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"Free-standing ER's"?

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So as I was poking around the internet, I stumbled across something I'm kinda surprised I haven't seen before- places that claim to be "free-standing ER's". Not urgent care, mind you.....they literally call themselves an emergency room. No inpatient facility on site. Completely private, some with multiple locations, some with only one. It appears, based on the website of some of them, that they are only located in suburban areas of Texas- if there are others around the country I'm unaware of it.

 

Has anyone else either worked at or heard of these? It appears one of their selling points is having only board-certified ER docs working there, but I'm unclear how this is otherwise different than urgent care?

 

-IF they bill themselves as an "emergency room", can they actually have EMS drop off there? (I'm pretty sure they can't- I guess this is more of a rhetorical question I have)

- Do they have a contract with an inpatient facility for admissions? What if you need a specialist?

 

The largest of them is called "First Choice" emergency room. They even have a mascot, named "Fever", who is a giant dog they use for PR events.

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So as I was poking around the internet, I stumbled across something I'm kinda surprised I haven't seen before- places that claim to be "free-standing ER's". Not urgent care, mind you.....they literally call themselves an emergency room. No inpatient facility on site. Completely private, some with multiple locations, some with only one. It appears, based on the website of some of them, that they are only located in suburban areas of Texas- if there are others around the country I'm unaware of it.

 

Has anyone else either worked at or heard of these? It appears one of their selling points is having only board-certified ER docs working there, but I'm unclear how this is otherwise different than urgent care?

 

-IF they bill themselves as an "emergency room", can they actually have EMS drop off there? (I'm pretty sure they can't- I guess this is more of a rhetorical question I have)

- Do they have a contract with an inpatient facility for admissions? What if you need a specialist?

 

The largest of them is called "First Choice" emergency room. They even have a mascot, named "Fever", who is a giant dog they use for PR events.

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We have a free standing ER in Newport News that has been open for about 11 years. I don't know much about it other than yes - EMS can indeed bring patients there. They are open 24/7 and have greater capabilities than local urgent care offices (which close at 9pm) including CT scanner, ultrasound, full lab, etc. They even have a hyperbaric chamber! The ER can admit to any of the area hospitals. They are owned by a group that has a full hospital near by and the same group of ER physicians staff both facilities. I know the UC I am currently at has a mix of emergency and family practice board certified docs, so maybe that is why they advertise having "only board certified ER docs", although they are staffed with 1 MD and 1 PA at all times (which is the same as the UC I am at). The ER's website is below if you are curious:

 

http://www.sentara.com/HospitalsFacilities/OutpatientCareCenters/PortWarwick/Pages/portwarwick.aspx

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We have a free standing ER in Newport News that has been open for about 11 years. I don't know much about it other than yes - EMS can indeed bring patients there. They are open 24/7 and have greater capabilities than local urgent care offices (which close at 9pm) including CT scanner, ultrasound, full lab, etc. They even have a hyperbaric chamber! The ER can admit to any of the area hospitals. They are owned by a group that has a full hospital near by and the same group of ER physicians staff both facilities. I know the UC I am currently at has a mix of emergency and family practice board certified docs, so maybe that is why they advertise having "only board certified ER docs", although they are staffed with 1 MD and 1 PA at all times (which is the same as the UC I am at). The ER's website is below if you are curious:

 

http://www.sentara.com/HospitalsFacilities/OutpatientCareCenters/PortWarwick/Pages/portwarwick.aspx

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Yes, they are full service ED's and hold clientele on-site until receiving hospitals have an admission bed available (not in the ED) at which point they are transferred by ambulance. There are several variations in the N. Texas area. My former nurse moonlights at one that uses PA's and they are now open 24/7 whereas others claim to have physicians only. Many are located in major intersection shopping centers either in free-standing structures or mixed into the strip mall. I saw one while ago while running errands that had an "ambulance bay" on the side of the building.

