three states in the country ranked lower than Texas in providing adequate access to emergency care.

Making matters worse, recent trends indicate that it is becoming more difficult for traditional hospitals to operate in rural areas, and many are forced to close. Since 2010, 10 rural hospitals in Texas have shut down, and an April report by iVantage Health Analytics identified 75 others at risk of closure — by far the most of any state.

Closing a hospital creates a void in emergency care, causing patients to travel for emergency services. This places additional pressure on already overcrowded and overworked hospitals and increases EMS ambulatory transport times for patients. Longer transport times can mean there are fewer ambulances available to respond to other emergencies.

These issues highlight the need for alternative approaches to emergency care. One approach that is taking hold in Texas is the freestanding emergency center, or FEC. Although they are not physically attached to hospitals, FECs are fully equipped emergency care facilities that help reduce the number of patients reporting to overcrowded hospital ERs. By screening and triaging patients accurately, FECs provide a valuable clinical service. Only patients who require complex inpatient services, like surgery or specialist care, are transferred to traditional hospitals.

Shorter wait times are another advantage offered by FECs. When a patient arrives at a traditional hospital ER, they often face long wait times seeing a physician. Sitting in a waiting room for hours without receiving medical attention allows symptoms to worsen; studies have shown that as hospital wait times for patients increase, so too does patients’ risk of death.

The aging population and overall increase in patient volume also impacts the cost of care. As strained hospital ERs see more patients, they have less quality time to spend with each of them.

Analysis of admission rates shows that FECs admit patients at a lower rate than their hospital ER counterparts. When the cost of admitting a patient to the hospital in Texas is approximately $2,000 per day, costs can add up quickly.

Given the slowing of the Texas economy, rising Medicaid costs, overcrowding of emergency departments, and the state’s aversion to tax increases, the 85th Legislature will be forced to make some difficult decisions. It is critical that we consider new, innovative methods of delivering emergency care — like FECs.

By having FECs as an alternative to hospital-based ERs, we can address the symptoms created by hospital closures and overcrowding, while simultaneously reducing the costs of health care, lowering admission rates and providing exceptional patient outcomes.