• Rain E Freeman, Krislyn M Boggs, Ashley F Sullivan, Mohammad K Faridi, Rachel D Freid, and Carlos A Camargo.
• Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; School of Public and Community Health Sciences, University of Montana, Missoula, MT.
• Ann Emerg Med. 2021 Jan 1; 77 (1): 48-56.

Study ObjectiveThe number of freestanding emergency departments (EDs) has increased rapidly in the United States, and there is concern that such entities are located near existing EDs rather than in areas lacking emergency care. In 2018, the Medicare Payment Advisory Commission recommended a reduction in Medicare reimbursement rates to freestanding EDs located within 6 miles of the nearest hospital-based ED. We aim to assess the potential effect of this proposal.MethodsUsing the 2016 National Emergency Department Inventory-USA database, we identified the locations and visit volumes of all US freestanding EDs. Using QGIS, we mapped the distances from all freestanding EDs to both the nearest hospital-based ED and to the nearest ED (either hospital-based or freestanding ED).ResultsWe collected location information for all 5,375 EDs open in 2016. Of these EDs, 609 (11%) were freestanding. Few freestanding EDs (1.4%) were located in rural areas and only 11% were located in areas with a median household income of less than $43,000. Overall, 460 freestanding EDs (76%) were within 6 miles of the nearest hospital-based ED, and these had 5.3 million total patient visits, whereas those greater than 6 miles away had 2.6 million visits.ConclusionWe found that most freestanding EDs (76%) are within 6 miles of the nearest hospital-based ED, and most visits (67%) to freestanding EDs are to those within that proximity, indicating that many freestanding EDs would be affected by this Medicare Payment Advisory Commission proposal, if implemented.Copyright © 2020 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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