A push by hospitals to build detached emergency rooms miles away from their doorstepseven in an adjacent cityhas sparked a Florida legislative debate over how to regulate their construction and oversight.
Competing bills in Floridas Legislature seek to address concerns over where to build free-standing ERs and how regulators can guarantee patients receive quality emergency care far from the hospitals that run them. The legislation comes as Floridas Agency for Health Care Administration considers requests from two hospitals to open satellite ERs after a two-year ban on their development expired in July 2006.
Morton Plant Hospital, in Clearwater, won initial approval for an $8 million ER adjacent to its Bardmoor Outpatient and Surgery Center, in Largo, six miles south of the 524-bed hospital, said Philip Beauchamp, president and chief executive officer of four-hospital Morton Plant Mease Health Care.
Floridas Agency for Health Care Administration is also reviewing 685-bed Mount Sinai Medical Centers architectural plans for a detached ER, said agency spokeswoman Shelisha Durden, in an e-mail. Officials for Miami Beach-based Mount Sinai were unavailable for comment, spokeswoman Kathleen Dorkowski said.
Hospitals with the free-standing centers say they fill a need in communities they serve, though some wonder if theyre being built to battle competitors. Construction of the ERs doesnt require certificate-of-need approval. The bills have not been endorsed by the Florida College of Emergency Physicians, said Vidor Friedman, chairman of the groups governmental affairs committee and Florida Hospital Celebration Healths director of emergency services and chief of staff. Any regulation should ensure that satellite ERs are not built to snag market share from competitors, Vidor said. Rules should also guarantee ERs offer the same access and services provided by hospitals existing ERs, he said.
The Florida maneuvering comes amid a national effort to improve funding and quality of emergency care. The U.S. House of Representatives passed a bill last week that would authorize $12 million in grants to states, cities and counties by 2008 to increase the availability of trauma care nationwide. Co-sponsored by Reps. Michael Burgess (R-Texas) and Gene Greene (D-Texas), the bill would require the Health Resources and Services Administration to work with each state to help establish advanced life support systems and train emergency medical system personnel for rural areas, according to a copy of the remarks Burgess made on the House floor.
In addition, Sens. Arlen Specter (R-Pa.) and Debbie Stabenow (D-Mich.) introduced the Access to Emergency Medical Services Act of 2007, a companion bill to a House version introduced in February. The bills call for a national bipartisan commission to examine factors that affect the delivery of care in U.S. emergency departments, and they provide for additional payments for certain physician services in emergency departments.
In Florida, a Senate committee cleared a Florida Hospital Association-backed bill in late March that would add to oversight of free-standing ERs. The legislation calls for free-standing ERs to offer identical care, seek identical accreditation and match licensing criteria applied to in-house ERs. The bill also calls for regulators to report by Jan. 31, 2008, on the need for statewide rules for patient transportation from satellite ERs.
A bill in the state House of Representatives would go further. It sets distance and population criteria for free-standing ERs and would require the Florida Department of Health to draft protocol for patient transfers. Under the proposal, satellite ERs cannot be located within 15 miles of an acute-care hospital in counties with at least 200,000 residents. That distance increases to 25 miles in counties with a population less than 200,000.
Neither goes as far as Floridas Agency for Health Care Administration 2004 recommendation to subject stand-alone ERs to the states CON review. The agency endorsed satellite ERs to boost access in communities that do not need a hospital, but urged lawmakers to subject development to utilization review in order to evaluate the complex market issues associated with free-standing emergency departments, the recommendations said.
Morton Plants Beauchamp rejects any call to subject free-standing ERs to CON or mileage requirements. The mileage has no relationship to need, he said. Construction on Morton Plant Hospitals 16,000-square-foot ER is expected to be completed later this year, when it will undergo its final licensure review, he said. Located in a densely populated community, Beauchamp said the second ER in Largo is needed to alleviate traffic in its existing ER. The hospitals ER, which handled 55,000 visits in 2006, spent a total of roughly one month last year diverting patients elsewhere because of heavy demand, he said.
Florida has two free-standing ERs. Munroe Regional Medical Center opened Floridas first free-standing ER in April 2002 roughly 12 miles from the 378-bed hospital in Ocala. And in 2003, HCA-owned, 247-bed Fort Walton Beach Medical Center opened its satellite ER in Destin.