Freestanding emergency department compliance with consumer protections: evidence from Texas

Freestanding emergency departments (FrEDs) are a major source of emergency care in Texas, but pricing and network participation have historically lacked transparency. Texas House Bill (HB) 2041 aimed to strengthen consumer protections by requiring FrEDs to disclose facility status, standard fees, network participation, and prohibited deceptive advertising. We evaluated FrED compliance with HB 2041.

We identified 16 reporting requirements spanning facility disclosure (n = 1), facility fees (n = 5), observation fees (n = 4), and insurance information (n = 6). Using a list of Texas FrEDs (n = 351) from the Department of State Health Services, we linked facility locations to hospital-based emergency department counts from the American Hospital Association Annual Survey and population data from the Census Bureau. We assessed compliance overall, by facility type (satellite vs independent FrED), reporting parameter, geography, and emergency department competition. Differences were evaluated using t tests.

FrED compliance with all 16 parameters ranged from 15% to 100%. Average compliance ranged from 64.5% and 44.7% among independent and satellite FrEDs, respectively. Among independent FrEDs, 11.5% complied with all requirements. The lowest compliance was observed for disclosure of facility and observation fees. Compliance was higher with greater emergency department competition.

Findings suggest opportunities to enhance enforcement with Texas' consumer protections.