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No hospital, just an emergency 'department'. They're popping up all over.

Dr. Traci Ryan explains the intake patient process during a tour of Bayfront Health’s new free-standing emergency department in Pinellas Park. The facility opens today. [TAILYR IRVINE | Times]
Published Dec. 10, 2018

From the outside, the new Bayfront Health building in Pinellas Park looks like a typical medical clinic.

With its brick facade and modest parking lot, it could be an urgent care center or a doctor's office. But it's actually a free-standing emergency room, equipped to handle much more critical cases. The facility at Gandy Boulevard and Interstate 275 is the first of its kind for Bayfront Health, which operates a traditional emergency room just a few miles away at its downtown St. Petersburg hospital.

So why build another one?

To keep up with everyone else. Nearly every hospital chain is opening free-standing emergency rooms — commonly referred to as emergency departments, or EDs — to connect the dots between their major hospitals while cutting wait times and medical costs for consumers. They're popping up everywhere in Tampa Bay.

"Larger hospital centers like Adventist or Bayfront Health see this as being part of their 'extended tentacles' into the community to provide access," said Jay Wolfson, a professor at the University of South Florida's Morsani College of Medicine. "One of the more profound parts of this phenomenon is that millennials are using these things extensively. Probably because there are lower wait times."

As the health care industry evolves, most hospital operators are moving away from banking on sick people coming to their ERs. Instead, they are beefing up primary care and trying to keep patients out of the hospital. Many are opening urgent care clinics and creating telemedicine apps where patients can interact with doctors from their cell phone screens. Emergency departments offer yet another layer of care, just around the corner.

"The hospital is no longer the absolute center for health care in the community, unless it's for intensive or emergency care," Wolfson said. "But this is motivated by business as well. These health care companies are going to encourage people to go to these other sites, like free-standing EDs and preventative care services, as a way to introduce patients to their brand. Once you're in the system, and you had a good experience, you'll be more likely to return to that brand."

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Bayfront Health's free-standing ED will open on Dec. 10. It will be manned by at least one trauma-trained physician and support nurse, plus technician and laboratory staff 24 hours a day, seven days week. The 8-bed unit is equipped with a resuscitation room, pediatrics care, radiology and lab services.

It also has a drive-up loop for ambulances. Bayfront Health is working with local paramedic providers to coordinate protocols for transporting patients to and from the facility.

It will be able to handle medical emergencies like respiratory distress, food poisoning, allergic reactions, bone fractures and minor burns, but residents should know that they can't stay there overnight for care. Such facilities operate in a space between urgent care clinics and regular emergency rooms, the latter where patients can be quickly admitted into hospitals.

Still, emergency departments are committed to quality care and keeping wait times low, said Dr. Traci Ryan, medical director at the new Bayfront Health facility.

"The doctors and nurses here are trained the same as the doctors and nurses who work in the emergency room in St. Petersburg," Ryan said. "If a patient comes here and is having a heart attack, that is something we can stabilize here, and then transfer that patient to the hospital to be admitted."

Urgent care clinics, which are rarely open 24 hours, offer services for more routine and less severe medical issues like diagnosing the flu, wound care, eye or ear infections, and some minor fractures. But patients can sometimes get confused about where to go, in part because free-standing emergency departments and urgent care clinics often have a similar look, typically housed in shopping plazas or along busy commercial stretches.

The cost difference, however, can be substantial. Patients in states like Texas and Colorado have reported receiving bills for thousands of dollars from emergency departments, when they thought they were walking into an urgent care clinic.

With emergency departments, "we're providing an opportunity for people to be seen by a doctor quickly. Consumers are utilizing them, which is evidenced by the fact that we've built them, and they've come," said Mike Shultz, CEO of AdventHealth's west Florida division. "It's our job now to educate consumers on where they need to go and for the best cost option."