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Yes, they are full service ED's and hold clientele on-site until receiving hospitals have an admission bed available (not in the ED) at which point they are transferred by ambulance. There are several variations in the N. Texas area. My former nurse moonlights at one that uses PA's and they are now open 24/7 whereas others claim to have physicians only. Many are located in major intersection shopping centers either in free-standing structures or mixed into the strip mall. I saw one while ago while running errands that had an "ambulance bay" on the side of the building.

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Seattle has one. they have all the resources of a hospital(CT, u/s, on call specialists, etc) aside from inpt beds. They take ambulances. they are usually affiliated with another hospital that takes their admits.

we are opening one as well in the next few years. the idea is they are feeders for admits to your primary hospital and take away admits from a closer competing hospital(at least that is why we are opening one in a ritzy part of town where folks have insurance....).

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Seattle has one. they have all the resources of a hospital(CT, u/s, on call specialists, etc) aside from inpt beds. They take ambulances. they are usually affiliated with another hospital that takes their admits.

we are opening one as well in the next few years. the idea is they are feeders for admits to your primary hospital and take away admits from a closer competing hospital(at least that is why we are opening one in a ritzy part of town where folks have insurance....).

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We have a couple in the Minneapolis area. One calls itself "the Urgency Room" and another is the new and improved version of what had previously been a large UC. I had a couple of people drive up last week as I was leaving and ask about my clinic. They seemed to feel it was a "ripoff" that these free-standing joints can bill at ER rates even though there's no hospital physically attached.

 

I dunno, sounds like it could be a fun place to try and snag some shifts at some point.

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We have a couple in the Minneapolis area. One calls itself "the Urgency Room" and another is the new and improved version of what had previously been a large UC. I had a couple of people drive up last week as I was leaving and ask about my clinic. They seemed to feel it was a "ripoff" that these free-standing joints can bill at ER rates even though there's no hospital physically attached.

 

I dunno, sounds like it could be a fun place to try and snag some shifts at some point.

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We had none where I'm originally from or where I'm going to school (both fairly rural areas), but when I was living in New England they were all over the place. I believe that medic25 works on one affiliated with his hospital.

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We had none where I'm originally from or where I'm going to school (both fairly rural areas), but when I was living in New England they were all over the place. I believe that medic25 works on one affiliated with his hospital.

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Sounds like a goldmine for ems

The "vision" for ours is that folks will arrive by regular ems but if they require transfer to our primary hospital a unit run and staffed by the hospital will do the transfer...at a premium price of course....

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Sounds like a goldmine for ems

The "vision" for ours is that folks will arrive by regular ems but if they require transfer to our primary hospital a unit run and staffed by the hospital will do the transfer...at a premium price of course....

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I do around 75% of my clinical time working in a free-standing ED, with the other 25% in the ED at our primary hospital. We staff the ED with the same physicians and PA's who staff the main hospital ED; the only difference is we don't have any residents. As far as EMS we receive ambulances routinely, with specific exceptions written into the EMS protocols (no STEMI's, stroke alerts, traumas, etc). We still get critical medical patients, including cardiac arrests. The acuity overall is probably a little lower than our main hospital (tertiary academic center/level 1 trauma center), but it's fairly similar to my experience in most typical community ED's. We've got most of the typical resources of other ED's (in-house labs, DI including CT and ultrasound).

Overall I like the model. We provide some volume relief for the primary hospital, and the community loves having the option of being seen locally rather than driving into the city. They actually like it so much that we routinely get patients who drive past both of our hospitals just to be seen in the free-standing ED.

 

From a practice perspective, it's the best of both worlds. We've got the autonomy and efficiency that's often found in community ED's, but are backed up by the resources of a major academic institution; patients needing consults or admissions are simply transferred to the mother ship. Feel free to PM me if you've got any other questions.

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I do around 75% of my clinical time working in a free-standing ED, with the other 25% in the ED at our primary hospital. We staff the ED with the same physicians and PA's who staff the main hospital ED; the only difference is we don't have any residents. As far as EMS we receive ambulances routinely, with specific exceptions written into the EMS protocols (no STEMI's, stroke alerts, traumas, etc). We still get critical medical patients, including cardiac arrests. The acuity overall is probably a little lower than our main hospital (tertiary academic center/level 1 trauma center), but it's fairly similar to my experience in most typical community ED's. We've got most of the typical resources of other ED's (in-house labs, DI including CT and ultrasound).

