Hospitals expand reach with stand-alone ERs

One recent evening after office hours, Dr. James Magee got a phone call about a patient, a woman in her 40s. She complained of tingling on one side of her body, in her arm and leg. Could it be a stroke?

Magee told the woman’s husband to rush her to the free-standing emergency room downstairs from his office in Southwest suburban Homer Glen. He told the man: “This is not something that can afford to wait.”

The convenience of 24-hour emergency care may be coming to more Illinois communities as hospitals make plans to build stand-alone ERs up to 50 miles from their flagship facilities.

For hospital executives, it’s a way to expand turf, compete for patients and prepare for an aging population and more Americans gaining insurance under the federal health overhaul law. For families who live far from a hospital, stand-alone emergency rooms provide the comfort of knowing trained doctors and nurses are nearby and ready to handle most health crises.

But for the health care system as a whole, the trend could raise costs, particularly if more patients use emergency rooms for nonemergency problems instead going to an urgent care clinic or primary care provider.

While hospitals and insurance companies contest the question of costs, Illinois is poised for a possible miniature boom in miniature ERs. The state now has five stand-alone emergency rooms. In Southwest suburban Frankfort, two hospitals are competing to build another after state lawmakers last year extended a sunset date for new licenses.

Fewer than 300 hospitals in the U.S. have free-standing emergency departments, nearly double what it was in 2005, according to an American Hospital Association survey.

Dr. Alex Rosenau, president-elect of the American College of Emergency Physicians, said he expects demand for emergency care to increase as President Barack Obama’s health care law expands the number of people with insurance starting in 2014.

“Urgent care centers will probably expand. And hospitals may see fit to open more free-standing emergency departments,” Rosenau said.

Urgent care centers can handle problems that aren’t life-threatening, such as sprains, cuts, insect bites and simple broken bones. They usually are open late and on weekends.

In contrast, free-standing emergency centers are staffed around the clock. They can handle many life-threatening emergencies, although patients who need surgery and other complex procedures are transferred to full-service hospitals. They generally are equipped with imaging tools such as CT scanners and MRI machines.

Blue Cross and Blue Shield of Illinois spokesman Michael Deering said free-standing ERs “demand significantly higher reimbursement rates from insurers than an urgent care clinic or a retail clinic because they bill for costly facility fees that urgent and retail clinics do not.” Deering is worried patients will be confused about where they should seek care.

Hospital leaders counter that patients usually know when they need an ER and when they need urgent care.

The Illinois health planning board will decide which hospital system — if any — will get a permit for the Frankfort facility. Hospitals nearby are worried a competing ER would siphon away nurses and contribute to a staffing shortage.

Hospitals nationally have been using free-standing ERs to attract patients in prosperous suburbs with growing, well-insured populations, said Emily Carrier, co-author of a 2012 study on hospital expansion and a senior health researcher at the nonpartisan Center for Studying Health System Change in Washington, D.C.

Free-standing emergency rooms cost less to build than full-service hospitals, she said, but hospitals can charge the same rates and transfer patients into their main hospitals.

“This is another tool that hospitals can use to grow. You can locate a free-standing emergency department in a community where you’d like to have a presence,” Carrier said. “It’s a way to get patients into the doors of your system.”

Another study found that most free-standing ERs are in urban areas, even though they originally were conceived as a solution for rural areas with no hospitals nearby.

Illinois law says each free-standing emergency department must be in a city with a population of no more 50,000. It must be staffed 24 hours a day by at least one board-certified emergency doctor. It must have an ambulance that can take patients to a full-service hospital if necessary. It must be owned by a hospital system and can’t be marketed as a hospital emergency department.

Riverside Medical Center in Kankakee and Silver Cross Hospital in New Lenox are competing to build the Frankfort center. Both systems have noted the area’s population growth. Silver Cross operates the existing Homer Glen free-standing ER.

“How we deliver health care keeps evolving and this is one more evolution in how we deliver health care closer to patients,” said Maggie Frogge, senior vice president of corporate strategy for Riverside Medical Center.

Magee, the Homer Glen doctor who is a member of the Silver Cross medical staff, said the patient with the possible stroke turned out to be suffering from something less life-threatening.

“We’re still in the process of sorting that out,” he said. He added that he’s grateful the stand-alone ER was available.

“That’s the kind of convenience that is good for me as a physician.”