What would it be like to have an emergency department built in South Anchorage or Eagle River? Your child has a bicycle accident, hits his head, and can be treated in a new, well-outfitted facility minutes from your home. Your pregnant wife gets in a fender bender and can have a neighbor bring her to the nearby South Anchorage ED for an evaluation. You develop cold symptoms, with cough, chest tightness and shortness of breath. Again, nearby well-trained emergency medicine doctors can see you a short drive from home or work. Grandma visits and develops some dizziness; stop by the Eagle River ED to make certain things are OK. Convenient, professional, local emergency care is very good thing to have in your community.
However, the current proposal by Hospital Corporation of America does NOT offer to build emergency departments in South Anchorage or Eagle River. Their proposal is to introduce a new health care option with the confusing and misleading name of free-standing emergency departments. An FSED is a storefront medical care center that offers 24/7 care by emergency medicine physicians without the surgical, obstetric, pediatric, cardiovascular, neurologic or other services offered at a traditional hospital-based emergency department. Essentially it's a high-cost urgent care clinic.
What does this actually mean? If your son with the bicycle accident turns out to have an expanding blood collection in his brain requiring immediate surgical treatment, a transfer must be arranged to a hospital-based ED for drainage of the blood collection by a neurosurgeon. If your pregnant wife undergoes an ultrasound, which shows that the placenta has separated from the uterine wall and the fetus is now in distress, an emergency C-section will be necessary. As this service is not available at the FSED, your wife's care will be delayed while waiting for a transfer to a hospital-based ED where the C-section can be performed. If the FSED physician determines that your cold symptoms are actually due to an atypical heart attack, you will need to be transferred to the hospital-based emergency department for cardiac catheterization to open a blocked blood vessel. Every minute of delay adds to the damage your heart sustains. If your grandmother's dizziness progresses to weakness she may require immediate transfer to the hospital-based ED for treatment of a new onset stroke. Because of the delay associated with her transfer, she may no longer be eligible for time-sensitive, clot-busting medications.
These are just some examples of patients who will require transfer, resulting in delayed care and higher risk of avoidable disabilities and even death. Patients often do not know what is wrong when they seek emergency care, and physicians cannot always immediately tell. All emergencies requiring hospital admission for surgery, cardiac catheterization, blood transfusion and other specialty care will require transfer to a hospital-based emergency department. If a patient seeks care at an FSED with the expectation that it is equivalent to a hospital-based emergency department, the outcome can be extremely bad.
So, why would HCA, the largest for-profit hospital chain in the United States and the owner of Alaska Regional Hospital, promote FSEDs in our community??
FSEDs were initially introduced for isolated rural settings far from existing hospitals. Billing rules were established that allow FSEDs to charge a separate facility fee equivalent to those charged by hospital emergency departments. The intent was to promote hospitals to invest in remote settings where there is no emergency care. But HCA has lead the introduction of FSEDs into urban areas already served by hospital-based EDs as a business expansion strategy. This occurred first in Texas and now is continuing throughout the country. Because of the facility fees and lower operating expenses due to the lack of support services, these FSEDs are a very lucrative business.
In Houston, Texas, where excellent hospital-based emergency departments are in abundance, FSEDs are placed in wealthy neighborhoods with high levels of private health insurance coverage among residents. FSEDs collect more money, and direct these well-paying patients, when sick, to their hospital for admission. FSEDs promoted in urban settings, such as Eagle River and South Anchorage, represent an ugly attempt to confuse the public, siphon funds from existing hospital-based emergency departments, and potentially endanger patients who wrongly assume that FSEDs can handle all emergencies.
Some emergency medicine physician groups have elected to build their own FSEDs, drawn by the ability to target wealthy populations and collect hospital facility fees despite the absence of full hospital services. However, more and more physicians, communities, and states (Florida, Georgia, Colorado, New York, California) are organizing to oppose FSEDs as a misleading product that increases costs to patients who do not need emergency care while lacking the surgical, cardiac, blood bank, obstetrical, pediatric and neurologic services needed for those who do.
On Monday the Alaska Department of Health and Social Services will hold a public meeting where Alaska Regional Hospital's FSED proposal will be discussed by the community's health care providers and members of the public. The meeting will run from 4-7 p.m. in the Wilda Marston Theatre at Loussac Library, 3600 Denali St. Please attend.
Tim Silbaugh M.D. is a board certified emergency physician and Fellow of the American College of Emergency Physicians. He is the business manager for Alaska Emergency Medicine Associates, which provides emergency medical services at Providence Alaska Medical Center, and has lived and worked in Anchorage since 1988.
The views expressed here are the writer's own and are not necessarily endorsed by Alaska Dispatch News, which welcomes a broad range of viewpoints. To submit a piece for consideration, email commentary(at)alaskadispatch.com.