By Cindy Krischer Goodman | [email protected] | South Florida Sun Sentinel
Free-standing emergency rooms are spreading all over South Florida, extending the reach of hospitals into fast-growing suburbs.
In Broward, Palm Beach and Miami-Dade counties, about 30 standalone emergency rooms have opened, are under construction or planned.
For residents in cities like Pembroke Pines, Deerfield Beach or Boca Raton, the burst of development brings emergency care closer to home. These standalone ERs are intended to be more convenient than a longer drive to a hospital and typically have shorter wait times.
For health systems, the new construction in targeted neighborhoods is a way to boost their bottom line, lure privately insured patients, and serve an area without the cost of building a full-service hospital.
"Emergency departments are the front door of a hospital, which is why they want to make them readily available," said Steven Ullmann, professor and director of the Center for Health Management and Policy at Miami Herbert Business School. "It's a way to draw patients into a hospital system."
Almost every major health system in Florida has built at least one free-standing ER or has one underway. "As long as there is population growth, there are going to be more free-standing ERs," Ullmann said.
HCA Healthcare is one of the hospital companies in the state that is participating more aggressively in this wave of development. It now has 63 free-standing ERs in Florida and at least a half-dozen more planned or under construction.
"In an emergency, minutes matter," said John Gerhold, CEO of HCA Florida Lake Monroe Hospital. "We are strategically building free-standing emergency rooms in neighborhoods where the population is growing to increase access to emergency care. It may be much quicker for a patient to get to one of our free-standing emergency rooms than to drive across town through traffic to a hospital." HCA Florida also has 48 hospitals in the state.
Emergency physicians and ER-trained nurses who staff these standalone locations have the equipment and medication to treat potentially serious medical conditions. However, they don't have overnight beds and can't provide high-level care for severe trauma.
Experts caution that patients should understand if they have a high-level emergency or need to be admitted, physicians at a free-standing ER will transfer them by ambulance to a full-service hospital. They could be waiting for a bed to open up in a hospital while at a facility that lacks the high-level care they require.
Patients also need to know that their bill and their co-pays at a standalone ER will be as high as if they went to a hospital ER.
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Research shows free-standing ER bills can be up to 10 times the cost of a comparable visit to an urgent care center, primarily because of a facility fee charged by hospitals. The teacher retirement system in Texas has warned its members to avoid free-standing emergency rooms: "They can cost you hundreds or even thousands more for care ... unless your issue is life-threatening, urgent care clinics are more affordable."
Daniel Marthey, a researcher at Texas A&M who studies free-standing ERs, said many patients go to these ERs for problems that could be treated at a lower-cost urgent care center. "I think some people can't tell or don't know the difference between urgent care and free-standing EDs."
"They are trying to compete with urgent care, and in a lot of ways, that makes them dangerous for patients who don't know the difference in cost," Marthey said.
These off-site ERs must treat all patients, regardless of their ability to pay, and are open 24 hours a day, 7 days a week. They have equipment like defibrillators, imaging machines and on-site laboratories. They are ideal for cuts that need stitches, severe burns, chest pain or seizures.
Most urgent care centers are open for limited hours and have limited lab and X-ray capabilities. They are better for minor ailments like fever, cough, earaches or sprains.
It is the 24/7 convenience of free-standing ERs that often serves as a lure.
"Research shows when a nearby urgent care facility closes at the end of business hours, there's an increase in patients with emergent conditions showing up in free-standing ED who could have been treated in urgent care," Marthey said.
Many Americans have difficulty accessing primary care, and tend to go without it. Nancy Batista-Rodriguez, CEO of Baptist Outpatient Services, said that plays a role in the popularity of free-standing ERs, particularly those built in health deserts.
"There's a lack of primary care in many markets, so patients' conditions may get worse, and depending on the time of day and the situation, people need the care they need," she said. "We do see more people moving to Florida and looking for convenience."
An advantage of standalone emergency rooms and the new construction is they are operationally designed for quick response and minimal waiting time. Patients tend to be quickly checked in and taken to a bed.
Batista-Rodriguez said the long wait times in the ED at Baptist Health's Kendall Hospital prompted the construction of the system's first standalone emergency room, Baptist Health Emergency Care in West Kendall. "We had to look at solutions for how to solve that problem for our patient base."
Baptist Health South Florida now operates three free-standing EDs in South Florida and has three new facilities under construction, along with one planned in Pembroke Pines.
"Our goal is to get our patients who are coming for less acute things to be treated and sent home in a reasonable amount of time. Usually, about two-and-a-half hours is the goal," Batista-Rodriguez said.
In Broward County, established public health systems like Broward Health and Memorial Healthcare are building free-standing ERs, marking the first time in their long history they are expanding into this type of emergency medicine. The new structures are part of the hospitals' strategy to target higher-income, privately insured patients and funnel them into their system instead of a competitor's. The two health systems also are building one together in Sunrise.
"The goal is to create more access points to Memorial throughout the district and to provide care as close to our patients' neighborhood as possible," Mark Greenspan, vice president of Construction & Property Management for Memorial Healthcare System, told the South Florida Sun Sentinel.
Greenspan said the new ERs will relieve pressure and improve wait times in the emergency department at Memorial West in Pembroke Pines, known for its long wait times and patients overflowing in hallways.
Memorial's construction in Pembroke Pines comes as competitor Baptist Health South Florida plans to build a free-standing ER in the same city. HCA Florida Healthcare also has one planned on land it purchased nearby.
To compete, Batista-Rodriguez said Baptist Health will also build an office complex with its Pembroke Pines ER, allowing emergency physicians to refer patients to its primary care, brain and spine, and heart specialists in the attached building for follow-up.
Urgent care centers have blanketed the suburbs of South Florida, creating an alternative to primary care for many patients. They are primarily staffed with medical providers who practice family or internal medicine rather than emergency medicine.
Batista-Rodriguez said Baptist Health already operates 20 urgent cares in the South Florida market. "Our urgent care service line is more mature. I think we reached our cap," she said.
Holy Cross Health of Fort Lauderdale operates an urgent care center in Fort Lauderdale and one in Coral Springs. Now, it is building a free-standing ER in Deerfield Beach, a bold expansion into a new community. Palm Beach Health Network, composed of six Tenet Healthcare Corporation hospitals, also ventured into free-standing ERs, with one in Coral Springs and another in Lake Worth. It has a third planned for Avenir, a new community in Palm Beach Gardens.
Ullmann at the University of Miami said these new structures will benefit the hospital systems despite competition. "Even if the ERs are not highly utilized, any patient coming through who has better financial means and good insurance has the potential to fill the hospital itself."