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Letter to the Editor: Freestanding EDs Here to Stay

doi: 10.1097/01.EEM.0000405502.46843.3f
Letter to the Editor


The article “The Emergence of Freestanding EDs” surprised me. It is extremely biased and unfair as well as being inaccurate. (EMN 2011;31[7]:1.) The article begins with the sentence, “Lured by the appeal of a quick profit” followed by the statements that these centers are “seemingly exempt from many of the rules governing hospital EDs,” and that they are “self-defined emergency departments.” The reader is immediately biased as to the nature and the untrue statement regarding these facilities.

I have been working in one of these facilities for more than a year, and I can vouch for the inaccuracy of the statements. Our company was established, designed, and owned by an emergency physician who saw the need to provide excellent care outside the hospital setting. After 30 years of working in a variety of settings, including large trauma centers, private hospital EDs, rural EDs, and academia for half of my career, I can say that I am able to give my patients the best of my experience in a private, clean, and friendly environment where I am not rushed to “move the meat.”

I am able to give patients the care I was not able to provide in a rushed hospital ED in the most efficient manner. The satisfaction is a mutual one for me and my patients. Our patient surveys reflect the extremely positive experience that our patients have at our facilities. We take the time to explain diagnoses as well as course and treatment of disease, and yes, we can stabilize any condition that a hospital ED sees. All of the STEMIs at our facility have less than a 40-minute our door-(our door)-to cath time!

The overwhelming majority of our patients is admitted directly and bypasses hospital EDs. We do have arrangements with hospitals in the area! Our wait time is virtually nonexistent! We have developed an excellent relationship with the area hospitals and their specialists. I challenge any hospital ED to treat patients with the efficiency and care that I am able to provide! Many of our patients have been seen at other facilities prior to coming here.

I have had my own family treated at our facility, and would recommend it to anyone! As a conscientious physician who has given much to emergency medicine, I can say that this facility offers me the opportunity to practice emergency medicine in the most satisfying environment I have encountered. So I have to speak out for our company's facilities and the way we operate. The EMN article could not be further from the truth on many counts. And Blue Cross should not be used as a source. Of course, this profit-making corporation is going to mislead you. Just look at the warning they just removed from their website! It was very general and alarming, and used to attempt to keep their clients away from us, but it did not work! The state of Texas has created a special designation for our facilities, and they are certified by the state if the facility passes a more intense survey than I ever saw in a hospital ED!

This is not only structural, but also includes very detailed and outlined policies and procedures with documentation that is not even required of hospital EDs. We have to be Joint Commission-certified as well as EMTALA-compliant. All of our transfers are performed in compliance with EMTALA regulations, with which I am very familiar. And we are certified by the state of Texas as a freestanding ER, and as such insurers are required to compensate rates equivalent to a hospital ED. And perhaps that is why you obtained such negative biased information from Blue Cross/Blue Shield.

As far as the other sources, they are probably not as familiar with our company and its organization and compliance, and I am not at liberty to criticize them as I do not know their background regarding this area of emergency medicine. One is a very politically involved individual who can speak out on any topic! But if you want to do emergency physicians justice, you should hear from those of us who are involved in the actual provision of care. Or would you rather remain biased? I am ready to answer all your questions. And speaking of the lure of quick profits, how about hospitals using midlevel providers? All our facilities are staffed by board certified or eligible physicians, many with years of experience. Our credentialing process is as intense or more so than a hospital ED!

So the bottom line is that your article was misleading and unfair to our facilities. We try harder as we know what does not work in a hospital setting and yet emergency physicians are rarely in a position to change operations. In our setting, the patient dictates what we will provide, and we offer it without answering to layers of bureaucracy. You are witnessing the true freedom of emergency physicians, the right to own our own facilities just as surgeons did with their surgicenters. We know how to do it better, and now we can! As far as hospital-owned facilities, I cannot speak for them. They are not designed, operated, or owned by emergency physicians so that speaks for itself.

I am very familiar with our state regulations as our facility was one of the first in the state to by surveyed and certified, and if you need real and unbiased data, I can refer you to the proper authority, not your biased sources. And feel free to contact me if you want to know more about how we really operate. I trust EMN will continue to be fair and unbiased, and present the facts to its physician readers. Freestanding emergency centers are here to stay, and may they continue to be owned and operated by board certified emergency physicians. Our patients will dictate our success.

Juan M. Nieto, MD

Austin, TX

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