Overall I like the model. We provide some volume relief for the primary hospital, and the community loves having the option of being seen locally rather than driving into the city. They actually like it so much that we routinely get patients who drive past both of our hospitals just to be seen in the free-standing ED.

 

From a practice perspective, it's the best of both worlds. We've got the autonomy and efficiency that's often found in community ED's, but are backed up by the resources of a major academic institution; patients needing consults or admissions are simply transferred to the mother ship. Feel free to PM me if you've got any other questions.

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I have to admit this doesn't sound like a bad idea and may help with crowding issues in hospitals. It's entirely possible that a free-standing ER that can admit to any hospital would much more efficiently manage admissions than an ER that is attached to a hospital. Hospitals with ERs are managed like silos and only consider transfer to a different hospital for services unavailable or at patient request (sometimes also insurance requirements). An ER that can admit to any local hospital would be able to more appropriately admit patients and also avoid hospitals that don't have beds available, thus freeing up space in the ER and more efficiently managing hospital resources.

 

It's got me thinking now....

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I have to admit this doesn't sound like a bad idea and may help with crowding issues in hospitals. It's entirely possible that a free-standing ER that can admit to any hospital would much more efficiently manage admissions than an ER that is attached to a hospital. Hospitals with ERs are managed like silos and only consider transfer to a different hospital for services unavailable or at patient request (sometimes also insurance requirements). An ER that can admit to any local hospital would be able to more appropriately admit patients and also avoid hospitals that don't have beds available, thus freeing up space in the ER and more efficiently managing hospital resources.

 

It's got me thinking now....

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our model is looking at only admitting back to our primary hospital. the free standing e.d. would be in a ritzy part of town. it's an effort to draw folks who pay their bills away from our competition hospital...

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our model is looking at only admitting back to our primary hospital. the free standing e.d. would be in a ritzy part of town. it's an effort to draw folks who pay their bills away from our competition hospital...

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We probably admit 90-95% of our patients to one of our two hospitals, but theoretically we can admit patients anywhere they like. Our patients come from a reasonably big catchment area, so they sometimes want to be admitted to other hospitals that they normally use. The main issue is that at the other facilities we need to find an accepting service willing to admit them, and for our own shop we can just admit them as soon as we make the call to admit.

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Shady Grove Adventist Hospital of Rockville Md opened one back in 2005 or so. EMS could transport to it with previous noted limitations..if patient needed more, they were transported via EMS to main hospital about 8 miles away. EMS was county funded via tax base so the hospital paid a contract fee to cover their fair share of services.

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I will be working in one soon, to reiterate what most have said we accept EMS, minus STEMI's stroke, trauma. Our particular model has 24 hr MD coverage at 3 eight hr shifts, and 3 PA/NPs that provide coverage spanning from 08:00-01:00. three different shifts. It is essentially mid-level run as all the PAs/NPs see the patients, and then report to the Doc. The Doc agrees with your plan or not and you move on. As well the Doc always sees the Pt so as to boost the 85% medicare reimbursement to 100%. We too have lab, U/S, CT, Xray. We have about a 10% admit rate.

The current model we have set up has caught the attention of many other free standing EDs.Our press ganey scores are always high, thus the cash flow is coming in. There is no "fast track" per se, but anyone who has spent even 1 day in the ER knows that 90% of ED patients dont belong in the ED to begin with. The Pt load is on a rotational basis. So If its your turn to see a pt, then thats what you get. The group I will be working for is contracted through Swedish, and runs three different free standing EDs on the east side (WA state, Issaquah, Redmond, Mill Creek)

I have worked at another one, it was brand new, and once word on the street got out we were soon over whelmed with Pt load. This was the group's fault for poor staffing. All in all I feel a free standing ED is a decent place to work Emed as long as youre not chomping at the bit to see trauma.

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