Free-Standing ERs Licensed in Texas Soon

The 2009 Texas Legislature passed a new law (HB 1357) that will regulate free-standing ERs in Texas. It's hard to tell how many there are, but it appears that there are about 40 free-standing ERs in Texas. Also, it's important to not confuse these with the walk-in retail clinics (CVS, etc.).

The licensing of free-standing ERs in Texas will begin in September 2010. The regulators are in the process of drafting regulatory measures.

Some of the key issues include:

* Whether or not you can have two different types of facilities licensed at the same address (you can't currently do that under Texas law). But there are probably a few health care facilities that would like to add a free-standing ER to their building.

* Another big question is what should the credentials of the physicians at the ERs be. Currently, a physician does not have to have special emergency medicine credentials to work in a free-standing ER (or even in a hospital ER).

* Pediatric credentials for an RN will be a big measure that needs to be addressed. (Should a nurse with pediatric emergency credentials be in the facility at all times?)

* Perhaps the most interesting issue that will have to be addressed involves that of laboratory services. The proposed rules suggest three types of labs: waiver, moderate, and high-end. The latter two require strong credentials for the lab director (MD or PHD and additional training). The question in this case ultimately becomes: What will lab services look like in a few years? Should the government prescribe a lot of standards now and then turn around and those standards will be out-of-date in a few years?