HCA executives in North Texas have signed an agreement to lease a building with more than 10,000 square feet and plan to convert it into a stand-alone emergency department. The former Wolf Camera Store location north of downtown Dallas will be the sixth ER HCA has opened in the city. The company (Ticker: HCA) is pursuing a similar strategy in several of its other important markets.
HCA has been approved to build an 80-bed hospital in Oviedo, Florida, on the site of an existing freestanding emergency department.
Central Florida Regional Hospital opened its freestanding ER on 48 acres in Oviedo, northeast of Orlando, last November. According to state documents, the ER has seen significant utilization, including a 17 percent admissions increase in its first three months of operation. HCA intends to add inpatient services, diagnostics and more to the future Oviedo Medical Center. An estimated construction cost was not reported.
Officials with HCA have laid out similar plans locally, with long-term plans to add service lines — and possibly a full hospital — on the site of TriStar Health's freestanding ER in Spring Hill, 30 miles south of Nashville.
The state years ago denied HCA's certificate of need application to build a full hospital in Spring Hill, but approved the ER construction, considering it a satellite department of TriStar Centennial Medical Center in midtown. The ER was built in 2012, and officials say they continue to monitor the facility's services and capabilities, evaluating the need for additions or a full hospital.
HCA Holdings this week announced an agreement to admit to its 10 Dallas-area hospitals patients from the freestanding ER departments run by First Choice Emergency Room. The latter company, which is based in Dallas, runs 17 facilities in Texas and Colorado.
The agreement aims to ensure bed availability for First Choice ER patients needing acute care services provided by nearby HCA hospitals. First Choice ER transferring patients will avoid HCA hospitals' emergency departments and will instead be directly admitted when non-emergent criteria are met.
Local health IT company InQuicker continues to grow quickly — it now works with almost 180 hospitals around the country, up from 135 in July — and has found plenty of fans in the industry. But Stephanie Armour at Bloomberg says some people have an issue with the idea that certain patients are either getting dibs on emergency services or using the ER when they don't need to.
“I’m just floored,” Sara Rosenbaum, a health law and policy professor at George Washington University in Washington, said in an interview. “It’s concierge emergency departments, and by definition, if you’re making an appointment, it’s not an emergency. These are the same hospitals that go crying that they’re awash in patients and don’t know what to do.”
Growth remains strong at InQuicker, the Nashville-based company that lets consumers schedule emergency room and urgent care clinic visits. The six-year-old company is now working with eight University Hospitals facilities in the Cleveland area, which has lifted its network of hospitals to 158 in 21 states. That's up from 135 in July and more than double its year-ago number. Interestingly, no Nashville hospitals have signed on yet.
So The New York Times has published the expected second story stemming from its investigation of HCA Holdings. The piece lays out the big rewards reaped by the hospital chain's private-equity investors but spends most of its time on the changes to ER admission procedures executives rolled out in 2008.
Nearly overnight, HCA’s patients appeared to be much, much sicker. By 2010, HCA had surpassed other hospitals, with 76 percent of its payments coming from the two most expensive classifications, versus 74 percent for other hospitals.
For individual HCA hospitals, the change made a big difference. At Riverside Community Hospital in California, Medicare reimbursements for the highest classifications surged to $949,000 in 2010, from $48,000 in 2006. Likewise, at Kendall Regional Medical Center in Miami, Medicare payments jumped to $1.5 million from $69,000.
The story also takes HCA to task for some of its staffing levels, saying the company's aggressive approach has resulted in higher-than-normal rates of bedsores and, in some cases, much more serious complications.
Things appear to be going swimmingly at InQuicker, the young local company whose website lets patients schedule emergency room and urgent care clinic visits. In a note touting improvements in waiting times, InQuicker officials say they now work with 135 hospitals around the country. That's up from 115 when we working on our Entrepreneur of the Year package in March.
Many hospital operators — including the two biggest based in Middle Tennessee — are these days asking emergency room visitors to pay for at least part of their care up front, reports Kaiser Health News. The approach, they say, lets them better manage potential bad debts but also eases the strain on ER networks, who often treat patients that could be getting their treatment from other providers. One potential wrinkle with that idea: Human behavior isn't always rational and many people won't go to a doctor's office on Monday if they leave an ER untreated on Saturday night.
"This is a real problem," said Dr. David Seaberg, president of the American College of Emergency Physicians, who estimated that 2 to 7 percent of patients screened in ERs and found not to have serious problems are admitted to hospitals within 24 hours.
Tenet Healthcare CEO Trevor Fetter was feisty Tuesday when asked about the chances of his team dropping its admissions-related lawsuit against Community Health Systems. "We have no intention of withdrawing," he said, suggesting instead that CHS could at some point offer a satisfactory settlement.
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