Comparing Utilization and Costs of Care in Freestanding Emergency Departments, Hospital Emergency Departments, and Urgent Care Centers

Ho, Vivian; Metcalfe, Leanne; Dark, Cedric; Vu, Lan; Weber, Ellerie; Shelton, G. C.; Underwood, Howard R.

doi:10.1016/j.annemergmed.2016.12.006

Cited by 82 publications

(96 citation statements)

References 13 publications

(13 reference statements)

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“…1 In one US state up to 17.6% of all ED patients were seen in FSEDs. 1 In one US state up to 17.6% of all ED patients were seen in FSEDs.…”

Section: Hypothetical Scenariomentioning

confidence: 99%

“…2 One emergency medicine commentator recently hailed this as an innovative solution developed by emergency physicians (EPs) themselves to address the increasing demand for emergency care and issue of ED overcrowding. 1 It may be inevitable that FSED concept is considered in Australia in the future as ED attendance is growing at a rate of over 2% annually. 1 It may be inevitable that FSED concept is considered in Australia in the future as ED attendance is growing at a rate of over 2% annually.…”

Section: Hypothetical Scenariomentioning

confidence: 99%

“…1 Further research is needed to explore whether any cost savings could be achieved because of potentially reduced inpatient admission rate through FSEDs. Building FSEDs will be costly.…”

Section: Cost Of Emergency Carementioning

confidence: 99%

“…1,2,12 It has been argued that FSED is a supplemental care model to HBED, and therefore, they may not offer cost savings. 1,2,12 It has been argued that FSED is a supplemental care model to HBED, and therefore, they may not offer cost savings.…”

Section: Cost Of Emergency Carementioning

confidence: 99%

“…Substitute care models such as UCCs may be able to provide care at a much lower cost for a patient with the same diagnosis. 1,2,12 Currently, the private sector engagement in providing emergency care in Australia is limited. 2 An example diagnostic code is cellulitis of lower limb.…”

Section: Cost Of Emergency Carementioning

confidence: 99%

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Should freestanding emergency departments be considered in Australia?

de Alwis

2018

Emerg Medicine Australasia

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The concept of freestanding EDs is a popular operational model of emergency care in the USA. This model has been described as an emergency physician-created innovative solution in resolving ongoing overcrowding issues in EDs. A decentralised community-based emergency care model may be a solution to meet the increasing demand for emergency and unscheduled acute care in Australia. It may also help to reduce the number of acute hospital admissions through EDs. The aim of freestanding EDs should be to manage and discharge a cohort of patients, mainly in Australasian Triage Scale 3 and 4 categories, currently seen in hospital-based EDs. This article briefly examines the potential merits and issues if this concept is considered in Australia. It also provides an early proposed model for such EDs.

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“…1 In one US state up to 17.6% of all ED patients were seen in FSEDs. 1 In one US state up to 17.6% of all ED patients were seen in FSEDs.…”

Section: Hypothetical Scenariomentioning

confidence: 99%

Section: Hypothetical Scenariomentioning

confidence: 99%

“…1 Further research is needed to explore whether any cost savings could be achieved because of potentially reduced inpatient admission rate through FSEDs. Building FSEDs will be costly.…”

Section: Cost Of Emergency Carementioning

confidence: 99%

Section: Cost Of Emergency Carementioning

confidence: 99%

Section: Cost Of Emergency Carementioning

confidence: 99%

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Should freestanding emergency departments be considered in Australia?

de Alwis

2018

Emerg Medicine Australasia

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Revisiting States’ Experience With Certificate of Need

2020

JAMA

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Many states enforce certificate of need regulations that require hospitals to obtain approval from a designated state agency before opening new facilities, adding capacity, or offering particular complex, costly services, such as hearttransplants. Yet at least 9 states took steps in 2019 to modify their certificate of need rules, often because those laws are viewed as ineffective in controlling overutilization or improving quality. 1,2 As Yuce and colleagues 3 observed in this issue of JAMA, most of the literature examining the association between certificate of need and measures of utilization and patient outcomes is more than a decade old, and advances in quality measurement and improvement warrant the updated analysis that these authors undertook.Yuce et al analyzed claims for 1 545 952 Medicare beneficiaries who received 1 of 10 types of surgeries from 2016 through 2018 to compare the experience of patients treated in states with vs without hospital certificate of need regulations, including 468 236 (30.3%) in 15 states vs 1 077 716 (69.7%) in 35 states and the District of Columbia. In this comparison, they found no significant differences between states without vs with the regulation in adjusted overall median hospital procedural volume (241 vs 272 procedures per hospital for 3 years; absolute difference, 31; 95% CI, −27.64 to 89.64, P = .30); median hospital market share (median, 28% vs 52%, absolute difference, 24%; 95% CI, −5% to 55%; P = .11); procedure rates per 10 000 Medicare eligible population per capita (median, 239.23 vs 205.41 operations per Medicare-eligible population for 3 years, absolute difference, 33.82; 95% CI, −84.08 to 16.43; P = .19); or the number of low-volume hospitals (defined as at or below the fifth percentile of procedure-specific volume). With respect to patient outcomes, there were no significant differences in the adjusted odds of 30-day mortality (1.17% vs 1.33%, odds ratio [OR], 1.04; 95% CI, 0.93 to 1.16; P = .52), surgical site infection (1.24% vs 1.25%; OR, 0.93; 95% CI, 0.83 to 1.04; P = .21), or readmission (9.69% vs 8.40%; OR, 0.80; 95% CI, 0.57 to 1.12; P = .19).The study by Yuce et al has several strengths, including the analysis of recent data, examination of a wide range of common low-and high-risk procedures, and the use of 3 different measures of patient outcomes. However, the study also has limitations to consider. The analysis was crosssectional and compared states with and without a certificate of need in 2016 through 2018 rather than examining the experience of states that had previously repealed the legislation. If states that chose to maintain the regulation differ systematically from those that discontinued it in terms of factors that may influence quality such as health care system organi-

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Analysis of a Commercial Insurance Policy to Deny Coverage for Emergency Department Visits With Nonemergent Diagnoses

et al. 2018

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Key Points Question If commercial insurers retrospectively deny coverage for emergency department (ED) visits based on diagnoses determined to be nonemergent, what visits will be denied coverage? Findings This cross-sectional study found that 1 insurer’s list of nonemergent diagnoses would classify 15.7% of commercially insured adult ED visits for possible coverage denial. However, these visits shared the same presenting symptoms as 87.9% of ED visits, of which 65.1% received emergency-level services. Meaning A retrospective diagnosis-based policy is not associated with accurate identification of unnecessary ED visits and could put many commercially insured patients at risk of coverage denial.

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Comparing Utilization and Costs of Care in Freestanding Emergency Departments, Hospital Emergency Departments, and Urgent Care Centers

Cited by 82 publications

References 13 publications

Should freestanding emergency departments be considered in Australia?

Should freestanding emergency departments be considered in Australia?

Revisiting States’ Experience With Certificate of Need

Analysis of a Commercial Insurance Policy to Deny Coverage for Emergency Department Visits With Nonemergent Diagnoses

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