The commission has found those independent facilities to operate efficiently and provide effective care, says Beverly Robins, a Joint Commission field director in the survey management group. Quality has not been compromised. The free-standing ED does the same type of care as the hospitals do.
The push for improved access to emergency medicine comes as patient visits are increasing while the number of emergency departments falls, according to the federal National Center for Health Statistics. In its 2008 National Hospital Ambulatory Medical Care Survey, the center reported that the overall ED utilization rate increased by 18.4%, from 34.2 to 40.5 visits per 100 persons from 1996 to 2006, the latest year for which data are available.
Patients with private insurance accounted for some 47,000 of the total 119,200 visits to EDs in 2006, or nearly 40%, with Medicaid and Medicare patients following at nearly 30,400 and 20,700, or 25.5% and 17.4%, respectively. Self-paying patients accounted for about 19,000 visits, or 1.6%, according to the survey.
Although some see free-standing sites as a way to alleviate the growing patient load, stand-alone sites are not without controversy. Last year, the Tennessee Health Services Development Agency board denied Wellmont Health System a certificate of need to build a $40.9 million facility halfway between its Kingsport, Tenn., hospital and its rival, Mountain States Health Alliance in Johnson City, Tenn. Mountain States contended the free-standing site would increase healthcare costs and place patients at risk.
Its not just hospitals fighting other hospitals: Providers also worry that private companies can operate facilities more freely because theyre not required to accept Medicare and Medicaid patients and can focus on people who can afford to pay out-of-pocket, Fitz says. Not only do you make money from the physician charges, you make money from the facility charge, the lab charge. Theres a whole big bag, he says.