The State of Texas is one of Austin’s largest employers, with about 70,000 workers locally. If an addition to the senate budget bill passes, those employees will have less options to choose from in the event of a medical emergency.
That is because of a “rider” the Senate Finance Committee voted to add to Senate Bill 1, the Senate’s budget bill. A rider is a provision added to a bill under consideration by the legislature having little connection with the subject matter of the bill.
Based on recommendations from a cost containment budget work group, the rider would direct the Employee Retirement System (ERS) to “disincentivize member utilization of freestanding emergency rooms.” This would effectively shift a larger portion of costs for emergency care rendered at a freestanding ER to the enrollees of the plan.
The results of this action would be significant. Through the Texas Employee Group Benefits Program, ERS health insurance plans cover about one out of every 52 Texans. That means more than 540,000 participants statewide would have less choices when it comes to emergency medical care.
It is not a stretch to predict that if the rider passes, state employees who are injured or fall ill close to a freestanding ER would feel financial pressure to travel longer distances to receive care at hospital-based emergency rooms. Numerous studies indicate that longer delays in receiving emergency care, which include critical medication and procedures to stabilize, lead to adverse outcomes.
I operate four freestanding ERs in Austin, Pflugerville, Round Rock, and Dripping Springs. For many folks living in the Austin suburbs, my facility is the closest emergency care facility by a considerable distance. If state employees feel pressure to drive past freestanding ERs and into the city, where traffic can be a nightmare, just to receive care from a traditional hospital-based ER, the risk of death or permanent disability significantly increases.
The fact is, our entire state performs poorly when it comes to access to emergency care. The American College of Emergency Physicians ranks Texas 47th among states in that category with a grade of ‘F’.
That’s why freestanding ERs are so crucial. They help improve access to care by offering patients an alternative setting to overcrowded hospital-based emergency rooms. While not attached to a traditional hospital, freestanding ERs are fully functioning emergency rooms that provide the exact same level of service as hospital-based ERs, and can treat true medical emergencies like heart attacks and strokes. The facilities also offer added convenience in the form of reduced wait times compared to hospital-based ERs.
According to both state and federal law, emergency medical care is an essential health benefit, and must be provided without limitation – regardless of network status. This budget rider to disincentivize usage of freestanding ERs is in direct violation of patients’ ability to exercise their out-of-network benefit right. By shifting more costs to ERS patients through coinsurance and copayments, ERS is financially limiting the options available to its members and reducing access to care.
Data considered by the work group clearly shows that freestanding ER billed charges – the lone variable that providers control themselves – are much cheaper than hospital-based ER billed charges. The ERS insurance plan was poorly managed, which is why a new insurer has been awarded the contract beginning later this year.
Not only is this rider anti-competitive and illegal, it endangers the lives of thousands of state employees across Texas by limiting their options for care in the event of a medical emergency. The Texas Association of Freestanding Emergency Centers urges the Senate Finance Committee to reconsider this rider, which ultimately hurts patients. Blaming providers and punishing ERS enrollees for a poorly managed health insurance contract is not the answer, and it will only lead to increased litigation for the state.
The Senate Finance Committee should seek cost containment through alternative measures that do not violate federal and state law or jeopardize the health of thousands of Texans throughout the state.
Marysol Imler, RN, is vice president of Five Star ER and serves on the board of the Texas Association of Freestanding Emergency Centers.