The rise of the freestanding ED

Freestanding emergency departments are springing up left and right. 

In 2001, only 1% of all U.S. emergency departments were freestanding, according to the National Emergency Department Inventory. Fifteen years later, freestanding facilities accounted for 11% of EDs nationwide — and that number continues to climb as health systems zero in on outpatient strategy. 

Ambulatory care is top of mind for many of the nation's top health systems; Michael Dowling, CEO of New Hyde Park, N.Y.-based Northwell Health, recently told Becker's that only about 46% of the organization's revenue is coming from the hospital sector. He cautioned other systems against relying on hospitals as the primary point of care, saying those that do so are "going to lose." 

The freestanding ED has become particularly popular, adopted by the likes of Chicago-based CommonSpirit Health; Nashville, Tenn.-based HCA Healthcare; Marriottsville, Md.-based Bon Secours; and New Orleans-based LCMC Health. Executives from Fort Lauderdale, Fla.-based Broward Health and Hollywood, Fla.-based Memorial Healthcare System — which recently partnered on a freestanding ED of their own — met with Becker's to discuss the reasons behind the trend. 

The appeal for patients 

The partners chose Sunrise, Fla., for their freestanding ED since the area is currently a healthcare desert, James Roach, DO, chief of emergency medicine for Broward Health, told Becker's. The community needs access to care, and there are multiple reasons why a freestanding ED is the right model to fill the gap. 

"Emergency departments are built such that you don't need an appointment," Dr. Roach said. "You could walk in and you get pretty comprehensive care, which makes it attractive for people." 

Freestanding facilities do not admit patients — and rely on transfers for any cases requiring inpatient care — making them more efficient than EDs attached to a hospital, which are infamous for long wait times. 

There's also an aspect of comfort that a freestanding ED brings a community, according to Caitlin Stella, CEO of Memorial's Joe DiMaggio Children's Hospital. In areas that do not have easy access to a full-service hospital, a freestanding ED offers a nearby option for acute events like heart attacks and strokes. 

"The appeal of a freestanding ED from a consumer's perspective is that it's close to home, it's more accessible," Ms. Stella told Becker's.

The appeal for health systems 

It's no coincidence that freestanding EDs are gaining traction as health systems' budgets tighten. They're a smart investment from a financial perspective, the executives said. 

"Standing up a freestanding emergency department is definitely more economical in terms of capital because you're not building a full hospital," Ms. Stella said. "I think it's a strategy for all of us to fulfill our missions of being where people need us when they need us, and doing it in a way that's more cost effective than trying to build hospitals every year. There's really not good value in continuing to just build the same model over and over, so [the freestanding ED is] a little more innovative." 

As competition continues to rise, freestanding emergency departments can also help systems infiltrate new markets and become the provider of choice. 

"Healthcare organizations are competing for market share, and having a freestanding emergency department in a neighborhood allows that access to care so it plugs [those community members] into your institution," Dr. Roach said. "If you go to a Broward Health freestanding, then you might be more likely to go to a Broward Health follow-up, primary care specialty care. I think that hospitals recognize this from a business standpoint and think if we put out freestandings, that will bring [patients] into our system and we will gain the downward services." 

Broward Health is confident in the model and is already looking at properties to build a second freestanding ED in Lighthouse Point, Fla., Dr. Roach confirmed. 

A unique feature of the Broward-Memorial partnership 

Broward Health and Memorial Healthcare System did not choose to partner because of proximity, but because of aligned values, Ms. Stella said. Both systems recognize the value of specialized emergency care for pediatrics, which Joe DiMaggio Children's will provide at the new freestanding ED. 

Memorial Healthcare System currently has three dedicated pediatric emergency rooms, and Broward Health has two; the new facility will be the sixth between the pair. 

"We share that philosophy [with Broward] that children are not small adults, they need to have separate types of services and things set up for their developmental needs," Ms. Stella said. "This [ED] is just adding to a larger fabric and a larger mission that we all share and value: that children need child-specific care. This is just another outpost." 

The joint facility, set to open in 2025, is expected to see 15,000 patients per year and have a $10.8 million economic impact on the community through job creation. Read more about the partnership here.

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