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The ED Stands Alone

John Commins, for HealthLeaders Magazine, June 13, 2008
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A growing number of hospitals are considering freestanding emergency departments as a way to reach more patients and improve efficiency. But not everyone is convinced such facilities are everything they claim to be.

Freestanding emergency departments can create greater efficiency for medical staffs that are stretched thin, provide critical-access services to underserved communities, reduce ER congestion at hospital main campuses, and pare life-saving minutes from emergency response times. Or …

Freestanding emergency departments are some hospitals' attempts to end-run an arduous, lengthy, costly, and litigious state government approval process, to build a facility in an affluent neighborhood outside of the main campus' service area, and cherry pick wealthy patients from rival health systems.

When it comes to freestanding EDs, both schools of thought have plenty of devotees in the healthcare community. The number of such facilities nationally is gradually rising—but does the concept of a freestanding ED present too many financial, logistical, and staffing challenges to become the next major provider trend?

Morton Plant Mease Health Care falls squarely in the pro-freestanding ED camp. Patient need was the driving factor in the Clearwater, FL-based system's March opening of a $9 million, 15,000-square-foot freestanding ED on its Bardmoor campus in Largo, says Kelly Triolo, director of patient care services at the four-hospital nonprofit system. Research on the South Pinellas County area projected approximately 84,000 ED visits within a four-mile radius of the Bardmoor campus, she says, adding that hospital EDs in that radius could not accommodate all 84,000 visits.

The facility is already seeing volumes that are "more than we had anticipated" at between 45 and 48 patients per day, says Triolo. "It just goes to show that our research was correct. People were needing something closer to home." Roughly 14% of the patients seen at the Bardmoor freestanding ED are admitted to Morton Plant Hospital in Clearwater and other nearby hospitals, Triolo says.

While freestanding EDs are opened ostensibly for patient need, improving access or efficiency, critics say that such facilities are rarely built near public housing projects or trailer parks.

Dennis Vonderfecht, president and CEO of Johnson City, TN-based Mountain States Health Alliance, acknowledges that freestanding EDs have the potential to fill a need in underserved or fast-growing areas. But Vonderfecht contends that rival Wellmont Health System's attempt to build a $41 million, 30,000-square-foot freestanding ED on a 73-acre site in the affluent Boones Creek area of Tennessee's Washington County was "a market-share grab for our insured patients." The proposal would have placed the Wellmont facility less than four miles from MSHA's soon-to-be-built Franklin Woods Community Hospital, which will feature a large emergency department.

Kingsport, TN-based Wellmont did not respond to HealthLeaders' request for an interview. But press releases from the health system late last year quoted President and CEO Richard Salluzzo, MD, as saying the facility, which would have been the first freestanding ED in Tennessee, would "address Washington County's most pressing healthcare need—timely access to high-quality, cost-effective medical care."

The Tennessee Health Services and Development Agency, which oversees hospital development and other healthcare construction costing $5 million or more, had rejected Wellmont's 2000 application to build a hospital on a different site. The subsequent freestanding ED proposal, which was rejected, as well, would have been "built to hospital-grade standards. We firmly believe that this was a stake in the ground to start a hospital," Vonderfecht says.

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