Freestanding Emergency Centers, Part I: Know Your Options

In recent years, the number of freestanding emergency centers (FECs) has grown as patients in the U.S. healthcare system have made a simple request: they want immediate access to emergency healthcare when the need arises. With shorter wait times than hospital emergency rooms (ERs), 24/7 access to care, and ER-trained physicians on staff at all times, FECs are specifically designed to meet this need. Despite high rates of patient satisfaction (1), insurance companies are funding campaigns against FECs and penalizing patients who receive treatment from these facilities. They are even going so far as to contact patients directly to discourage them from seeking care from FECs. Why are they doing this, and is this negative image of FECs fair? To help you understand your options, this article will discuss the differences between emergency healthcare models and dispel some of the myths surrounding FECs.

Definition of the Freestanding Emergency Center Model

In June 2014, the American College of Emergency Physicians (ACEP) published the following:

“A freestanding emergency department (FSED) is a facility that is structurally separate and distinct from a hospital and provides emergency care. There are two distinct types of FSEDs: a hospital outpatient department (HOPD), also referred to as an off-site hospital-based or satellite emergency department (ED), and independent freestanding emergency centers (IFECs).”(2)

This article focuses exclusively on the IFEC (or FEC) model as defined by ACEP.

Understanding the Differences Between Urgent and Emergency Care Models

One of the issues stemming from insurance companies’ misrepresentations of FECs is a misunderstanding of the differences between types of care facilities. In most communities with freestanding emergency centers, three distinct options for treating immediate healthcare concerns are available to patients:

1.       Urgent Care Clinic

2.       Local Hospital Emergency Room (ER)

3.       Freestanding Emergency Center (FEC)   

While there are some similarities between these models, each serves a distinct purpose. To help you understand your options, we will discuss the three models as they relate to the following: level of emergency care available, provider type required at the facility, patient volume and wait time, retail cost of care, and the facility’s relationship with health insurance companies.

Level of Emergency Care Available

Urgent care facilities offer healthcare services much like those available through a primary care physician’s office. While their doors are open beyond normal business hours, they do not offer 24/7 patient care. Although some of these facilities have pharmacies on location, they do not stock all of the medications that might be necessary for treating true emergencies. These facilities are a patient’s best option for the treatment of minor injuries or common illnesses, whereas medical emergencies that require immediate attention are best treated in hospital emergency rooms or FECs.

FECs and hospital ERs are state-licensed emergency facilities. They must meet state requirements for equipment and architectural standards at much higher levels than the standards for urgent care models. Open 24/7 every day of the year, these facilities offer advanced lab and imaging services and stock medications beyond those available at urgent care clinics.

Aside from trauma care, FECs are legally required to provide the same level of care and services available in hospital ERs. Since 87% of emergency patients do not need to be admitted to the hospital (3), FECs are a great option for conveniently located, high-level care. When hospital admittance is necessary, FECs support patients in transfers to hospitals of their choice.  

Provider Type Required at Facility

In order for patient care to be offered, urgent care facilities are required to have nurse practitioners (NPs) or physician assistants (PAs) onsite. It is a legal requirement that hospital emergency rooms and FECs have medical doctors (MDs and DOs) onsite for patient care at all times. When a patient arrives at a freestanding emergency center, an ER-trained and licensed physician is immediately available to assess and treat patients. ER-trained and licensed physicians are also available in hospital emergency rooms, but a higher patient volume means that patients may have a longer wait time before receiving care. This leads to our next area of discussion.

Patient Volume and Wait Time

The comparison here is really between FECs and hospital ERs due to their similar patient populations. While both FECs and hospital ERs are designed to offer high-level, immediate treatment for emergency healthcare needs, the high patient volume in hospital ERs typically means a longer wait time for patients. FECs, on the other hand, tend to have lower patient volume and shorter wait times, meaning patients are treated more quickly. With a lower patient volume, doctors are also able to spend more time with each patient.

FECs tend to be conveniently located near shopping centers or other neighborhood hubs close to patients’ homes—another feature that can lessen the amount of time a patient must wait to receive care. Choosing an FEC might also help to reduce overcrowding in hospital ERs, allowing these facilities more time and resources to treat the most serious cases.

Retail Cost of Care

The cost of services at FECs and hospital ERs is higher than the cost of urgent care services, but this is not without good reason. When ER-trained doctors, lab and imaging services, and life-saving medications are available to patients 24/7 (as is required for FECs and hospital ERs), there is an understandable increase in the cost of operation. This means that the retail cost of emergency care is necessarily higher than the cost of care received at an urgent care clinic. The retail cost of care at FECs is equal to or less than the cost of hospital ER care (3). 

Facility’s Relationship to Health Insurance Companies

When a healthcare facility is labeled “in-network,” this means that the facility has entered into a service contract with your insurance company and has accepted pre-negotiated coverage terms for services. Any healthcare facility that does not enter into a service contract with your particular insurance company is then labeled “out-of-network,” meaning that your insurance will not reimburse the facility (or will reimburse at a different rate) for services and you will likely be stuck with higher out-of-pocket costs. This is why your insurance company advises you to seek treatment from in-network facilities. (More on this in Part II of this series.)

Patients cannot choose where and when the need for emergency care will arise, so insurance companies are required to cover emergency services (4). Because freestanding emergency centers offer only emergency care—which must be covered by health insurance—many FEC’s choose not to enter into these agreements with health insurance companies. As a patient, this should not mean higher out-of-pocket costs for you.  

In Conclusion

Healthcare works best when patients are given choices for quality care. Now that you know more about the emergency healthcare options available to you, stay tuned for our next blog post, “Freestanding Emergency Centers, Part II: Why Is Health Insurance Keeping Patients Away?” to understand why health insurance companies are trying to limit those options.



1.       Guarsico, Joseph. “Freestanding Emergency Departments: What Can We Learn.” Common Sense, vol. 23, no. 5, 2016, pp. 17–18.,

2.       Freestanding Emergency Departments Annals of Emergency Medicine, Volume 64, Issue 5, 562. Nov 2014.

3.       Texas Association of Freestanding Emergency Centers. TAFEC, 2018, . Accessed 26 Mar 2018.

4.       Riner, Myles. “What Is A Surprise Balance Bill for Emergency Room Services?” American College of Emergency Physicians. . Accessed 11 Apr 2018.