TOPLINE:

The opening of hospital-owned satellite freestanding emergency departments (EDs) was associated with a $98.20 increase in median county-level medical debt and a 2-percentage-point rise in the share of residents with medical debt in collections, a study showed, underscoring the need for policies to protect patients' financial health.

METHODOLOGY:

• Researchers conducted a cross-sectional study and examined the association between hospital-owned satellite freestanding EDs and medical debt between 2014 and 2021.
• The study compared counties with freestanding EDs (n = 48) with those without freestanding EDs (n = 1320).
• Data on freestanding ED openings were obtained from the Centers for Medicare & Medicaid Services (CMS) Provider of Services file, and medical debt data were drawn from the Urban Institute Credit Bureau Panel.
• The outcome was the median amount of medical debt in collections among those with medical debt in collections.

TAKEAWAY:

• Freestanding ED entry was associated with a $98.20 increase (95% CI, $17.60-$178.81) in county-level median medical debt among those with debt in collections and a 2-percentage-point increase in the share of the population with a credit history who had medical debt in collections.
• Debt increases emerged 2 years after the ED opened and became larger over time (15% increase at year 2 and 17% at year 4).
• In counties with nine or more EDs, median debt increased by about $578.
• Counties with freestanding EDs had a lower baseline share of residents with medical debt in collections (22.0% vs 26.0%; P = .001), had higher median household income ($53,284 vs $46,535; P < .001), and were more often urban (75.0% vs 35.1%; P < .001) than counties without freestanding EDs.

IN PRACTICE:

"This pooled cross-sectional study is the first to examine the association between satellite freestanding ED entry and medical debt. Our results underscore the need for policy and practice to weigh the potential benefits associated with improved access to outpatient emergency care with the potential long-term implications of burdening people with higher medical debt," the authors wrote.

SOURCE:

The study was led by Daniel Marthey, PhD, Texas A&M University, College Station. It was published online on July 23, 2025, in JAMA Network Open.

LIMITATIONS: 

The study included only CMS-certified EDs, likely underestimating the total number of freestanding ED facilities. Exact addresses were unavailable, which could have led to misclassification of counties. Healthcare utilization patterns that might explain changes in medical debt were not observed, and factors such as differential enrollment in high-deductible health plans may have confounded the results.

DISCLOSURES:

Funding information was not provided for the study. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.