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

To better understand the financial viability of hospital emergency departments (EDs), we created national estimates of the cost to hospitals of providing ED care and the associated hospital revenue using hospital financial reports and patient claims data from 2009. We then estimated the effect the Affordable Care Act (ACA) will have on the future profitability of providing ED care. We estimated that hospital revenue from ED care exceeded costs for that care by $6.1 billion in 2009, representing a profit margin of 7.8 percent (net revenue expressed as a percentage of total revenue). However, this is primarily because hospitals make enough profit on the privately insured ($17 billion) to cover underpayment from all other payer groups, such as Medicare, Medicaid, and unreimbursed care. Assuming current payer reimbursement rates, ACA reforms could result in an additional 4.4-percentage-point increase in profit margins for hospital-based EDs compared to what could be the case without the reforms.

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“…3,4 Furthermore, the emergence of freestanding EDs in some markets suggests that emergency care is profitable—at least for some visits. 5 …”

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confidence: 99%

Emergency Department Profits Are Likely To Continue As The Affordable Care Act Expands Coverage

Wilson

Cutler

2014

Health Affairs

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“…One survey counted 80 FEDs operating in 2007 (1.6% of all US EDs) 1 ; subsequently, the American Hospital Association reported 222 in 2009, 191 of which were hospital affiliated or “satellite” units 16 ; more recently, the New York State Department of Health found more than 400 in 45 states. 2 However, as Simon et al recently observed, research involving FEDS has yet to yield a precise definition.…”

Section: Background and Demographicsmentioning

confidence: 99%

Simulation for Operational Readiness in a New Freestanding Emergency Department

et al. 2016

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Summary StatementSimulation in multiple contexts over the course of a 10-week period served as a core learning strategy to orient experienced clinicians before opening a large new urban freestanding emergency department. To ensure technical and procedural skills of all team members, who would provide care without on-site recourse to specialty backup, we designed a comprehensive interprofessional curriculum to verify and regularize a wide range of competencies and best practices for all clinicians. Formulated under the rubric of systems integration, simulation activities aimed to instill a shared culture of patient safety among the entire cohort of 43 experienced emergency physicians, physician assistants, nurses, and patient technicians, most newly hired to the health system, who had never before worked together. Methods throughout the preoperational term included predominantly hands-on skills review, high-fidelity simulation, and simulation with standardized patients. We also used simulation during instruction in disaster preparedness, sexual assault forensics, and community outreach. Our program culminated with 2 days of in-situ simulation deployed in simultaneous and overlapping timeframes to challenge system response capabilities, resilience, and flexibility; this work revealed latent safety threats, lapses in communication, issues of intake procedure and patient flow, and the persistence of inapt or inapplicable mental models in responding to clinical emergencies.

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“…There are previous articles and research that looked into the travel distance, proximity of freestanding emergency departments as well as the presence of nearby UCCs on the census of the hospitals' EDs. They all demonstrated conflicting conclusions that may not reflect today's trends [10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Impact of Urgent Care Centers on Emergency Department Visits

Yakobi¹

2017

Health Care Current Reviews

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Background: Urgent Care Centers (UCC) and Retail Clinics (RC) have become popular as the need for convenient care continues to grow in light of long waits to be seen by Emergency Departments (ED). Objective:To analyze the impact of UCC on the ED census of nearby hospitals.Methods: This retrospective analysis examined census for the EDs located within 2 miles from UCC. The census was obtained for a period of January 2010 through December 2015 from four different hospitals in New York City. This period corresponds to the rapid expansion of UCC in the metropolitan area.Results: Although some variation was seen during certain years, there was an increase in ED census in the year 2015 as compared to that of 2010. About 100 UCCs operate among the various boroughs of New York City that are capable of addressing illnesses that are classified by ED as ESI Level 4 and 5. Insurance companies would prefer patients to be seen by these centers rather than in costly EDs. Also the overall healthcare cost could potentially benefit if roughly 20% of the ED visits were seen in UCC. Nonetheless, no impact on total ED census was observed. Conclusion:While UCCs are relatively new in New York City and the wait time is much shorter for simple illnesses, the presence of UCCs did not decrease the census of main EDs. It is anticipated that these alternative care centers will play a bigger role in the future.

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

Cited by 31 publications

References 6 publications

Emergency Department Profits Are Likely To Continue As The Affordable Care Act Expands Coverage

Emergency Department Profits Are Likely To Continue As The Affordable Care Act Expands Coverage

Simulation for Operational Readiness in a New Freestanding Emergency Department

Impact of Urgent Care Centers on Emergency Department Visits

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