When Largo Medical Center executives wielded golden shovels this week to break ground for a standalone emergency room on one of Clearwater's busiest thoroughfares, they were mirroring a national trend: hospitals carving out highly profitable ER niches in each other's territory.
Clearwater's Morton Plant Hospital did the same thing six years ago, opening one of the state's first standalone ERs in Bardmoor in Largo Med's back yard.
The Largo hospital's Clearwater ER will be the third standalone in Tampa Bay - Brandon Regional Hospital also has one in Plant City. There are 12 in Florida and more than 450 nationwide.
Hospitals want standalone ERs because they can charge hospital prices without the overhead of a massive campus. They can build them without having to prove a public health need to the state, as they must with hospital construction. And the ERs are a useful funnel to the main hospital if patients need more care, experts say.
Not to be minimized: Health care consumers love them.
"People say, 'They can see me right away. It looks spotless, they have a DVR for my kid and lovely waiting rooms,'" said Vivian Ho, an economist at Rice University in Houston who has studied standalone ERs.
That's the tack taken by executives of Largo Med and its owner, HCA, at Wednesday's groundbreaking for the $8 million, 10,600-square-foot ER the hospital estimates will serve 18,000 a year on the site of a former car lot at 2339 Gulf-to-Bay Blvd.
Peter Marmerstein, president of HCA's West Florida Division, pointed out that hospital ERs are often overcrowded here, especially during snowbird season.
"How do we unclog that system? We do that by expanding our capacity ... to provide easy, more convenient, consumer-oriented health care services," he said.
Standalone ERs also help hospitals compete against the explosive expansion of urgent care clinics, which charge much less than standalone ERs and are often a better option for less serious conditions, Ho said.
But in Florida, the 400 or so urgent care clinics must post a menu of services and their prices. Standalone ERs aren't required to do that. The different rules can "create an uneven playing field for urgent care," said Sam Yates, founder of the Urgent Care Association of Florida.
"Hospitals and medical centers have deeper pockets, they can advertise more, market more, gain a greater share of the market," Yates said.
Largo Med CEO Anthony Degina argues that eastern Clearwater has a demonstrable need for a standalone ER. Morton Plant Hospital and its emergency room are on the west side of the city, 4.5 miles of congested roads from his hospital's new outpost on Gulf-to-Bay, Degina said. Mease Countryside Hospital, on Clearwater's eastern border in Safety Harbor, is 7.5 miles away along similarly clogged McMullen-Booth Road.
Largo Med's Clearwater ER will offer more comprehensive services than a typical urgent care clinic, he said. It will have CAT scan equipment, radiology, laboratory services and six board-certified ER physicians, and it will be open 24 hours a day.
But it won't be a cheaper alternative. Fees will be the same as at the hospital-based ER, a Largo Med spokeswoman said.
And a patient transported by ambulance to a standalone ER who then must be taken to a hospital for admission may face two bills from the transport service.
While Degina said the standalone ER will offer the same level of care as a hospital emergency room in terms of stabilizing and evaluating patients, paramedics won't normally transport major trauma or life-threatening cases there, said Craig Hare, Pinellas' EMS director. Instead, they will treat Largo Med's new facility like they do Morton Plant's Bardmoor ER - suitable for less serious cases like someone who needs stitches or has a broken leg, Hare said.
"A full-blown heart attack or trauma we wouldn't take there," he said.
EMS protocol reinforces the notion that most people don't need a standalone ER when an urgent care clinic can handle the garden variety aches, pains and mishaps, critics say.
"Things that can be taken care of in an urgent care center - which is quite a few things - you should go there," Ho said. "It's cheaper."
One reason behind the growth in both walk-in settings is the new federal health care law, said Yates. Newly insured people who previously were accustomed to receiving their medical care in an emergency room - often the only option for the uninsured - could be drawn to a standalone ER, Yates said.
That is, until they see the bill, Ho said. That should be enough to dissuade return trips by Florida's newly insured, many of whom likely purchased high-deductible plans on the health insurance exchanges, she said.
Morton Plant and Mease Countryside had little comment this week about Largo Med's move into their territory.
"It's too soon to say what the impact may be," said Beth Hardy, a Bay Care Health System spokeswoman. Morton Plant and Mease Countryside are part of the Bay Care network. "We're focused on our ERs and running our hospitals."
While the value of standalone ERs continues to be debated in the medical community, Clearwater Mayor George Cretekos noted that for-profit HCA pays taxes, and he welcomed the ER's well-compensated jobs - more than 45 positions - to a stretch of the city better known for fast-food restaurants, retail and mobile homes.
"Tourism is always going to be No. 1 in Clearwater," he said. "But a tourism job isn't a high-paying job."
Charlie Frago can be reached at email@example.com or (727) 445-4159. Follow him on Twitter @CharlieFrago