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 These EDs provide round the clock emergency care but are separate
facilities from acute care hospitals. Freestanding EDs can provide
many of the same services as their traditional counterparts housed
inside hospitals – the big exception is they don’t admit patients
for ongoing care.
Nationwide, the number of freestanding emergency departments surged
62 percent to 360 as of March 2015, from just 222 in 2009,
researchers report in the Annals of Emergency Medicine.
When researchers took a look at the three states with the greatest
number of these freestanding EDs – Texas, Ohio and Colorado – they
found the facilities located in areas with population growth, higher
incomes, a higher proportion of people with private health insurance
and a lower proportion of residents with Medicaid, the U.S. health
insurance program for the poor.
“Freestanding EDs have the potential to increase access in several
ways: they can be located in areas without emergency care, like a
rural area, or they can open in an area without adequate emergency
care, for example, where hospital EDs have chronic long waiting
times,” said lead study author Dr. Jeremiah Schuur of Brigham and
Women’s Hospital and Harvard Medical School in Boston.
“Overall, in the three states we examined in this study,
freestanding EDs are not primarily locating to address the regional
access to care – rather they are more likely locating in areas where
the population has good payment sources, which are also more likely
to have more sites of health care like doctors’ offices and hospital
EDs,” Schuur added by email.
To assess where freestanding EDs are choosing to open up shop,
Schuur and colleagues analyzed population and demographic data by
ZIP code for these facilities and compared it to data for
hospital-based EDs within the same state.
Nationwide, about 54 percent of freestanding EDs are owned by, or
affiliated with, hospitals, while 36.6 percent are independently run
by physician groups or other entrepreneurs.
Across the country, 45 percent of freestanding EDs were for-profit
and 44 percent were non-profit.
In Texas, where there were almost 200 freestanding EDs, these
facilities were mostly concentrated around urban areas in ZIP codes
with fewer Hispanics, a greater number of hospital-based EDs and
physician offices and more physician visits and medical spending per
year, the study found.
Just 22 percent of the freestanding EDs in Texas were owned by or
affiliated with hospitals, while about 71 percent were for-profit
operations.
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Things looked different in Ohio, where all but one of the 34
freestanding EDs were affiliated with hospitals and only about 6
percent were for-profit, the study found.
The picture was more mixed for Colorado’s 24 freestanding EDs. About
46 percent were affiliated with hospitals and 62 percent were
for-profit.
More research is still needed to understand how the expansion of
freestanding EDs impacts access to care, outcomes and health
spending in local communities, the authors note.
“Freestanding EDs have the potential to provide emergency care to
the patients with less access,” Nitish Patidar, a researcher at
Quinnipiac University in Hamden, Connecticut, who wasn’t involved in
the study, said by email.
Paramedics may choose to bypass freestanding EDs when they transport
patients that may need intensive care, said Dr. Benjamin Lawner, a
researcher at the University of Maryland School of Medicine in
Baltimore, who wasn’t involved in the study.
“These facilities may not improve care for more complex medical
conditions because they’re simply not resourced with the same
inpatient beds and availability of specialists,” Lawner said by
email.
Generally, patients should choose the closest ED when they have a
true emergency, whether it’s freestanding or not, said Dr. Erin
Simon, a researcher at Northeast Ohio Medical University in
Rootstown, who wasn’t involved in the study.
“For less time critical emergencies where the patient feels they
have the time and convenience to choose a location, freestanding
emergency departments may represent a great alternative when (other
places) have long wait times or overcrowding,” Simon said by email.
SOURCE: http://bit.ly/2aryZ3h Annals of Emergency Medicine, online
July 12, 2016.
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