Freestanding Emergency Departments: Filling a Niche

By Maggie Behringer
Sunday, November 1, 2015

In 1978, an Orkand Corp. survey of freestanding emergency departments (FEDs) counted roughly 55 such facilities in the United States. Today, that number is approaching 500, with the facilities banking on the advantages of brand growth and looking to increase patient volumes for hospital systems as well as provide additional access for patients.

According to a 2012 study by the Urgent Care Association of America, hospital emergency departments treat, on average, 100–150 patients daily, compared with the 35–40 patients FEDs see each day. From industry experts’ perspective, this contrast is striking, as healthcare systems struggle to sustain their investments in inpatient settings.

“It fits a niche in today’s health care,” says Maureen Fuhrmann, MHA, Chief Business Development Officer for Neighbors Health System, an organization based in Texas that delivers care through FEDs. “We’ve got overburdened and overcrowded emergency departments. Across the nation, emergency departments are closing and the population is growing. This is truly an access point to care and convenience of care.”

The Operators

Panos Lykidis, MBA, Vice President of California-based healthcare consultancy The Camden Group, and David White, MBA, Director of Analytics at North Carolina-based consultancy FreemanWhite, explain that hospital systems view FEDs as avenues to increased patient volumes and expanded coverage in the name of improving population health. The FEDs serve as brand ambassadors, links to the larger system, in areas outside those from which the hospitals’ highest patient volumes traditionally come.

Physicians are also positioning independently run FEDs as an alternative to congested emergency rooms. A group of emergency physicians founded Neighbors Health System in 2010 with a stated goal of offering patients a more personalized experience. The company now operates 11 FEDs across Texas.

The Playing Field

When working with clients, Lykidis and White both rely on market-by-market analytics. They explore what populations clients can and do serve, where current services exist, and in what settings FEDs can fill gaps in clients’ portfolios without hurting existing facilities. FEDs typically open in developing spaces around expanding metropolitan centers — areas that had been considered rural only a few years earlier.

“You have communities popping up and building a critical mass, but not enough to warrant [more comprehensive facilities],” Lykidis says. “The FED is being welcomed. They are adding value to those growing communities.”

Retail locations offer prime spots for FEDs, blending the facility into potential patients’ usual routes around their communities. Fuhrmann notes that this positioning allows patients to see the emergency center and learn how to get there — before they need it. The retail setting also appeals to the comfort factor.

FEDs may also be incorporated effectively into existing medical facilities. Between 2012 and 2013, FreemanWhite advised Tallahassee Memorial HealthCare in Florida on the construction of a FED connected to a medical office building. The 30,000-square-foot facility combined an emergency center with pediatric and geriatric services, designed with the patient experience in mind.

“A high-tech, high-touch feel will be reinforced through … state-of-the-art registration and waiting amenities — planning that facilitates optimized throughput and therefore reduced wait times — and a customized concierge service model,” White says.

Lykidis says The Camden Group’s clients have consistently seen patient volumes exceed projections at their FEDs without negatively affecting volumes at other settings.

The Rules

FEDs must obtain a certificate of need and maintain licensure from their state’s Department of Health to operate. The licensing regulations dictate the facilities’ capabilities and the manner in which they explicitly designate themselves as emergency medicine settings.

“We don’t want patients to come to a level of care they don’t need, [so] we have a packet of reliable resources: clinics that are open in the area, physician offices with extended hours. ... We have good working relationships in the community to get the patient to the right place.”
— Maureen Fuhrmann, MHA, Chief Business Development Officer, Neighbors Health System

As Fuhrmann explains, Neighbors Health System FEDs have capabilities such as X-ray and CT scan imaging, a certified laboratory and pharmacy, and features including 8-foot-wide hallways. They also have transfer agreements with nearby hospitals in the event patients must be admitted.

“There are 180 pages of regulatory compliance that we have to meet …,” Fuhrmann adds. “We have to provide all of the services you get in a regular ED.”

To avoid confusion with an urgent care center, Neighbors Health System FEDs include the term “emergency center” in paperwork and patient greetings. In addition, they rely on participation in civic functions to educate patients and the community generally about their role in local health care.

“We’re active in schools and civic organizations,” Fuhrmann says. “If there’s a community event, we have a booth set up and do first aid for them. We look at it as ‘see us and meet us before you need us,’ so they know who we are when we move into a community.”

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