Acute care facilities outside of the hospital, also known as freestanding emergency clinics (FECs), are able to deliver much faster care for “emergent” conditions than their in-hospital counterparts. That’s the claim made by Eric McLaughlin, MD, the medical director at Elite Care Emergency Center in Houston, Texas.
McLaughlin discussed his research and experience working in both high-volume hospital based facilities and in FECs in a recent article for Emergency Physicians Monthly. He compared data from eleven FECs in Texas to data from the National Institutes of Health, finding that patients routinely received care faster at the FECs, even for more serious complaints like abdominal pain and chest pain. Even for STEMI “door-to-balloon” times at the receiving cath lab, FECs were able to average 67 minutes overall.
Increased efficiency is among the many reasons that FECs are growing in popularity. “Our clients are finding that these facilities meet key needs for both patients and their business strategies,” said Scott Duckworth, regional vice president of Brasfield & Gorrie Regional, a construction company building FEC facilities throughout the country. A Brasfield & Gorrie blog post listed several key factors are driving the growth of freestanding EDs: reduced crowding (which contributes greatly to faster care), improved access (particularly In rural areas), greater convenience for patients in suburban areas, growth opportunities for hospitals and other owners, similar billing practices to traditional ERs, and lower cost of construction.
The National Association of Freestanding Emergency Centers (NAFEC) hosted its first annual conference in June. During the conference, emergency physicians, practice managers, owners, and others gather to discuss the history and benefits of FECs, but also addressed some of the controversy surrounding the growing number of FECs, including Medicare and Medicaid’s unwillingness to pay for facility fees in FECs that aren’t owned by a hospital.
According to a June Modern Healthcare article, Daniel Sternthal, a conference presenter and Houston attorney advising the group, said one of the first items on the agenda for the NAFEC is to establish quality standards for FECs, comparable to current hospital-based EDs, in order to address concerns among lawmakers and regulators and to help them grow more comfortable with this new model.
“It’s clear these guys are disruptors, so there are going to be challenges,” Sternthal told Modern Healthcare.
Another key element of the conference was to equip attendees to join the lobbying movement.
While, FECs have been operated by hospitals and health systems for years–currently there are 400 to 500 such centers in more than 40 states– independent ERs with no connection to a hospital are relatively new. Some are owned by doctors. Others are owned by larger companies. Currently, not all states even allow independently owned FECs, though most states will allow hospital-owned FECs.
Even physicians are torn between the two models. Some believe hospitals, with their large investment in resources like imaging centers and laboratories, better serve patients, while others believe independently own FECs are a more nimble option in a change healthcare industry.
Perhaps Dr. Paul Kivela, an emergency-medicine doctor in Napa, Calif., who serves as vice president of the American College of Emergency Physicians, said it best with his both-and perspective. “I don’t think it would be a good thing if these free-standing facilities take away the paying patients from the ER,” he told Modern Healthcare. “But I don’t think every community can support a full-service hospital.”
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