Free-standing emergency rooms seem to be emerging as a new category of healthcare facilities, at least in New York City. This according to a recent article about this trend (see: E.R., Not a Hospital, Is Set to Open at St. Vincent’s Site). Below is an excerpt from the article:
The shiplike building on Seventh Avenue that used to house part of St. Vincent's Hospital is reopening in the coming days as a stand-alone emergency room and medical care center....The new E.R. [called HealthPlex], however, is part of a trend that has as much to do with a hospital’s bottom line as it does with providing acute care. Free-standing emergency rooms...have sprouted up around the country in recent years, driven by competition to capture lucrative markets, like the neighborhoods around Greenwich Village. Operators of free-standing emergency rooms....say they fill an important void in areas without full hospitals. They can bring in significant revenue, since they are allowed to charge the same high fees that hospitals charge while having lower overhead. And, since half of admissions come from the emergency room, free-standing E.R.s can funnel patient business to their parent hospitals....The first free-standing emergency room in New York State opened in the Bronx last year, and three more have opened since....Operators of free-standing emergency rooms like the HealthPlex say they fill an important void in areas without full hospitals. But the HealthPlex also appears designed to be an advertisement for the larger North Shore system, and to attract the kind of wealthy West Village residents who avoided St. Vincent’s....Ambulances will not bring patients suffering major trauma, head or spinal cord injuries, heart attacks, acute strokes, psychiatric disturbance or pregnancy-related complications, among other maladies, to the HealthPlex. But...[a hospital representative] said that if someone with any of these conditions walked through the door, the doctors at the HealthPlex would do everything that would be done in a hospital-based emergency room to stabilize the person and then transfer the patient by ambulance to the nearest appropriate hospital....Dr. Howard Mell, a spokesman for the American College of Emergency Physicians, said that in about 1 percent of cases, minutes could make the difference between a good outcome and a bad one, and the extra time for the transfer might be detrimental. But, he said, there were also cases in which getting to an emergency room sooner — because a free-standing emergency room had opened in an area that lacked a hospital — could be lifesaving.
So, like many initiatives in healthcare, the quest for increased revenue seems to be one of the main drivers in the development of free-standing ERs. The hospital systems that own them are allowed to charge the same rates for services as they do in the case of an embedded hospital ER. However, free-standing ERs don't incur the cost of expensive inpatient units such as the critical care units. They thus benefit from higher profit higher margins while, at the same time, providing the opportunity for inpatient admissions to nearby local hospitals within their system. Residents of the neighborhood benefit from rapid attention if they have a acute medical issues but suffer from the disadvantage of needing to then be transported to an inpatient facility for further treatment.
As I have pointed out in previous notes, we now have the following continuum for routine to emergent healthcare in larger cities: office visit to a PCP or visit a walk-in clinic for simple matters > urgent care clinics for minor injuries or illnesses > free-standing ERs for serious problems (these may require transport to a nearby hospital) > typical hospital ER visit with possible inpatient admission. There is also a gradient of cost across these facilities. This is important for patients with no health insurance or a high-deductible policy to understand. Urgent care facilities provide treatment at a fraction of ER costs (see: Rapid Growth of Urgent Care Clinics; Cost Competition for Hospital ERs). This complex health delivery system puts pressure on consumers who often need to perform self-triage in order to get themselves to the best facility for their problem.