1. Health

More locations, shorter waits put freestanding ERs in competition with hospitals

CITRUS PARK — With its ambulance bay, clinical laboratory and sleek CT scanner, the new 24-hour medical facility near the Westfield Citrus Park Mall has the look and feel of a hospital.

Only it's not. It's just an emergency room.

The Citrus Park ER is one of four freestanding emergency rooms in the Tampa Bay area. It can receive patients with practically any acute illness or injury — although those needing surgery or specialized services must be taken to a full-service hospital after they are stabilized.

In just three years, the number of standalone ERs in Florida has catapulted from six to 24. The for-profit hospital chain HCA recently announced plans to open another in Palm Harbor early next year.

Hospital executives say the facilities enable them to provide faster care in a more comfortable and convenient setting.

"These ERs bring full-service emergency care even closer to communities," HCA West Florida president Peter Marmerstein said.

But industry analysts say there's a business-side reason for opening the facilities: In this era of cutthroat competition among health care providers and flat hospital admissions rates, freestanding ERs are a way to draw new patients into an existing hospital system.

"They are trying to build a footprint and capture inpatient admissions via ambulance service," hospital consultant Peter Young said, adding that the facilities often pop up in communities where people have commercial health insurance coverage or Medicare.

The trend stands to threaten the viability of some traditional hospitals that provide emergency services.

Unlike some states, Florida only allows freestanding emergency rooms that are affiliated with full-service hospitals. The Citrus Park ER, for example, is part of the Medical Center of Trinity.

To add a freestanding ER, a hospital must update its state-issued license to include the new facility. That's easier than building a new hospital or adding speciality services like trauma, both of which require a demonstrated public health need.

The not-for-profit BayCare Health System built the region's first standalone emergency room in Largo in 2008. Its construction was prompted by the closure of two nearby ERs, said Kelly Cullen, BayCare director of patient care services.

HCA later built three more: the Emergency Center at Plant City, and the Clearwater and Citrus Park ERs.

The 2-month-old Citrus Park facility stands in a high-traffic area of Hillsborough County and has two well-appointed reception areas: one for adult patients and one for kids. During peak hours, patients can use an automated kiosk to check in. It's like a kiosk at the airport ticket counter, only a scan of your driver's license pulls up medical records instead of a boarding pass.

"The patients that are drawn to facilities like this are looking for convenience and ease of access," CEO Leigh Massengill said.

Citrus Park's goal is to get patients in and out within 90 minutes, unless they need to be transferred to a hospital for further care. That's possible because patients in a standalone ER don't have to wait as long for X-rays or lab results as they would in a hospital, operations manager Mike Eldert said.

"We're not in competition with any other departments in the hospital (to use the equipment)," Eldert said. "We're it."

Patients who need further treatment in a hospital aren't required to go to the affiliated Medical Center of Trinity. But Eldert suggests they do. That way, their test results will transfer easily, and the hospital will pick up the cost of transportation, he said.

It's hard to tell how the standalone emergency rooms stack up when compared to region's conventional ERs. Most of the facilities are new, and data on outcomes is scant.

But Vivian Ho, a health economist at Rice University, said their proliferation could have long-term consequences, especially because patients can get some of the same services at urgent care centers for a fraction of the cost.

"The more people use these facilities out of convenience rather than true necessity, the higher our premiums will be," she said.

Other economists have expressed concerns that in targeting mostly middle- and upper-class patients, freestanding ERs will leave traditional emergency rooms to care for a larger share of uninsured patients, threatening their viability.

But Massengill, the Citrus Park CEO, said all ERs are legally prohibited from cherry picking patients.

"We can't turn away patients because they are uninsured," she said, adding that the facilities stand to help nearby hospitals by lightening the load of emergency room patients.

The demand is likely to grow as the word spreads.

Satisfied customers include Emily Bennett, who took her 22-month-old daughter Molly to the Citrus Park ER earlier this summer when she cut her chin on a plastic toy before bedtime.

"It was a pretty deep-looking gash," the mother recalled.

Bennett chose the facility because it was a five-minute drive from her home. She figured she would be there all night, but Molly's wound was closed in less than 90 minutes.

With two other small children and another on the way, Bennett said she is likely to be a repeat customer.

"I'm sure it wasn't our last visit," she said.

Contact Kathleen McGrory at or (727) 893-8330. Follow @kmcgrory.