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Freestanding EDs Are Sane Response

doi: 10.1097/01.EEM.0000403719.48155.f4
Letter to the Editor


Freestanding EDs are the only sane response to EMTALA and the Joint Commission to be developed since EMTALA threw a wrecking ball on all of medicine through the doors of the emergency department. (EMN 2011;33[6]:1; Really, are we such sheep that we cannot even say publicly that EMTALA, if not unconstitutional, is destroying our professions and the economy? Can we not call for its repeal? I know I'm dreaming, but can't we speak openly and honestly?

And the criticism of freestanding EDs? Some people are not reimbursed by their insurance companies? Their bills are higher than expected? I would be willing to bet that a nurse or doctor in a freestanding ED knows how much an EKG costs. Can you answer, all you indentured servants to the government? All of you hospital-based EPs?

It is just terrible that one patient was completely shocked when she was asked for her copay because this was not spelled out in a neon sign at the entrance to the ED. Terrible.

How exactly is this any different from what goes on in hospital-based EDs, where there is no cost transparency, where different patients receive different bills based on their ability to pay, and where three separate bills are often generated from one encounter?

We should be cheering for the success of the freestanding ED as a way out of the (seemingly) insoluble mess that we are in because it is the only solution being offered where the patient is included in the discussion about who is responsible for medical bills.

John Shields, MD

Clarksville, TN

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