The Impact of Two Freestanding Emergency Departments on a Tertiary Care Center

Simon, Erin L.; Griffin, Peter; Jourıles, Nicholas

doi:10.1016/j.jemermed.2011.06.099

Cited by 3 publications

(4 citation statements)

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“…Initial data show that they may reduce ED crowding in neighboring hospitals while increasing the volume of emergency care delivered in a region. 7 Although questions remain on how best to implement freestanding EDs on a permanent basis, 6 such facilities may Rebuilding Emergency Care After Hurricane Sandy Disaster Medicine and Public Health Preparedness serve a unique, transitional role when inpatient care is compromised in disasters. Permanent freestanding EDs are constructed following a period of market analysis with established provider agreements, referral networks, and transfer arrangements.…”

Section: Discussion Freestanding Emergency Departmentsmentioning

confidence: 99%

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Rebuilding Emergency Care After Hurricane Sandy

Lee

Smith

McStay

et al. 2014

Disaster med. public health prep.

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A freestanding, 911-receiving emergency department was implemented at Bellevue Hospital Center during the recovery efforts after Hurricane Sandy to compensate for the increased volume experienced at nearby hospitals. Because inpatient services at several hospitals remained closed for months, emergency volume increased significantly. Thus, in collaboration with the New York State Department of Health and other partners, the Health and Hospitals Corporation and Bellevue Hospital Center opened a freestanding emergency department without on-site inpatient care. The successful operation of this facility hinged on key partnerships with emergency medical services and nearby hospitals. Also essential was the establishment of an emergency critical care ward and a system to monitor emergency department utilization at affected hospitals. The results of this experience, we believe, can provide a model for future efforts to rebuild emergency care capacity after a natural disaster such as Hurricane Sandy. (Disaster Med Public Health Preparedness. 2014;0:1-4).

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Section: Discussion Freestanding Emergency Departmentsmentioning

confidence: 99%

“…In areas with sufficient inpatient capacity, freestanding EDs have emerged as an alternative to traditional hospital-based EDs. Initial data show that they may reduce ED crowding in neighboring hospitals while increasing the volume of emergency care delivered in a region 7 …”

Section: Discussionmentioning

confidence: 99%

Rebuilding Emergency Care After Hurricane Sandy

Lee

Smith

McStay

et al. 2014

Disaster med. public health prep.

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“…Previous research has demonstrated that hospitalbased ED volumes declined significantly when freestanding EDs opened within a twelve-mile radius, despite the fact that the overall ED volume in that particular health care system increased. 15 Theoretically, if freestanding EDs cause hospital-based EDs to have lower patient volumes, hospital-based EDs might have lower waiting times. However, our analysis showed that the entry of freestanding EDs did not significantly affect the waiting times of nearby hospital-based EDs.…”

Section: Policy Implicationsmentioning

confidence: 99%

Freestanding Emergency Departments Preferentially Locate In Areas With Higher Household Income

Dark

2017

Health Affairs

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Freestanding emergency departments (EDs) are a relatively novel phenomenon, and the epicenter of this movement is in Texas. Limited evidence exists about the communities in which freestanding EDs locate or the possible reasons behind location choice. We estimated logistic regressions to determine whether freestanding EDs in 2016 were more likely to be in areas of high demand or in those that could yield high profits. When we compared Public Use Microdata Areas that contained freestanding EDs and those that did not, we found that areas with such EDs had significantly higher household incomes. This finding was driven by the location choices of independent freestanding emergency centers and not by those of hospital-affiliated satellite emergency centers.

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“…One study of a hospital ED at a tertiary care center found that patient volume fell 7.5% during a period of 3 years when two FrEDs opened nearby, while total patient volume for all three facilities combined rose 45% . Another study found that Medicare expenditures per beneficiary were $55 higher for each FrED that entered a county between 2003 and 2009.…”

Section: Discussionmentioning

confidence: 99%

Freestanding Emergency Department Entry and Market‐level Spending on Emergency Care

Akhter

2019

Academic Emergency Medicine

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Background: Freestanding emergency departments (FrEDs) could reduce wait times in overcrowded emergency departments (EDs), but they might also increase usage and overall spending for emergency care. We investigate the relationship between the number of FrEDs entering a local market and overall spending on emergency care. Methods:We accessed data from Arizona, Florida, North Carolina, and Texas in Blue Cross Blue Shield Axis; a limited data set of deidentified insurance data claims that we linked to Public Use Microdata Area (PUMA) data from the American Community Survey; and lists of licensed FrEDs from state agencies. Regression analysis was used to estimate the association between changes in the number of FrEDs in 495 PUMAs and total spending on emergency care, out-of-pocket spending, utilization, and price per visit from January 2013 to December 2017. Final estimates came from a PUMA-level fixed-effects model, with controls for state, quarter, and PUMA-level demographics.Results: Entry of an additional FrED in a PUMA was associated with a 3.6 percentage point (pp; CI = 2.4 to 4.9) increase in emergency provider reimbursement per insured beneficiary in Texas, Florida, and North Carolina. There was no change in spending (2.5 pp; CI = À8.2 to 3.1) associated with a FrED's entry in Arizona. Entry of an additional FrED was associated with a 0.18 (CI = 0.12 to 0.23) increase in the number of emergency care visits per 100 enrollees in Texas, Florida, and Arizona. In contrast, entry of another FrED was not associated with a change in utilization (À0.03; CI = À0.09 to 0.02) in North Carolina. Estimated out-of-pocket payments for emergency care increased 3.6 pp (CI = 2.5 to 4.8) with the entry of a FrED in Texas, Florida, and Arizona, but declined by 15.3 pp (CI = À26.8 to À3.7) in North Carolina.Conclusions: Rather than functioning as substitutes for hospital-based EDs, FrEDs have increased local market spending on emergency care in three of four states' markets where they have entered. State policy makers and researchers should carefully track spending and utilization of emergency care as FrEDs disseminate to better understand their potential health benefits and cost implications for patients.

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The Impact of Two Freestanding Emergency Departments on a Tertiary Care Center

Abstract: States and Canada and whether opportunities exist to render care in a more cost-effective manner.

Cited by 3 publications

References 0 publications

Rebuilding Emergency Care After Hurricane Sandy

Rebuilding Emergency Care After Hurricane Sandy

Freestanding Emergency Departments Preferentially Locate In Areas With Higher Household Income

Freestanding Emergency Department Entry and Market‐level Spending on Emergency Care

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