Free-standing EDs: Access or Just Excess?

By: Cari Frank

I recently sold my home in “Disturbia” (aka the south suburbs of Denver), and was pleasantly surprised at how much it had increased in value in just two short years. My excitement quickly faded when I realized I would have to spend a lot more money for a lot less house in the same neighborhood. The Denver housing market is currently thriving because of the influx of people moving here and the fact that new construction and established home availability isn’t keeping pace with the demand.

New health care facilities are popping up left and right as well, which at first thought makes sense given the increase in population and potential demand. More people means more health care needs, right? Access to care is a huge issue, especially in rural areas of the state, so you would logically connect more facilities with expanding access. In some instances that might be the case, but it’s important to look at what types of facilities we’re building, what kind of care they provide to whom, and at what costs to determine whether or not it’s a true benefit to Colorado.

One relatively new facility type that’s spreading like wildfire is the Free-standing Emergency Department (ED). Colorado now has more than 20 Free-standing EDs – all built within the last two years. They are located in suburban areas along the I-25 corridor, and in most cases are in close proximity to each other and not far from an urgent care facility or hospital.

You could make the argument that their location in highly populated suburban neighborhoods could be beneficial in cases like a heart attack when getting care in five minutes versus 20 minutes could mean the difference between life and death. However, Colorado All Payer Claims Database data shows us that with the exception of chest pain, the top ten reasons people visited a Free-standing ED in 2014 were for non-emergent issues like sore throats, stomachaches, colds and fevers.

So, if Free-standing EDs aren’t saving tons of lives, are they at least a cheaper alternative to a traditional hospital ED? The answer is no. They cost virtually the same. Looking at abdominal pain – the fifth most commonly treated condition – the price tag ranges from $4200-$5600 compared to only $142-$151 at an urgent care center. The chart below shows comparative prices for all of the top non-emergent conditions at Free-standing EDs compared to urgent care centers. The difference is astonishing, and I for one can think of a lot of things I could do to my new house with an extra $4000 or even $5450!

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From a recent cost-driver analysis, we know that Colorado has the potential to save $800 million a year if patients stopped going to EDs for common conditions like colds and headaches. By placing Free-standing EDs right in people’s backyards, essentially disguised as urgent care centers, we run the risk of inadvertently increasing ED usage in the state and driving costs even higher.

Bottom line is that as a state we need to be more thoughtful and intentional about building a system that provides smart health care options focused on keeping us healthy, and when we need it, providing us with access to the best, most cost-effective care possible.