Utilization and Value in the Wake of an FSER Boom
Over the last several years, freestanding emergency rooms (FSERs) have seen a boom in popularity. FSERs provide 24/7 emergency care and are physically separate from a hospital campus. The allure of these offsite emergency departments stems from their potential to increase access to healthcare resources. However, FSERs are falling under scrutiny for the lack of price transparency and their tendency to operate in more affluent, populated areas.
Florida's state health regulatory entity, the Agency for Health Care Administration (AHCA), provides publicly available data on emergency room visits for the state of Florida. The AHCA data provides a field to differentiate which emergency visits occurred at a hospital-based ER and those at a FSER. Stratasan has analyzed the impact and utilization of FSERs to determine if they are providing a benefit to the communities they serve. Check out our infographic to find out what we learned.
Share this Image On Your Site
The state of Florida has been the front runner for benefiting from the FSER trend. Florida does not require a certificate of need to build an FSER, but only allows hospitals to operate them. Additionally, the FSER must be within 35 miles of its parent hospital. Florida's first FSER opened its doors in 2002. Between 2002 and 2011 only seven were operational. However, beginning in 2012, the trend started to take off with three opening in that year alone. Last year in 2018, 13 FSERs were added to the inventory and so far 13 have opened in 2019. Florida is expected to see at least three more open later this year. Seven more have been slated to open in 2020. Including those currently operational and those announced, this gives Florida a total of 75 FSERs.
From 2014-2018, Florida's population grew 7.7%, adding 1.4M more people. Over that same time frame, ER volume grew by 12%, outpacing population growth. However, hospital ER volume grew by 7.4% while FSER volume grew by 145%. FSER volume accounted for 3% of all ER volume in 2014; by 2018 it accounted for over 7%.
Many critics claim that FSERs do not serve their intended purpose of increasing access to care or relieving hospital ERs from the lower acuity patients that take up hospital resources with minor issues. When looking at the acuity level of patients seen in the hospital vs ER setting, variances are observed. Acuity levels range from one to five, with one representing the most urgent and five being non-urgent. Over 52% of the FSER visits in Florida are level three, compared to 36% for hospitals.
FSERs also seem to differ from traditional hospital ERs in what time patients are seeking care. When comparing the hour of arrival of patients to hospital ERs vs FSERs, the hours of 5pm to 9pm are significantly more popular for FSERs than for hospital ERs. This could be due to traditional doctors' offices being closed during these hours and indicate people are seeking alternatives.
Many FSERs tout their ability to get patients in and out within a few hours, compared to five to six, or more, for traditional hospital ERs. AHCA data provides both an hour of arrival and an hour of discharge. This data indicate that 71% of FSER patients are discharged in two hours or less, compared to 49% of hospital ER patients. 41% of FSER patients spend an hour or less, while only 24% of hospital ER patients are discharged in that same time frame.
Over 30% of FSER patients are commercially insured, compared to 25% for hospital ERs. Data indicates that the older, Medicare population is more likely to visit a hospital ER, with 19% of the volume. Only 15% of FSER volume is Medicare. This trend is also apparent when looking at age distributions of volume. 44% of FSER volume is between the ages of 18-44, compared to 41% for traditional hospital ERs. Over 23% of FSER volume is between ages 0-17, while hospital ER volume is 20%.
Data indicates that people are willing to travel outside of their home county to an FSER. Over 33% of FSER patients are treated at a facility outside of their county of residence. While 86% of hospital patients seek care at a facility in their home county.
The distribution of diagnoses for hospital ERs and FSERs also show differences between utilization. For both settings, general medicine is the top diagnosis. However, otolaryngology and orthopedics each account for 16% of FSER volume, while only accounting for 12% and 13%, respectively, for hospital ER volume. Over 9% of all otolaryngology ER volume is treated at a FSER. Cardiology diagnosis account for over 8% of all hospital ER volume, but only 5% of FSER volume.
A few conclusions can be drawn from the data.
The Medicare population has not caught on to the FSER trend yet. This could be due to their illnesses requiring more complex care, or a lag in adoption of a new model for care.
Given the high volume of ENT diagnoses and the popular hours of arrival for FSERs, it could be plausible that patients are utilizing FSERs for illnesses that can be treated at an urgent care. Potentially the popularity currently is due to lack of education on what an FSER is and when to use it vs an urgent care. However, access to urgent care could be an issue.
The data show that FSERs are more efficient with getting patients in and out more quickly. FSERs are also treating the less acute cases that can tie up crucial hospital ER resources.
For more information about Stratasan’s software and services—which can help to inform growth decisions, track market standing, and better understand your competition—schedule a discovery call today.
Infographic by Morgan Atkins, Director of Innovation for Stratasan