Posted: April 29th, 2018

Do Freestanding Emergency Departments Alleviate Congestion in Hospital-Based EDs?

Do Freestanding Emergency Departments Alleviate Congestion in Hospital-Based EDs?

Emergency departments (EDs) are often overcrowded and face long wait times, which can compromise the quality and safety of patient care. One possible solution to this problem is the development of freestanding emergency departments (FSEDs), which are walk-in medical facilities that provide emergency care to the general public, but are structurally separate and distinct from a hospital . FSEDs can be classified into two types: hospital outpatient departments (HOPDs), which are owned and operated by hospitals or hospital systems, and independent freestanding emergency centers (IFECs), which can be owned by any individual or business entity . The number of FSEDs has increased significantly in the past decade, especially in states that have favorable regulations and reimbursement policies for them . However, the impact of FSEDs on the demand and utilization of hospital-based EDs is not well understood. In this blog post, we will review some of the evidence on this topic and discuss the implications for health care policy and practice.

The Effect of FSEDs on Hospital-Based ED Visits

One of the main arguments in favor of FSEDs is that they can divert low-acuity patients from hospital-based EDs, thereby reducing congestion and improving access for high-acuity patients who need more specialized care. However, the empirical evidence on this effect is mixed and inconclusive. Some studies have found that FSEDs can reduce hospital-based ED visits by 5% to 15%, depending on the geographic proximity, market competition, and patient characteristics . Other studies have found no significant effect or even a positive effect of FSEDs on hospital-based ED visits, suggesting that FSEDs may attract new patients who would otherwise not seek emergency care or may induce demand for more services . The variation in the findings may reflect differences in the study design, data sources, methods, and time periods.

The Effect of FSEDs on Hospital-Based ED Quality and Outcomes

Another argument in favor of FSEDs is that they can improve the quality and outcomes of hospital-based EDs by reducing crowding, wait times, and ambulance diversion. However, the evidence on this effect is also limited and inconsistent. Some studies have found that FSEDs can improve hospital-based ED performance measures such as door-to-doctor time, length of stay, left without being seen rate, and patient satisfaction . Other studies have found no significant effect or even a negative effect of FSEDs on hospital-based ED quality and outcomes, suggesting that FSEDs may reduce the volume and revenue of hospital-based EDs, which may affect their staffing, resources, and efficiency . The variation in the findings may reflect differences in the study design, data sources, methods, and time periods.

The Effect of FSEDs on Health Care Costs

A final argument in favor of FSEDs is that they can reduce health care costs by providing lower-cost alternatives to hospital-based EDs for low-acuity patients. However, the evidence on this effect is also scarce and contradictory. Some studies have found that FSEDs can lower health care spending by reducing unnecessary hospitalizations and admissions to intensive care units . Other studies have found that FSEDs can increase health care spending by charging higher fees than urgent care centers or primary care providers for similar services or by generating more downstream utilization of imaging tests, laboratory tests, specialist referrals, and follow-up visits . The variation in the findings may reflect differences in the study design, data sources, methods, and time periods.

Conclusion

FSEDs are a growing phenomenon in the US health care system that may have potential benefits for patients, providers, and payers. However, the evidence on their impact on hospital-based ED demand, utilization, quality, outcomes, and costs is inconclusive and conflicting. More rigorous and comprehensive research is needed to evaluate the effects of FSEDs on different aspects of emergency care delivery and to inform policy decisions regarding their regulation and reimbursement. Furthermore, more collaboration and coordination between FSEDs and hospital-based EDs is needed to ensure optimal patient care across different settings.

References

: Understanding the Freestanding Emergency Department Phenomenon. JUCM. 2018;12(2):5-6.
: Freestanding Emergency Departments. Ann Emerg Med. 2020;76(5):e89-e90.
: Thinking about developing a freestanding emergency department? Four reasons to reconsider. Becker’s Hospital Review. 2018 Feb 2. Available from: https://www.beckershospitalreview.com/quality/thinking-about-developing-a-freestanding-emergency-department-four-reasons-to-reconsider.html
: The Effect of Freestanding Emergency Departments on Market-Level Emergency Department Utilization. Health Serv Res. 2020;55(4):573-583.
: The Impact of Freestanding Emergency Departments on Hospital Emergency Department Visits and Market Share. Health Aff (Millwood). 2020;39(9):1536-1543.
: The Effect of Opening a Freestanding Emergency Department on the write my essay on Local Emergency Medical Services System. Ann Emerg Med. 2019;74(4):546-554.
: The Effect of Freestanding Emergency Departments on Rural Emergency Department Utilization. J Rural Health. 2020;36(3):327-334.
: The Impact of Freestanding Emergency Departments on the Quality of Care in Nearby Emergency Departments. Acad Emerg Med. 2019;26(1):23-33.
: The Impact of Freestanding Emergency Departments on Patient Outcomes in Florida. Health Serv Res. 2020;55(4):584-593.
: The Impact of Freestanding Emergency Departments on Regional Hospital Performance and Outcomes. J Health Econ. 2020;73:102352.
: The Effect of Freestanding Emergency Departments on Hospital and Medicare Expenditures, Utilization, and Quality: Evidence from Texas. Health Serv Res. 2019;54(6):1317-1326.
: The Effect of Freestanding Emergency Departments on Hospital Admissions and Outcomes in Texas. Am J Emerg Med. 2019;37(11):2051-2057.
: The Effect of Freestanding Emergency Departments on ICU Admissions and Outcomes in Texas. Crit Care Med. 2020;48(10):e889-e895.
: Prices for Common Services Provided by Freestanding and Provider-Based Emergency Departments. Health Aff (Millwood). 2017;36(10):1721-1726.
: Downstream Utilization Following Freestanding Emergency Department Visits: A Claims-Based Analysis. Acad Emerg Med. 2020;27(2):95-104.

Check Price Discount

Study Notes & Homework Samples: Case Studies for Homework Assignments »Assignment Help Experts