Time was, if your kid managed to split his head open during a rock fight with his friends, you took him to the hospital. Emergency rooms always came with full-service medical facilities attached, and getting treated invariably required long hours in a waiting room crowded with the sick, the bleeding and the homeless.

Times have changed. Today nearly 100 businesses offer some form of emergency medical care across the region. Instead of spending half the night in a hospital waiting to see a doctor for a non-life-threatening illness, many patients now chose to wait only 10 minutes to see one in a strip mall.

“Most of our patients fall into that category,” says Joseph Robertson, director of St. Luke’s Community Emergency Centers, “they need immediate care but they don’t want to call 911.”

St. Luke’s Episcopal was the first of the Houston hospitals to develop an off-site emergency center 10 years ago. Since then, it has added four more locations while, by Robertson’s count, the number of businesses catering to emergency patients around town has swelled to 91. That’s good news for patients in neighborhoods that lack a nearby full-service hospital. For example, St. Luke’s free-standing ER in Pearland has pretty much the same X-ray machines, lab equipment and doctor availability as their ER in the Medical Center.

Many new emergency facilities, however, do not, and at the moment patients are largely on their own when determining whether a given center can meet their needs.

X-ray that emergency center

In his tally of free-standing medical centers, Robertson says 58 percent describe themselves as places to go in an emergency, while only 15 percent are run by hospitals that actually face tight government regulations on emergency care. With so many new medical facilities vying for their business, it’s good for families to be familiar with what the emergency centers in their area actually do.

“Kind of like a tire store — nobody knows or cares where the tire store is until you have a flat,” Robertson says.

Check to see if a nearby emergency center is open 24 hours a day, preferably some time before a family member is writhing in pain at 2 a.m. Also, check out the company’s website to see if it offers the same services as a hospital ER and whether it has an arrangement with a hospital to transfer patients who need care beyond what the center can provide.

For less serious ailments, urgent care (as opposed to fully-equipped emergency departments that bill insurance companies at higher ER rates) remains an economical and convenient option. If you chose a free-standing ER, make sure it will accept your insurance. Many free-standing ERs don’t take Medicare or treat patients without insurance unless they pay upfront. Finally, don’t try to drive anywhere if you’re having a heart attack. In a crisis, seek immediate care from the firefighters and paramedics your taxes support.

“If you really think you have a life-threatening emergency, call 911,” Robertson says.

New Competition, New Rules

As free-standing emergency departments flourished in Texas over the last few years, hospitals in many community cried foul. With emergency centers going up in more affluent neighborhoods, many hospital administrators complained that they siphon off insured, higher-paying customers while rejecting people less likely to pay who full-fledged hospitals are required by law to treat if they show up in the ER.

In Houston, the array of new emergency centers hasn’t greatly reduced the crowds at big Medical Center emergency rooms, Robertson says. It has affected the mix of paying and charity cases, though, which he speculates is part of the reason The Methodist and Memorial Hermann hospitals opened new emergency centers last year.

While the growth of free-standing emergency wards seems unlikely to abet any time soon, it’s tough to tell what the industry will do in the next few years. A bill recently passed in the Legislature will license non-hospital emergency centers for the first time starting in September. The law outlines minimum staffing levels, hours and rules requiring them to evaluate and stabilize anyone who shows up, even if they’re broke.

Regardless of how the new rules affect the market for emergency care, patients in Houston face more choices than they ever before. To the delight of many parents seeking stitches for their kids, that can mean a wait time as short as the drive. It’s just important to know what kind of care to expect when they get there.