Home >> ALL ISSUES >> 2017 Issues >> Diagnostics anchor freestanding ED

Diagnostics anchor freestanding ED

image_pdfCreate PDF

Anne Paxton

June 2017—To the business world, “appropriate technology” may evoke the era of tie-dyed shirts, bead curtains, and Mother Earth News. But the term, coined by Small Is Beautiful author E.F. Schumacher in 1973, comes close to describing the goal of health care systems as they opt to expand their facility footprint with freestanding emergency departments (FSEDs).

ohiohealth02_CMYK_KE

OhioHealth in February opened its first all point-of-care testing freestanding ED. “We don’t have a lab test missing that would be a key diagnostic indicator,” says Duane Perry (right), here with Dr. Mark Foran and Marci Dop.

Decentralized, autonomous, smaller-scale extensions of traditional hospital EDs—or, in the case of independent FSEDs, distinct and separate from hospitals—FSEDs are cutting emergency room wait times with their on-demand services, while reaffirming the maxim that bigger is not necessarily better. The Centers for Medicare and Medicaid Services distinguishes between hospital outpatient departments, which the CMS covers, and independently owned FSEDs, not recognized by CMS and considered out of network by many insurers, often requiring patients to pay the ED facility charges and other costs. FSED charges are equivalent to hospital charges, but FSEDs incur considerably lower overhead costs. Both forms of FSED promise easier, faster access and more responsiveness to the needs of their community.

At least in theory. With some 400 FSEDs now established in 32 states, and more on the drawing board, the model has won many proponents since it emerged about eight years ago. In Colorado and, most notably, Texas, where a 2009 law allowed licensing of EDs separate from hospitals for the first time, the spread of FSEDs has been remarkable. But investors’ enthusiasm was shaken by the bankruptcy, announced in April, of early, fast-rising industry leader Adeptus. Operating on a for-profit basis, Adeptus staked its fortunes on operating a network of 90 of its own independent FSEDs and those of health systems with which the company partnered. With the company’s setbacks, the question naturally arises: Can emergency rooms detached from a hospital survive and thrive?

The 11-hospital, not-for-profit OhioHealth system, the largest health system in the state, has the experience to answer with a resounding yes as it continues expanding its network of FSEDs. The health system believes it is well on its way to putting an OhioHealth ED within a 10-minute drive of anyone who lives or works in central Ohio.

“Making overcrowded hospital EDs bigger and bigger is an option that a lot of health systems and hospitals undertake,” says Mark Foran, MD, MPH, OhioHealth’s senior medical director of ambulatory care. “I think the uniqueness of the OhioHealth perspective is to say, instead of making a 48-bed expansion in one of our big hospital-based EDs, there is a better way to decompress hospital-based EDs.”

“Over the last four or five years, we’ve developed a lot of expertise and have innovated a great deal in many areas, including what we do with our lab tests,” says Dr. Foran. “One of the goals with our model is to make the lab testing, the imaging personnel, and the professional team working in these facilities as lean as possible, so the overall cost is lower than what you would see in a hospital-based ED.”

Susan A. Fuhrman, MD, director of OhioHealth Central Laboratories and chair of pathology at Riverside Methodist Hospital, says FSEDs are here to stay for a while because they are so convenient for patients. “Particularly as our emergency rooms become more and more overcrowded, I think we’re going to have to embrace this new challenge. It’s an opportunity for the lab to become a significant partner in providing quality care to this group of patients.”

As laboratorians, “We do a great job, but we’re like hot and cold running water; we don’t get a lot of visibility and nobody knows how complicated our work is. Our visibility as laboratorians has gone up enormously because of FSEDs.”

OhioHealth built its first FSED in 2012 in the Columbus suburb of Westerville; a second one was built in Pickerington in 2015. These two 16-bed “medical campuses” are the larger of the two FSED models OhioHealth is implementing. The 16-bed model has a full-service on-site laboratory that employs medical technologists and does 24/7 reporting. Also on site are emergency physicians, a full-time lab supervisor, a full radiology suite, and a pharmacy, while a part-time CLIA director makes regular visits.

CAP TODAY
X