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Freestanding ER - R Bays

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  • 1. Freestanding Emergency Medical Care Facilities Texas Department of State Health Services 25 TAC §131 Richard Bays MBA, RN, CPHQ © 2010
  • 2. Free-Standing Emergency Departments ER’s On The Rise… • Free-standing emergency departments (FSEDs) are on the rise. Unlike urgent care clinics, these facilities are designed to replicate the full array of services and procedures offered by traditional hospital emergency departments. Most accept ambulance traffic. However, FSEDs cannot admit patients for inpatient care. When such care is needed, the FSED must transfer the patient to a hospital with which it has a written transfer agreement.
  • 3. Free-Standing Emergency Departments On The Rise… • The development of FSEDs is driven by growing population trends in urban and suburban communities, demand for more convenient care closer to home, and a dwindling number of hospital emergency departments despite the growing need for emergency care. From 1995 to 2005, the number of emergency rooms (ERs) in the United States decreased from 4,176 to 3,795. • The need for emergency room services is growing in the United States. From 1995 to 2005, ER visits increased 31 percent.
  • 4. Free-Standing Emergency Departments In Texas: • FSEDs will currently be licensed in Texas as of September 1, 2010. The Department of State Health Services (DSHS), which licenses and oversees other types of health care facilities, will have authority to regulate them. • In 2007, legislation was filed to define the minimum operating criteria for FSEDs as well as to establish regulatory authority. TMA strongly supported the legislation. The bill stalled because of differences over whether FSEDs must be open 24 hours a day, seven days a week. • All FSED’s must be licensed as of September 1, 2010.
  • 5. Free-Standing Emergency Departments • A big "EMERGENCY" sign on a medical building has always stood for certain predictable things, including round-the-clock medical treatment for anything that ails you—albeit on a "most sick, first served" basis and long hours in crowded waiting rooms for people with less than dire medical problems. • At most of the nation's 4,500 or so hospital emergency rooms, the old ways still rule. But a new type of emergency facility is emerging across the country, one that isn't located at a hospital at all and whose claim to fame is customer service. Often situated in the fast- growing suburbs, these "freestanding" emergency rooms trumpet shorter wait times and a more pleasant environment and, at their best, bring much-needed emergency diagnostic and clinical expertise to underserved areas. • Catering to a mostly insured, affluent clientele, freestanding emergency rooms aim to smooth away the rough edges of an ER visit while providing top-notch care. Hospital ER's have new competition: freestanding facilities that tout customer service
  • 6. Free-Standing Emergency Departments More emergency rooms open away from hospitals • A commuter suburb near Washington, D.C., boasts new homes, shopping centers, plenty of traffic — and a state-of the-art 21-room emergency department tucked into an office complex. • Unlike most emergency departments, however, there are no patients awaiting transfer upstairs to a medical ward, because there is no medical ward. The nearest hospital is about 8 miles away. • The number of such facilities owned by hospitals or entrepreneurial doctors grew 23% from 2005 to 2006, jumping from 146 to 179, according to an American Hospital Association survey. About a dozen more are opening or in the planning stages in states such as Florida, Minnesota and Texas.
  • 7. Free-Standing Emergency Departments •The growth of stand-alone emergency departments comes amid continued overcrowding in hospital ERs and stiff competition among hospitals to expand their business in fast-growing suburbs. •The free-standing centers, open around the clock, often offer shorter wait times than hospital-based departments and can treat a variety of illnesses and problems, such as fevers, broken bones and serious cuts •Stand-alone ERs also can siphon patients with minor ailments away from lower-cost urgent care centers or doctors' offices. Urgent care centers differ from free-standing ERs because they usually are not open 24 hours and don't have the same level of high-tech equipment.
  • 8. Free-Standing Emergency Departments What customers want … • Convenient locations – Primarily Suburban Areas • Shorter wait times to see a physician – Hospitals are acuity based (Visitors spend an average of 3.2 hours in hospital ER’s) *2003 Data* • Availability – No office hour restrictions, Patients can access care before or after work or commuting • Boutique atmosphere opposed to sterile institution feel of hospitals • Customer Service - Personalized service, not becoming a medical record number • Avoiding overcrowded urban emergency centers
  • 9. Free-Standing Emergency Departments Catering to cash pay and insured customers
  • 10. Free-Standing Emergency Departments Show me the $$$... • Insurance plans and Medicare generally pay for care in stand-alone emergency departments, just as they do for hospital-based ERs. Yet, care in an ER — whether free-standing or attached to a hospital — costs the patient and the insurance company substantially more than at doctor's offices or urgent care centers. • For the same type of outpatient visit, for example, Medicare reimburses medical providers $316 if a patient is treated in an emergency department, compared with $138 in an urgent care center. Emergency departments are open longer hours and generally have more staff, so overhead costs are higher.
