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Do Freestanding EDs Help or Hurt?

July 8, 2019

Written by Clay Smith

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Freestanding EDs are popular with patients and physicians but do little to expand access to care, reduce traditional ED congestion, and lower overall healthcare costs.

Why does this matter?
Freestanding EDs are distinct locations that provide emergency care but are not located in a larger hospital. They may help with overcrowding but also may be mistaken for lower cost urgent care centers and drive up healthcare costs. ACEP has a policy statement on freestanding EDs. How do they affect traditional EDs and what is their impact on quality, cost, and access to care?

Expanding care options to those who need it least
Key points in this article were that they tend to see lower acuity. Patients were more likely to have private insurance. The locations tend to be in more affluent areas and not necessarily in areas that would increase access to care. Quality of care appears similar to traditional EDs. Cost is also similar to traditional EDs but is 10 times greater than urgent care centers. The authors advocate for better price transparency, so patients can tell the difference. They may increase overall healthcare cost in a given market. It is debatable whether they alleviate overcrowding. In fact, some studies indicate they may increase utilization of care. They may also adversely affect the payor mix for nearby traditional EDs, by siphoning off privately insured patients. Patients and physicians who work in them have greater satisfaction. The ideal is for hospitals to strategically place them in areas of need that will also generate profit or be budget neutral but will reduce traditional ED congestion, expand access and improve patient convenience, and generate downstream revenue for the institution.

Freestanding Emergency Departments: What Is Their Role in Emergency Care? Ann Emerg Med. 2019 Jun 7. pii: S0196-0644(19)30237-9. doi: 10.1016/j.annemergmed.2019.03.018. [Epub ahead of print]

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What are your thoughts?