– Quick medical attention, with a price
– Rapid emergency treatment, with a cost.
Accident – Death – Obituary News :
By Michelle Crouch
From SouthPark to Steele Creek, Mountain Island Lake to Waxhaw, modern and efficient standalone emergency rooms are appearing throughout the Charlotte region to cater to patients without the need for a hospital.
Since 2010, Atrium Health has unveiled eight freestanding emergency rooms in the Charlotte metro area, as part of a nationwide trend. Two more are in the pipeline, with anticipated openings in Ballantyne later this year and in Concord in 2025. Additionally, CaroMont Regional Medical Center operates a standalone ER in Mount Holly within the region.
This trend is also evident in other parts of the state, with new freestanding ERs in the Triangle and Greensboro, and more planned for the Asheville area.
For patients, these facilities offer convenience and typically shorter wait times compared to hospital-based ERs, which are often overcrowded. First-time visitors are often amazed at how quickly they can be seen and treated.
However, the shock may come later when they receive the bill, which can amount to thousands of pounds for a brief visit.
As the number of freestanding ERs grows in North Carolina and across the country, some healthcare experts are beginning to question whether the convenience justifies the rising costs and potential confusion for patients.
Moreover, there are concerns about accessibility. While hospitals claim that standalone facilities enhance access to care, they are predominantly located in affluent suburbs rather than rural or low-income areas.
“The argument that they serve rural areas is not entirely accurate,” explained Daniel Marthey, a researcher at Texas A&M specializing in freestanding ERs. “They tend to be situated in suburban areas, targeting privately insured patients who pay more, thereby driving up the cost of care for everyone.”
Studies indicate that many patients visit standalone ERs for conditions that could be treated at lower-cost urgent care centers, while others arrive with conditions requiring a higher level of care, necessitating an ambulance transfer to a hospital.
The emergence of hospital-free ERs
In 2001, freestanding ERs represented only 1% of all emergency departments nationwide. By 2016, this figure had risen to 11%, as reported by Becker’s Hospital Review. Recent data is scarce, but experts suggest that the trend has gained momentum.
In states like Texas, numerous standalone facilities have opened, including many unaffiliated with larger health systems.
The expansion has been more gradual in North Carolina, primarily due to the state’s Certificate of Need approval process regulating freestanding emergency departments. The state mandates that these facilities must be affiliated with a hospital.
Atrium, which operates nearly half of the state’s 16 freestanding ERs, selects locations with expansion and accessibility in mind, according to Jennifer Sullivan, an emergency medicine physician and Atrium’s senior vice president of strategic operations.
“This option has become more convenient for patients as they can drive themselves or a family member, as opposed to relying on an ambulance,” Sullivan added.
These centers allow the system to manage infrastructure costs efficiently, as they can serve an area without constructing an additional full hospital. Sullivan noted that Atrium uses them to “better serve rural areas like Waxhaw, Kannapolis, and in rural Georgia.”
Furthermore, she mentioned that freestanding ERs help alleviate patient pressure on hospital-based ERs.
Other hospitals in North Carolina are also increasing the construction of standalone facilities.
In the Triangle region, WakeMed Health & Hospitals recently opened its fifth standalone ER in early 2024. In a podcast, Carolyn Knaup, WakeMed’s senior vice president for strategic ventures and ambulatory operations, highlighted the success of the facilities.
“We believe that healthcare is truly local,” Knaup stated in an April 2024 podcast by the architectural firm designing the facilities. “Our standalones are strategically positioned around our three hospitals. The intention is for the standalones to support the hospitals, in case patients at the standalones require admission or higher-level care.”
Nashville-based HCA Healthcare, the owner of Mission Health in Asheville, has been actively constructing freestanding facilities nationwide. It has received approval to build its first two North Carolina facilities in Arden and Candler, located outside Asheville.
Novant Health, based in Winston-Salem, operates two freestanding EDs. One is situated in Bluffton, a rapidly expanding community near Hilton Head, S.C., and the other is in the Scotts Hill area of Wilmington, where Novant plans to open a full-scale hospital in 2026.
A strategy to attract affluent patients?
National research indicates that freestanding facilities primarily cater to a higher-income population that already has access to healthcare, with 76% located within six miles of the nearest hospital. Studies also suggest they are more prevalent in ZIP codes with fewer Medicaid patients.
This trend is evident in the Charlotte region, where most standalone facilities are located in affluent suburbs.
Experts suggest that these centers are typically part of a hospital strategy to target higher-income, privately insured patients and direct them to their system rather than a competitor’s.
“It’s about saturating your market space and increasing your market share,” explained Tina Marsh Dalton, an economist at Wake Forest University specializing in health policy.
Revenue generated from standalone facilities can assist health systems in subsidizing their hospital-based emergency departments, which often provide discounted or free care, she added.
A study by Marthey and colleagues revealed that patients visiting freestanding facilities are generally younger, healthier, more likely to have private insurance, and less likely to be identified as Black or Hispanic compared to those visiting traditional ERs.
Moreover, a higher proportion of visits to freestanding facilities are for conditions that could have been managed at a lower-cost facility, Marthey highlighted.
