More emergency rooms open away from hospitals

Heart attack patients who walk into the Germantown facility, for example, can be assessed quickly and sent by ambulance to the center's parent hospital, Jepson says.

Maryland lawmakers allowed the new center, which opened in 2006, after much debate. They're studying it and one other pilot project before deciding whether to permit more. In Florida, where there are at least four stand-alone centers, lawmakers adopted a moratorium on new facilities in 2007. Gov. Charlie Crist then vetoed the legislation.

"A lot of states are looking at them, partly out of fear that there is something less safe about them," says Juliet Rogers of Karlsberger Health Care Consulting Group in Ann Arbor, Mich. "These actually fill a need, but they are definitely controversial."

What customers want …

Stand-alone emergency departments have their roots in a growing health care customer-service movement that also has spawned convenience clinics staffed by nurses in supermarkets and doctor-owned urgent care centers. Among reasons for building free-standing emergency departments: shortening travel times for suburban or rural residents; gaining a foothold in a growing suburb; and competing with a rival hospital, says consultant Rogers.

The construction of such centers comes as traditional emergency departments treat more patients. From 2001 to 2005, the number of ER visits rose from 101 million to 115 million, says Carlos Camargo, a Harvard Medical School professor who coordinates the National Emergency Department Inventory.

Stand-alone centers, especially those affiliated with hospitals, "can make sense," he says. "If you can build them in the suburbs, they could take care of a lot of visits quickly."

They also likely will drive up the total number of ER visits: "Like anything else in medicine, the more you make something available, the more it will be used," he says.

Insurance plans and Medicare generally pay for care in stand-alone emergency departments, just as they do for hospital-based ERs. Yet, care in an ER — whether free-standing or attached to a hospital — costs the patient and the insurance company substantially more than at doctor's offices or urgent care centers.

For the same type of outpatient visit, for example, Medicare reimburses medical providers $316 if a patient is treated in an emergency department, compared with $138 in an urgent care center. Emergency departments are open longer hours and generally have more staff, so overhead costs are higher.

Free-standing emergency departments also can draw the insured away from hospitals, which rely on paying patients to make up for money they lose treating the poor and uninsured, says Unland, president of the Health Capital Group, a health care consulting firm in Chicago.

Stephen Marshall, chief of staff at Overlake Hospital Medical Center in Bellevue, Wash., says no one has done a wide-ranging study of the quality of care that stand-alone emergency centers offer.

"We're building these things without proof that we're providing quality care," says Marshall, whose hospital has a nearby urgent care center but no stand-alone emergency department. A rival hospital, Swedish Medical Center, opened a stand-alone ER near Overlake in 2005.

Rules on such centers vary by state and region. Most states and local emergency service providers set guidelines on who can be taken by ambulance to the free-standing emergency departments.

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