MUSTANG — Coeta Morrell keeps finding fewer reasons to drive into Oklahoma City.
Over the past 50 years, the Mustang resident has seen the number of businesses and services coming to her town continue to rise. Soon, Morrell can add a health care facility to that list.
Morrell was among several people who gathered last week at a St. Anthony groundbreaking ceremony for a health care campus it plans to build in Mustang.
“We're all looking forward to it, everybody I know,” she said. “And those of us who are getting older, sometimes time is of the essence, so we're very happy about that.”
The St. Anthony Healthplex Mustang will house Oklahoma's third freestanding emergency room, a term used to describe an emergency room facility that doesn't have inpatient beds.
Nationwide, the number of freestanding emergency rooms has increased from about 150 in 2005 to almost 300 in 2011, according to survey data from the American Hospital Association.
In early 2012, St. Anthony opened Oklahoma's first two freestanding emergency rooms, St. Anthony Healthplex South at 13500 S Tulsa Drive, and St. Anthony Healthplex East at 3400 S Douglas Blvd.
So far, other large health systems have yet to build freestanding emergency rooms.
An OU Medical Center spokesman said only that the hospital was evaluating the idea.
“We have seen success with freestanding ERs in other markets and are always evaluating new ways to serve our community,” said Scott Coppenbarger, OU Medical Center spokesman.
OU Medical Center is a Hospital Corporation of America hospital, a large for-profit health care management company that has freestanding emergency rooms in other states.
Meanwhile, neither Mercy nor Integris, which both have large networks throughout Oklahoma, have plans to build freestanding emergency rooms.
One of the reasons that Oklahoma only has two of these facilities, with a third on the way, might come down to the rules around who can operate an emergency room in Oklahoma.
Lee Martin, chief of medical facilities at the state Health Department, said in Oklahoma, only a hospital can be licensed through the state Health Department to operate an emergency room.
And the term “freestanding emergency department” doesn't exist within the rules regarding who can be licensed for an emergency room, he said.
Martin said companies and business administrators from other states have called him to ask about the rules around operating freestanding emergency rooms.
St. Anthony has a license from the state Health Department to operate its emergency rooms, and the state Health Department views the freestanding locations as branches of St. Anthony, he said.
Urgent care centers, meanwhile, are facilities that are operated through a specific physician's license, he said.
Kyle Nondorf, regional vice president of SSM Health Care of Oklahoma, said the concept of the freestanding emergency rooms came in 2009 after the company researched different markets where such a setup had been successful.
SSM Health Care of Oklahoma, which operates St. Anthony facilities, chose the locations of the three healthplexes after identifying markets with health care needs, Nondorf said.
“The cool thing about Mustang is, they were looking at a hospital with inpatient beds, and we approached them with — we think this is a sustainable model and is a model that's really going to be something we can develop for the future where health care is going,” he said. “They were very receptive and supportive of that concept.”
Nondorf said market research has shown between 5 percent and 8 percent of people who go to these types of facilities need inpatient care. Nationally, fewer people are using inpatient services, he said.
He said the freestanding emergency rooms can meet a community's needs and provide better access to services that are in high demand.
“Introducing more beds into the market, we felt like, was not the right thing,” he said. “What we needed to do was create more access points, and that's our focus. We think we're being good stewards of our resources by building these to meet more of the community's needs, as opposed to introducing more inpatient beds, which in the city of Oklahoma City, there are a lot of beds that aren't at capacity.”
Dip in patients
The St. Anthony Healthplex East sits directly east of Tinker Air Force Base. Midwest Regional Medical Center, which has a traditional emergency room, sits four miles northwest of that healthplex and the Air Force base, the source of a large percentage of the hospital's patients.
Shortly after the St. Anthony freestanding emergency room opened, Midwest Regional noticed a dip in patients. Damon Brown, CEO of Midwest Regional, attributes the dip to the newness of the freestanding facility.
Brown also serves as CEO of Integris hospitals in Clinton, Blackwell, Pryor and Seminole. He said freestanding emergency rooms might have a place in rural health care.
“Maybe that's what they need, versus a full acute-care hospital,” Brown said. “More and more things are becoming outpatient, things that we used to be in the hospital three or four days.”
ER misuse is common
Dr. Joseph Cunningham, chief medical officer for Blue Cross Blue Shield of Oklahoma, said too many people, especially in Oklahoma, are getting their primary care — health care that should be delivered by a family practice doctor — in emergency rooms.
“A lot of people don't have a primary care physician, so they seek their care when they have a sore throat or a cough or something that's not an emergency, in an emergency room,” said Cunningham, the company's vice president of health care management.
Cunningham said St. Anthony and other health systems could provide more access to health care by providing more space for primary care doctors, not more emergency services.
“If we allow these centers to pop up everywhere, and it drives our health care costs up as a state, then everybody pays,” Cunningham said. “That's how insurance is.”
Integris Southwest Medical Center sits somewhat between the two St. Anthony freestanding ERs.
Dr. David Hogan, who works at the Integris Southwest emergency room, said in general, he doesn't like the concept of freestanding emergency rooms.
“My personal opinion as a physician of 33 years is that really the only reason to have a freestanding is to increase one's market share,” Hogan said. “It's almost a purely business-related thing.”
Hogan is a member of TeamHealth — a health care company that staffs hospital emergency rooms — with doctors who work at the St. Anthony healthplex locations.
As part of TeamHealth, Hogan has been a part of the conversation among emergency room doctors and St. Anthony about how they can best serve patients without having a traditional hospital attached to the facility.
In other markets, freestanding emergency rooms have been criticized for looking like urgent care centers but charging emergency room prices. St. Anthony has been clear, though, that it is running an emergency room, Hogan said.
“I think that we are lucky here in the Oklahoma City metro in that Saints has done it right,” Hogan said. “For the most part, the freestanding that they have set up gives you as good of outcomes and good of time frames on critical patients as do most of the emergency departments that exist within hospitals ... But then beyond that, there are a lot of problems with freestandings outside our area.”
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