Thursday, May 5, 2016

An ER on Every Corner

This weekend I was driving with my family across Florida - from Palm Beach to Tampa. As my family was preoccupied with their movies, music and books, I focused on what lay in front of me. As I drove through Orlando towards Tampa, I couldn’t help but notice the proliferation of health care facilities and medical service sites. From urgent care centers and free standing emergency rooms to imaging centers, rehab and physical therapy practices and surgery centers, there was no shortage of points for medical service.

It made me think: “Do we have too much in the way of health care services? Do we really need it? Does it help or hurt those we are trying to care for?”

The answer is yes. There are too many options for “drive-thru health care” and what we have is disjointed and not operating in the best interest of the patient or health care consumer. Take free standing emergency rooms as an example. These are facilities constructed like hospital-based emergency departments but without a hospital attached. They are not a new phenomenon because they have been around for the last 20 years. In fact, they were originally built by hospitals as a way to serve rural populations that could not support an entire hospital and pitched as a community outreach initiative. 

However, the reality is that Florida hospitals saw the construction of these emergency outposts as a way to drive the market share back to them and away from competing hospitals. What these facilities fail to tell the consumer upon entry is that they are going to pay “hospital prices” because these facilities are licensed under the hospital system and are not priced like the retail-oriented urgent care establishments.

While it is true that free standing ERs can take care of a sicker patient with more complex needs, the reality is that if the patient needs to be admitted to a hospital, she will most likely not be sent to the closest or most appropriate facility, but the one that is owned by the same medical system that owns the ER.

I recently read that a medical center based in Pasco County, Florida has opened a free standing emergency room in Palm Harbor, Florida (population 57,439). Palm Harbor currently has at least three outstanding hospitals — all of which are more than meeting the health care needs of the community. Why would you need additional emergency medicine in an area that does not need more service providers, when all it does is drive up the cost of health care? 

The reason is pure and simple: to drive market share back to the hospital operating the free standing emergency department.

Palm Harbor is a more lucrative community with a median income of $52,051 versus the statewide Florida average of $46,036. Why not place these ERs in areas where members of the community need additional access to care--communities like Holiday, a town north of Palm Beach with a population of roughly 30,000 people and a median household income of $36,213. I would imagine a community like Holiday could use access to a free standing emergency room wouldn't you?

Many will tell you to simply sit back and let the free market take control and the facility that is most needed and best serves the consumer will rise to the top. And while I am a true believer in a free market economy, the reality is that the health care industry does not operate in a free market system. Health care is a government regulated industry - the government tells us what they will pay us for our service and the commercial market often uses the government rate as a point of negotiation. This means that at the end of the day, we offer our services at a deep discount in order to have access to the insured patients whose health care is covered through commercial plans. 

And as I pulled into my destination, I thought: so what do we do to create a more affordable system that focuses on the health of the patient? An appropriate first step would be to create a regulatory environment that helps eliminate unnecessary duplication of services.

An example of a regulatory process that currently works in Florida is the Certificate of Needprogram that regulates beds for inpatient hospitals, balancing the number of hospital beds available with the demonstrated need.  If we did not have the Certificate of Need program here in Florida, we would have a proliferation of hospitals in a state where there are already more than enough beds--leading to a rise in cost and a potential decrease in quality. 

And so, in order to truly serve our community, providing affordable and accessible health care, we need more of these types of regulatory systems in place instead of ERs on every corner, don’t you think?

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