AdventHealth, formerly known as Florida Hospital, operates two free-standing emergency departments in Tampa Bay — one in central Pasco County and another in Palm Harbor. Two more are under construction in West Shore and Brandon, Shultz said.

At most of the departments, the care costs the same as a regular emergency room visit, according to doctors at Bayfront Health's Pinellas Park facility. That means patients with insurance will be responsible for the usual co-pay, and, like any ER patient, won't be turned away based on their income.

"Some strategies are different than others but we believe we're providing a service," Shultz said. "Some do it to make a lot money. Some do it to expand their geography into areas they're not in."

But critics say that having too many emergency departments in one community reduces the quality of care because it shrinks the amount of practice that local trauma-trained physicians get when treating complicated injuries. A similar argument was made when Northside Hospital tried to open a trauma center earlier this year, but withdrew after two other area hospitals with trauma centers contested the expansion.

John Couris, the CEO of Tampa General Hospital, said free-standing emergency departments add to the exorbitant cost of health care, and that's why the hospital has no plans to open any more of them. Tampa General operates one free-standing facility at its Brandon Healthplex, which opened last year.

"To be part of the solution, we must curb costs and improve access for consumers," he said. "I also think it's time to be transparent about costs. People should be able to see what they're paying for. You can, usually, in an urgent care clinic, but not one of these emergency departments."

UF Health Shands Hospital in Gainesville opened two free-standing emergency departments in 2013 and 2016. But Shands CEO Ed Jimenez said the motivation to do so was unique compared to other hospitals.

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"Gainesville is a small town compared to Tampa Bay," he said. "The hospital is on the edge of the (University of Florida) campus, but the growth of our community has been outward of the city, making the hospital not that accessible to the people around us."

So Shands opened the two facilities in areas where patients would otherwise have to drive nearly an hour to get to an emergency room.

"Patients were coming from across the city and from Cedar Key, where there is no hospital or ER," he said. "But if we did this purely for volume of patients, we would have built onto our existing hospital. This was a way to create access, not to take away from our main ER."

But Jimenez, like Tampa General's Couris, doesn't buy the idea that emergency departments are cutting down on medical costs. He estimates that the cost to treat patients at the new facilities is roughly the same as in the regular emergency room in Gainesville.

Whether it's to offer more choice to consumers or to expand into new regions, experts agree that free-standing emergency departments are here to stay.

"The outcomes tend to be better financially. They don't have kids and moms and pregnant people, with a variety of diagnosis. And they tend to have easier parking. Infection rates are lower. Overall, they're just more convenient," said Wolfson from USF.

"The reality is that health care is going this way and isn't slowing down. Now it's on your iPhones. And when you need a doctor, you can pick a place best on the appropriate level of care."

Contact Justine Griffin at jgriffin@tampabay.com or (727) 893-8467. Follow @SunBizGriffin.

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Health care: an expanding menu

Not long ago, people had two options when they got sick or injured: make an appointment at the doctor's office or head to an emergency room. Now they have a few more choices. Here's a breakdown:

Telemedicine

Patients interact with doctors or nurse practitioners online, including through smartphone apps or retail stores.

Treatment: Staffers can diagnose cold or flu symptoms, minor infections, and prescribe medication.

Cost: $20-$50, depending on insurance and the provider.

When to go: Usually business hours, but some offer on-call hours.

Urgent care clinics:

Staffed with primary care physicians and nurse practitioners to treat routine medical issues.

Treatment: Sprains, minor fractures, burns and wounds, flu and cold, infections.

Cost: $40-$75, depending on insurance and the provider.

When to go: Usually business hours, but some offer early morning and late evening care.

Freestanding emergency departments:

Emergency care in a smaller clinical space, staffed with trauma-trained physicians and nurse practitioners.

Treatment: Most medical emergencies. Staffers can stabilize more severe cases before moving patients to a hospital.

Cost: $100-$500, depending on insurance and the provider.

When to go: Usually open 24 hours, seven days a week.

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