title: State Regulation Of Freestanding Emergency Departments Varies Widely, Affecting Location, Growth, And Services Provided.
abstract: Freestanding emergency departments (EDs), which offer emergency medical care at sites separate from hospitals, are a rapidly growing alternative to traditional hospital-based EDs. We evaluated state regulations of freestanding EDs and describe their effect on the EDs' location, staffing, and services. As of December 2015, thirty-two states collectively had 400 freestanding EDs. Twenty-one states had regulations that allowed freestanding EDs, and twenty-nine states did not have regulations that applied specifically to such EDs (one state had hospital regulations that precluded them). State policies regarding freestanding EDs varied widely, with no standard requirements for location, staffing patterns, or clinical capabilities. States requiring freestanding EDs to have a certificate of need had fewer of such EDs per capita than states without such a requirement. For patients to better understand the capabilities and costs of freestanding EDs and to be able to choose the most appropriate site of emergency care, consistent state regulation of freestanding EDs is needed.
authors.affiliation: Catherine Gutierrez is a medical student at Harvard Medical School, in Boston, Massachusetts.
authors.forename: Catherine
authors.initials: C
authors.lastname: Gutierrez
authors.affiliation: Rachel A. Lindor is a resident physician in emergency medicine at the Mayo Clinic College of Medicine, in Rochester, Minnesota.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Lindor
authors.affiliation: Olesya Baker is a statistician in the Department of Emergency Medicine at Brigham and Women's Hospital, in Boston.
authors.forename: Olesya
authors.initials: O
authors.lastname: Baker
authors.affiliation: David Cutler is the Otto Eckstein Professor of Applied Economics at Harvard University, in Cambridge, Massachusetts.
authors.forename: David
authors.initials: D
authors.lastname: Cutler
authors.affiliation: Jeremiah D. Schuur (jschuur@bwh.harvard.edu) is chief of the Division of Health Policy Research in the Department of Emergency Medicine at Brigham and Women's Hospital and an assistant professor of emergency medicine at Harvard Medical School.
authors.forename: Jeremiah D
authors.initials: JD
authors.lastname: Schuur
mesh_terms: D000554:Ambulatory Care Facilities / Q000191:economics* / Q000706:statistics & numerical data; D003365:Costs and Cost Analysis / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000706:statistics & numerical data / Q000600:supply & distribution*; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D062306:Geography, Medical; D033161:Government Regulation; D006801:Humans; D010561:Personnel Staffing and Scheduling / Q000592:standards; D014481:United States
keywords: Access To Care; Health Spending; Legal/Regulatory Issues; Organization and Delivery of Care; State/Local Issues