Free Standing ERs

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Screw the GST
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Nov 24, 2002
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We have one in our group, and it's no faster than any of the other EDs that we cover; it simply doesn't have an inpatient unit or any consult services attached to it.

Admissions go downtown, or to the community hospitals if they're full downtown or the pt's doc admits at one of the other ones.

In this case, it's 'freestanding', but is NOT a "doc in the box" place; it's completely integrated into the health system.


I have worked at 2 such facilities that are prototypes for this; staffed with em docs and pa's, ct, u/s, and lab on site, ties to a larger facility with guaranteed transfers for admission( ie they can never be on divert to us).
on the positive side they can do most of what a regular ed can do for pts not requiring surgical intervention. on the downside if you need a surgeon/ortho/ent etc to take the pt to the o.r. they need to be transfered to another facility with an o.r./icu/etc
so for the 90%+ of pts who don't require emergent operations it's a great concept. for anyone really just needing a surgeon and all the bells and whistles of a full hospital(icu, etc) a stop at this facility is a delay in care when the "real" hospital is usually within the same town and within 30 min of driving.
my current facility is thinking about adding one as part of a new medical complex that includes a medical specialty office building and outpt ambulatory surgical ctr so it would have an o.r. and availability of specialty consults during the day but no beds for admissions after surgery.


Chronically painful
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Nov 27, 2002
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Most of the controversy about these places involves the economics. One of the reasons these places have proliferated is that the big university med center type places have seen their payor mixes deteriorate despite the fact that they have good reputations in the community (or at least they think they do). So these places were looking for ways to tap into the high payor mix suburbs without actually having to go to the massive expense of opening additional full service hospitals. One solution was opening stand alone EDs in the suburbs who would feed transfers to the mother ship. Just for reference another way to do this was to open primary care clinics with the name of the U hospital that would feed admissions.

The argument against stand alone EDs is that they don't provide the range of services that an actual hospital would and the people in the community are poorly served by having their loved ones trucked downtown making it tough to visit, confer with docs and so on. By existing these places ward off actual hospitals from coming in because they would have to compete with the EDs and the name.

I don't really have a stand on the issue but those are the sticking points.

The White Coat Investor

Practicing Doc and Blogger
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Nov 18, 2002
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This isn't all that different from one place I work. For 2 years nearly every patient I admitted had to be transferred (we had no telemetry or ICU and were missing many specialties (neuro, GI, cards etc). It's not big deal if you have a low admission rate. If you have a standing agreement for admissions that makes it even easier. The patients get an extra bill, of course, for the transfer though. That isn't cheap.