HCA Healthcare plans to build three new freestanding emergency rooms (ERs) and four urgent care centers in central Florida by the end of next year.
HCA said it will build two ERs in Orange County and one in Seminole County.
HCA, under its urgent care-branded entity CareNow, will also add two centers in both Seminole County and Orange County. There is already a CareNow location in Winter Springs.
HCA’s announcement is another case of a health system transitioning in a healthcare environment that focuses on fewer inpatient admissions and more outpatient care.
There are now more than 400 freestanding ERs spread across the country, and they compete against urgent care centers, retail clinics and hospital ERs for dwindling healthcare dollars. That trend is already seen in central Florida, where Florida Hospital and Orlando Health are also planning freestanding ERs and urgent care centers.
Health systems are looking for outpatient solutions as payers create policies to push patients to receive more care on an outpatient basis, or in facilities other than hospitals. Anthem’s policies to not pay for “unnecessary” ER care in a hospital and not pay for MRIs and CTs in hospitals are two examples of this move away from hospital admissions. Also, there is a larger consumerism effort in healthcare. The idea is to make care access more convenient. That’s led to hospitals even looking to build outpatient facilities in former retail space.
There have been questions about whether freestanding ERs actually save money. A controversial Annals of Emergency Medicine (AEM) report this year found ER patients paid as much as 10 times more than urgent care patients for similar diagnoses. The study was later pulled over concerns and is undergoing a review, but the findings did cause alarm in the industry.
Nevertheless, alternative care settings remain an attractive option for payers looking to move more costly care out of hospitals. It's not only private payers involved in this trend. The CMS is interested in site-neutral payment systems as a way to move costly procedures to outpatient settings.
That trend may be here for the foreseeable future. Lea Halim, senior research consultant at Advisory Board Company, recently told Healthcare Dive that payers are closely following what happens as a result of Anthem's policies. If it's a success, more payers will follow suit.
"Will Anthem get a lot of pushback from patients and employers? Will hospital lobbies succeed in getting state governments to force Anthem to roll back the policy? If Anthem does not face, or successfully overcomes these types of challenges, other payers may very well follow suit," Halim said.