“Essentially, patients are seeking treatment at these facilities for issues that could have been addressed at an urgent care center for a fraction of the cost,” Marthey noted.
Enhanced service, but at a cost
Curt Warner, a resident of the Ballantyne area in Charlotte, shared his positive experience when he took his son to the Atrium freestanding emergency department in Waverly for stitches on Christmas Eve.
“The experience was seamless,” Warner recalled. “I was pleased with the service, cleanliness, level of care, and the reasonable wait time, especially on Christmas Eve when nothing else was open.”
However, he was surprised a few weeks later when he received a bill exceeding £3,000. After insurance coverage, Warner was responsible for around £1,750.
Health insurers, faced with an increasing number of claims from freestanding centers, are also apprehensive about the costs. They have highlighted the price disparities as a means to encourage patients to opt for more cost-effective options.
For instance, UnitedHealth Group’s analysis revealed that the average cost of treating common conditions at a freestanding ER facility (£3,217) is 22 times higher than at a physician’s office (£146) and 19 times higher than at an urgent care center (£167).
If you build it…
Do freestanding facilities alleviate overcrowding in hospital ERs? One study found that an Ohio hospital ER experienced a decrease in patient numbers after opening two freestanding ERs in the vicinity.
However, the study also noted that the overall number of emergency visits within the system surged, as many individuals sought care at freestanding centers for conditions that could have been managed at lower-cost facilities.
Marsh Dalton highlighted that some patients may struggle to differentiate between an ER and an urgent care facility.
“Freestanding EDs represent a novel concept,” she explained. “There’s also uncertainty about whether patients understand when to visit urgent care versus the ED. With numerous options available, clarity is lacking.”
Some patients may visit a freestanding facility for a condition necessitating a higher level of care available only at a hospital, risking a critical delay in receiving the required treatment. Many freestanding EDs lack operating rooms, pediatric equipment, or specialists on-site, unlike hospitals.
Some patients require a transfer
Emergency physician Tim Lietz, CEO and president of Mid-Atlantic Emergency Medical Associates in Charlotte, highlighted the importance of choosing the appropriate ER based on the situation.
While a standalone facility may be suitable for a time-sensitive, life-threatening emergency, Lietz recommended opting for a hospital-affiliated ER in certain cases. For instance, individuals experiencing pregnancy-related complications, anticipating surgery, or managing complex conditions may benefit from the resources available at a hospital.
“Typically, for older patients in their 70s and 80s displaying symptoms, hospital admission is likely,” Lietz pointed out. “While you can visit a freestanding ER, be prepared for a potential ambulance transfer to the hospital. Additional costs may apply for this transfer.”
Emergency medicine physician Jennifer Casaletto, who has practised in freestanding facilities, added that delays in transferring patients may occur.
“Given the current circumstances, where hospital ERs are frequently operating at full capacity, patients may face extended wait times in freestanding EDs before a bed becomes available for transfer,” Casaletto noted.
Heart-breaking delays in care
In rare instances, such delays can have devastating consequences — a reality that continues to haunt Lacey Williams of south Charlotte.
In 2017, Williams took her wife, Laura Maschal, to the freestanding Atrium ER in SouthPark due to a persistent headache.
Initially, doctors found no issues and discharged Maschal, 39. However, during the journey home, Maschal began experiencing uncontrollable vomiting and confusion, prompting Williams to rush her back. Subsequent tests revealed a ruptured blood vessel in Maschal’s brain, requiring emergency surgery to stem the bleeding.
Unfortunately, the freestanding facility lacked a surgeon — a resource typically available at most hospital ERs — and did not have an operating room on-site.
Although the ER staff arranged for Maschal’s transfer to Carolinas Medical Center, Atrium’s level 1 trauma center, they were unable to proceed until a bed became available.
It took three hours for the ambulance to arrive, during which time Maschal’s condition deteriorated, resulting in irreversible brain damage by the time they reached CMC.
“Would the outcome have been different if we had gone directly to CMC Main? I can’t say,” Williams reflected. “But the uncertainty is agonizing. Waiting for hours while your loved one is in a critical condition and nothing can be done is excruciating. I remember pacing and feeling overwhelming rage.”
In response to inquiries regarding Maschal’s case, an Atrium spokesperson cited privacy regulations prohibiting discussion of patient cases without consent. However, he emphasized that patient safety is paramount in every encounter.
He acknowledged that healthcare has evolved significantly since Maschal’s incident, and bed availability remains a challenge in both freestanding and hospital-based facilities.
“In emergency medicine, prioritizing urgent cases is crucial, including assigning beds and managing patient transfers between facilities,” the spokesperson stated. “While delays may occur due to bed availability or transportation constraints, we have established multiple processes to mitigate these issues, prioritizing care for those in need.”
Williams continues to grapple with guilt for not heading directly to the hospital and shares her wife’s story as a cautionary tale.
“I’ve undergone extensive therapy and sought closure,” she disclosed. “However, unless it’s a straightforward case like a broken bone or immediate care is required, I would not recommend taking an unwell loved one to a freestanding ED.”
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– Free standing emergency room services
– Benefits of using a standalone ER.
