State says ‘no’ to standalone emergency facility

Print Friendly and PDF By: Andy Miller Published: Dec 20, 2012

A proposal to build Georgia’s first freestanding emergency department has been rejected by state regulators.

But this week’s decision by Department of Community Health reviewers may not close the door to other proposals to build standalone emergency departments – which unlike traditional emergency rooms are not physically located at hospitals.

Two hospitals in Augusta are currently seeking to build a freestanding ED in Columbia County, west of the city.

The agency denied a request by HCA’s Eastside Medical Center in the Atlanta suburb of Snellville to build a $5.2 million emergency facility in the nearby town of Loganville, in Walton County.

The reviewers ruled that the Loganville area’s emergency needs were already being met, and that Eastside has capacity with its current ER.

Drew Tyrer, associate chief operating officer at Eastside Medical, noted Thursday that a large percentage of Loganville residents go to Eastside for emergency care.

“We are disappointed’’ by the state’s decision, Tyrer told GHN. He said he did not know whether Eastside would appeal the ruling, but added that he believes the state will eventually accept freestanding EDs.

Freestanding emergency departments emerged to serve people in rural areas where access to emergency care was scarce, according to a Kaiser Health News article last year. But in recent years, freestanding EDs have often been built in fast-growing suburban areas, where the need for them is not always so clear, the article said.

“It seems that now they’re being aimed at populations that do have a fair amount of access to health care already,” Emily Carrier, a senior health researcher at the Center for Studying Health System Change, told Kaiser Health News. Carrier is also an emergency physician.

Freestanding EDs are increasing in Southern states and elsewhere. In 2009, there were 241 freestanding emergency departments, 65 percent more than existed just five years before, the American Hospital Association told KHN.

Meanwhile, a significant number of traditional hospital emergency rooms have closed over the past 20 years.

From 1990 to 2009, the number of hospitals with ERs in urban and suburban areas declined by 27 percent, according to a 2011 Journal of the American Medical Association study.

Still, the study said, visits to hospital emergency departments climbed 30 percent between 1998 and 2008.

Many emergency departments struggle financially, partly because they draw a large number of uninsured and underinsured patients. EDs are often overcrowded, with long waiting times for patients.

Both University Hospital and HCA’s Doctors Hospital in Augusta cited ER crowding for their moves into Columbia County. Each also notes that Columbia is Georgia’s most-populated county with no hospital or ER.

“Our [hospital] ED is extremely busy,’’ said Ed Burr, vice president of legal affairs at University Hospital. “We will go way over 80,000 visits this year. We can’t handle that level of volume.’’

Burr said the proposed freestanding emergency department in Evans would be open 24/7, with emergency medicine physicians, high-end imaging and lab services.

Those features are also part of a similar Columbia County request by Doctors Hospital in Augusta.

Doug Welch, the hospital’s CEO, said the current facility’s ED has seen 10 percent growth in visits each year.

HCA has 24 freestanding emergency departments around the country, with seven more in development, Welch said. “We know how to do it.’’

Such facilities do not  perform any surgeries. Each has a similar price tag of more than $9.5 million.

The state will issue a decision on the Columbia County applications in January.

Construction of large health care facilities comes under the state’s certificate-of-need (CON) process. CON is a complicated set of regulations governing medical facilities’ expansion and construction, as well as services such as obstetrics and heart surgery.

The CON process can be controversial, because hospitals have often used it to challenge competitors’ planned projects.

Georgia and other states created this type of regulatory system decades ago to contain health care costs. Several states have eliminated such systems, while others have scaled back the regulations.

A 2008 Georgia law streamlined the CON process, exempting more hospital projects from regulatory review, such as the building of parking decks.

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