Cilia Zayas, MHA, MSF and Ph.D. student in the Department of Health Outcomes and Policy (HOP), gave an oral presentation at the 2017 American Public Health Association (APHA) Annual Research Meeting on how freestanding emergency departments affect the patient population seeking care at nearby academic medical center emergency departments. This year’s APHA conference in early November brought more than 12,000 public health professionals from across the United States and around the world to Atlanta to share their research, exchange ideas, network, and collaborate.
Zayas’ talk, “The Association Between Freestanding Emergency Departments in the Market and the Payer Mix of Academic Medical Center Emergency Departments,” reflected work undertaken with Thomas Payton, M.D., MBA, Travis Murphy, M.D. and Joshua Hurwitz, M.S., in the Department of Emergency Medicine at the University of Florida, and Nitish Patidar, Ph.D., MHA, MBBS, in the School of Business at Quinnipiac University.
Over the past several years, there has been a proliferation of freestanding emergency departments across the United States. Unlike traditional hospital-based emergency departments (EDs), freestanding emergency departments are not physically attached to a hospital and may or may not be affiliated with a hospital. Freestanding EDs often are strategically placed in more affluent communities with higher proportions of privately insured patients. This clustering near population centers with high percentages of privately insured patients could siphon potential revenue away from surrounding hospitals.
Additionally, siphoning away privately insured patients could negatively affect “safety-net” hospitals and emergency departments with higher percentages of uninsured and Medicaid patients that are already financially constrained. These hospitals rely on a certain percentage of privately insured patients to remain solvent. Of particular importance is the payer mix of hospitals affiliated with academic medical centers that not only tend to care for a higher number of uninsured and Medicaid patients, but also support education, research, and clinical missions.
The researchers examined the relationship between the placement of freestanding emergency departments within 10 and 35 miles of academic medical center emergency departments, and the payer mix of academic medical center emergency departments, as reported through the Academy of Academic Administrators of Emergency Medicine database.
“After controlling for differences in hospital emergency department characteristics, and market characteristics, we found that there is indeed a negative association when freestanding emergency departments are clustered within 10 miles of academic medical center emergency departments,” Zayas said.
The findings of this study quantify the impact of freestanding emergency departments on the payer mix of nearby hospital-based emergency departments, and show that the placement of freestanding emergency departments near hospital-based EDs may decrease the proportion of privately insured patients seen in hospital-based emergency departments. The potential long-term effects can vary depending on alternative sources of funding for public hospitals, but the effect could limit the ability of hospital-based emergency departments to serve as a “safety-net” for all patients within their community.