Texas News

TAB's Daily Message for Sept. 22

Mr. Berrett makes some very good points.  What do you think? 

Bill Hammond
CEO

http://www.dallasnews.com/opinion/latest-columns/20160901-how-the-spread-of-freestanding-emergency-rooms-hurts-patients.ece

How the spread of freestanding emergency rooms hurts patients

By Britt Berrett
Contributor

Freestanding emergency rooms are expanding fast in North Texas. You can hardly drive down any major street in Dallas without seeing one. But are they good for patients?

Park Cities, Allen and Plano are the newest locations for these slick and efficient facilities that claim the capabilities and services of full-service emergency rooms, guaranteeing treatment without the wait of a hospital-based emergency room. In a sense, patients receive the convenience of an urgent care center, but they anticipate receiving the same quality of a hospital emergency service.

Unfortunately, urgent care is not the same as emergency care, and freestanding emergency rooms simply cannot provide the same level of emergency treatment as hospitals. Urgent care centers, or walk-in clinics, are usually open outside of regular business hours, including evenings and weekends. They are ideal for treating minor injuries, such as sprains, or illnesses like fever or sore throat. Emergency rooms — open 24/7 — are the best place for treating severe or life-threatening conditions. True ERs can handle trauma, X-rays and surgical procedures and have access to specialists.

The freestanding emergency room concept is not new. According to health care management consultant Cherilyn G. Murer, the facilities were established in the early 1970s to expand services to underserved and critical-access areas that cannot support the economic obligations of a dedicated hospital. The increased demand for emergency care has prompted the growth of these types of emergency rooms, as hospitals cut back on emergency departments.

It is expensive to sustain a full-service hospital with surgical suites and sophisticated imaging capabilities. It is even more difficult in smaller, rural communities.

In response, freestanding emergency rooms provide immediate care, with less urgent patients treated and discharged, and more complicated cases transferred immediately to affiliated hospitals with more robust facilities. It seems like a perfect solution to provide appropriate and quality care throughout the region.

Unfortunately, innovative medical entrepreneurs recognize an opportunity to label urgent care services as emergency room care and are able to charge accordingly. A typical urgent care visit may cost $50. But re-label it as an emergency room visit, and your average charge inflates to more than $300. Not a bad pricing strategy.

Freestanding emergency room advocates claim that consumers resent long waits in hospital emergency rooms and prefer a more convenient, efficient solution. While this may be true in some cases, we should also recognize that hospital-based emergency rooms are staffed with trained technicians and clinicians prepared to respond to the most critically ill. A burst appendix, full cardiac arrest or a severe stroke all require immediate surgical or diagnostic intervention.

A fully staffed surgical suite is available 24/7. The cardiac catheterization department times "door-to-needle" care, and the MRI is always available along with technicians for immediate treatment. Suffering a stroke? Clinicians are standing by to administer clot-busting medicines or initiate other protocols for emergent care. These are just a few examples of the preparation and readiness that a hospital-based emergency room provides. And consumers expect this level of care.

What they don't realize is that a freestanding emergency room is ill-equipped to treat these types of illnesses. Instead, the patient will be diagnosed and then transferred to a hospital-based emergency room for treatment. This wastes critical time to treatment and generates additional expenses for the second emergency room care.

But perhaps even less consumer friendly are the exorbitant charges incurred by the growing number of patients at freestanding emergency rooms. The arriving patient might pay a minimal co-pay or even a no-pay; however, consumers complain about charges after they leave. They are often bombarded with uncovered charges due to insurance plan design or high-end deductibles.

Freestanding emergency rooms are an example of health care entrepreneurs responding to consumer demands with good intentions to benefit economic interests. However, in many cases, these facilities stray far from the original intent to provide care in underserved areas and may even cost patients precious time for treatment in hospitals.

Britt Berrett is director of the undergraduate program in Healthcare Management in the Naveen Jindal School of Management at UT Dallas.