  • 11. Free-Standing Emergency Departments Show me the $$$... • Free-standing emergency departments also can draw the insured away from hospitals, which rely on paying patients to make up for money they lose treating the poor and uninsured • X-rays, CT scans or other imaging tests are provided in about 43% of visits. Patients receive medication over 77% of the time, with painkillers being the most frequently prescribed drugs. *2003 Data*
  • 12. Free-Standing Emergency Departments Sample Accounting Projections Assets Current Assets Cash $5,400,000 Fixed Assets Computers / Servers 50,000 Software-T System 50,000 Lab Equipment 130,000 Video-TV’s 20,000 --------------- Total Fixed Assets 250,000 Accumulated Depreciation (250,000) --------------- Total Assets $5,400.000 ========= Liabilities & Equity Current liabilities Working Capital $292,500 Equipment loan 247,500 -------------- Total Current Liabilities 540,000 Equity Net Income 4,860,000 --------------- Total Equity & liabilities $5,400,000 =========
  • 13. Free-Standing Emergency Departments Developing the Model… • Location(s) • Facility – New construction / Build out • State Licensure / Architectural Review • Capital Equipment / Supplies • Imaging / Lab / Pharmacy • Staffing / Management • Marketing / Referrals • Revenue Cycle Management / Accreditation
  • 14. Free-Standing Emergency Departments Footprint
  • 15. Free-Standing Emergency Departments State Regulations Texas Administrative Code TITLE 25 HEALTH SERVICES PART 1 DEPARTMENT OF STATE HEALTH SERVICES CHAPTER 131 FREESTANDING EMERGENCY MEDICAL CARE FACILITIES SUBCHAPTER A GENERAL PROVISIONS SUBCHAPTER B LICENSING REQUIREMENTS SUBCHAPTER C OPERATIONAL REQUIREMENTS SUBCHAPTER D INSPECTION AND INVESTIGATION PROCEDURES SUBCHAPTER E ENFORCEMENT SUBCHAPTER F FIRE PREVENTION AND SAFETY REQUIREMENTS SUBCHAPTER G PHYSICAL PLANT AND CONSTRUCTION REQUIREMENTS
  • 16. Free-Standing Emergency Departments Equipment • Emergency department patient rooms are designed with the needed equipment and supplies to provide urgent care for the sick and injured.
  • 17. Free-Standing Emergency Departments Medical supplies • Portable light stands • Intravenous poles • Rolling trays (Mayo Stands) • Crash / Supply Carts • Med gases – O2 • Suture kits / Ortho Supplies • Tongue depressors, bandages, gauze • Culture supplies • Intubation supplies, bag-valve-masks, suction tubing • Nasal cannulas and masks • Patient gowns, drapes, emesis basins • Linens Equipment • Stretchers • Defibrillators • Woods Lamp • Otoscope / Opthalmoscope • Overhead lighting • Rolling Stools • Imaging (CT, MRI, US, etc) • Lab – Analyzer, Centrifuge, etc • Monitors – Mounted / Postable • Blood pressure cuffs
  • 18. Free-Standing Emergency Departments • Imaging / Lab / Pharmacy - Services • Cardiac Markers / Hematology / Chemistry / Pregnancy Testing / Tissue Specimens / Blood or Blood Components • CT / X-ray / US • Controlled Substances, Floor Stock, Formularies • DEA, DPS, TSBP Class F Licensed
  • 19. Free-Standing Emergency Departments • Staffing / Management • Although technology is critical, the expertise of medical personnel is just as important. Licensed nursing staff is required to have current certification in Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), and Pediatric Advanced Life Support (PALS), as well as education and training on equipment and procedures utilized in the Emergency Department. • Our Physicians are ready to provide prompt, quality emergency care for patients of all ages 24 hours a day, seven days a week.
  • 20. Free-Standing Emergency Departments • Marketing / Referrals “We understand how stressful a visit to the emergency room can be. That's why we now guarantee that you’ll receive immediate access to care within minutes of walking through our Emergency Department doors” Dr. Filley, Medical Director • FSED’s can alleviate congestion of minor care complaints in the hospital ER’s. In addition, focused demographic group marketing will target the desired cliental.
  • 21. Mission/Vision/Values Our Values We constantly strive to achieve the highest degree of caring, excellence, integrity and results. These essential core values form the foundation of our relationships with patients, customers, investors, partners and one another. Extraordinarily high performance standards serve as critical guides for making important clinical and business decisions. The expression of these standards is evident in our behavior, our attitude, and our approach to our daily work. The product of our strict adherence to core values is the ability to harness tremendous organizational energy to achieve our goal of upholding the highest standard for quality and service within the health care industry. This unique combination of values, performance standards and commitment serves as the key to our success. Our Mission To treat every individual with sincerity, respect and compassion, and provide prompt, affordable, quality health care every day of the year. Our Vision To be the leader in emergency care medicine.
  • 22. Free-Standing Emergency Departments • Revenue Cycle Management / Accreditation • The use of financial clearance solutions in your healthcare revenue cycle enables you to determine not only insurance eligibility but also the ability and willingness to pay healthcare costs. Including medical necessity checking during registration, scheduling and ordering can help reduce Medicare denials and increase reimbursement by providing medically necessary services or by issuing an ABN for non-covered services. • Accreditation programs can be accessed to participate in providing CMS services if desired.
  • 23. Free-Standing Emergency Departments Summary….. Insured and cash pay patients are seeking alternatives to traditional healthcare access. Freestanding ER’s are becoming increasingly popular as wait times at doctor’s offices and hospitals are ever lengthening. Convenient locations, availability of services, rapid delivery of service and customer relations are building these facilities while pulling ahead of the traditional hospital pack.
  • 24. Questions?? Richard Bays MBA, RN, CPHQ RBaysConsulting@gmail.com Office - 832.316.2701