Introduction
A freestanding emergency room—also referred to as a freestanding emergency department (FSED)—is a type of emergency care facility that operates in a standalone building rather than being physically connected to a hospital. Authoritative medical and policy sources describe these facilities as part of the emergency care landscape in the United States, but definitions, operational requirements, and regulatory treatment vary by organization and jurisdiction. This article presents only claims supported by high-quality evidence and clearly labels areas where evidence is limited or inconsistent.
What Does “Freestanding Emergency Room” Mean?
According to the American College of Emergency Physicians (ACEP), a freestanding emergency department is an emergency facility that is not physically connected to inpatient hospital services.
However, national data sources do not use a single, universal definition, and some distinguish between:
- Hospital-affiliated (satellite) freestanding emergency departments, and
- Independent (autonomous) freestanding emergency departments.
Because of these definitional differences, not all organizations classify or regulate freestanding emergency rooms in the same way.
How Definitions Differ
Key point
There is no single, universal definition, and operational requirements can vary.
Quick comparison
| Topic | What is supported by evidence in this article |
| Definition anchor | “not physically connected to inpatient hospital services” |
| Facility types | “Hospital-affiliated (satellite)” and “Independent (autonomous)” freestanding emergency departments |
| 24/7 requirement | “Some do, but not all data sources require 24/7 operation, and availability varies by facility and state.” |
| Regulation | “State regulation of freestanding emergency rooms varies widely.” |
How Freestanding Emergency Rooms Compare to Hospital Emergency Rooms
What Is Supported by Evidence
- Freestanding emergency rooms are designed to deliver emergency-level care, similar in scope to hospital emergency departments, according to hospital system documentation and professional organizations.
- Some health systems report that their freestanding emergency rooms and hospital-based emergency rooms offer the same level of emergency care, although this claim is system-specific and not established as universal.
- Freestanding emergency rooms typically have access to advanced diagnostic capabilities, such as CT scans, ultrasound, and laboratory testing.
What Is Not Universally Established
- There is no single, nationwide standard confirming that all freestanding emergency rooms provide identical services, staffing, or capabilities as hospital-based emergency departments.
- Operational requirements, including hours of operation, staffing models, and services, vary by facility type, ownership, and state policy.
Regulation and Legal Requirements
- State regulation of freestanding emergency rooms varies widely. Some states have detailed regulatory frameworks, while others have limited or no specific regulations.
- Federal emergency care requirements, such as the Emergency Medical Treatment and Labor Act (EMTALA), apply to certain freestanding emergency departments, particularly those that are hospital-affiliated and participate in Medicare.
- There is no high-quality evidence supporting a single regulatory model that applies uniformly to all freestanding emergency rooms nationwide.
Transfers and Hospital Admission
- When a patient requires inpatient admission or higher-level hospital services, freestanding emergency rooms may arrange transfer to an appropriate hospital.
- Transfers may involve ambulance or air transport, depending on medical need and local resources.
- There is no universal evidence standard describing identical transfer protocols across all freestanding emergency rooms.
Insurance, Billing, and Cost Considerations
Supported Evidence
- Some hospital systems report that their freestanding emergency rooms operate under a similar cost structure to hospital-based emergency rooms and accept the same insurance plans.
- Emergency care should not be delayed due to concerns about payment when a true medical emergency exists.
Evidence Gaps
- There is no high-quality evidence confirming that most freestanding emergency rooms accept all major insurance plans, Medicare, or Medicaid.
- There is no definitive evidence that freestanding emergency rooms are always more or less expensive than hospital emergency rooms or urgent care centers.
- Out-of-pocket costs vary depending on insurance coverage, facility type, and services provided.
When to Seek Emergency Care
Based on verified emergency care guidance:
- Symptoms such as chest pain, severe difficulty breathing, heavy bleeding, serious injuries, or neurological symptoms require immediate medical evaluation.
- Emergency medical services (911) should be contacted for life-threatening situations or severe trauma, as first responders can begin life-saving care before arrival at an emergency facility.
What We Don’t Know Yet
The following gaps are explicitly acknowledged within the verified claim set in this article:
- There is no single, nationwide standard confirming that all freestanding emergency rooms provide identical services, staffing, or capabilities as hospital-based emergency departments.
- There is no high-quality evidence supporting a single regulatory model that applies uniformly to all freestanding emergency rooms nationwide.
- There is no universal evidence standard describing identical transfer protocols across all freestanding emergency rooms.
- There is no high-quality evidence confirming that most freestanding emergency rooms accept all major insurance plans, Medicare, or Medicaid.
- There is no definitive evidence that freestanding emergency rooms are always more or less expensive than hospital emergency rooms or urgent care centers.
Frequently Asked Questions
Are freestanding emergency rooms real emergency rooms?
They are recognized emergency care facilities, but definitions and classifications differ across professional organizations and government data sources.
Do freestanding emergency rooms operate 24/7?
Some do, but not all data sources require 24/7 operation, and availability varies by facility and state.
Do freestanding emergency rooms have inpatient beds?
There is no high-quality evidence supporting this. By definition, they are not physically connected to inpatient hospital services.
Are freestanding emergency rooms regulated?
Yes, but regulation varies significantly by state, and there is no single national regulatory standard.
What is a freestanding emergency room?
A freestanding emergency room is an emergency care facility that is not physically connected to a hospital’s inpatient services. Definitions vary among authoritative sources.
What is the difference between a freestanding emergency room and a hospital ER?
Evidence supports differences in location and physical connection to inpatient services. Claims that quality or scope of care is always identical are not universally supported.
Are freestanding emergency rooms open 24/7?
There is no high-quality evidence supporting this as a universal requirement.
Are freestanding emergency rooms cheaper than hospital ERs?
There is no high-quality evidence supporting this.
Can ambulances take patients to freestanding emergency rooms?
There is no high-quality evidence supporting a universal rule. Destination decisions depend on local protocols and medical need.
APA Reference List
American College of Emergency Physicians. (2015). Freestanding emergency departments and urgent care centers (Information paper). https://www.acep.org/siteassets/uploads/uploaded-files/acep/clinical-and-practice-management/resources/administration/fsed-and-ucs_info-paper_final_110215.pdf
Centers for Medicare & Medicaid Services. (n.d.). Emergency Medical Treatment & Labor Act (EMTALA). https://www.cms.gov/medicare/regulations-guidance/legislation/emergency-medical-treatment-labor-act
Centers for Medicare & Medicaid Services. (n.d.). State Operations Manual (SOM): Appendix V—Interpretive guidelines—Responsibilities of Medicare participating hospitals in emergency cases (EMTALA). https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_v_emerg.pdf
Medicare Payment Advisory Commission. (2017). Stand-alone emergency departments (Chapter 8). https://www.medpac.gov/wp-content/uploads/import_data/scrape_files/docs/default-source/reports/jun17_ch8.pdf
Scott, K. W., & Sabbatini, A. K. (2025). Unpacking the financial risks of freestanding emergency departments. JAMA Network Open, 8(7), e2522883. https://doi.org/10.1001/jamanetworkopen.2025.22883