Maybe you have noticed and maybe not but last year I started seeing this grow as you have the new sometimes freestanding emergency rooms popping up.  They may not be in the same hospital building but normally anymore you see other build buildings around hospitals where doctors have their practices imageand many of these buildings also house an outpatient surgery center.  I see them all over Orange County.  Some are close to hospitals and some are not.  They are not owned by hospitals either, but there seems to be more of these popping up. 

The obvious reason is price of course and to keep folks out of the actual full functioning ER rooms of the hospitals.  This article is about another one going up in Florida.  It does get interesting as when hospitals own both they can strategize and run their analytics to move more procedures over to the out patient center ER center that also does surgical procedures, and of course patient safety is big and shoot I have seen almost like major surgeries going to the centers.  Some almost have every capability as far as equipment and IT infrastructure as the major ER rooms do.  All of the free standing surgical centers though are not ER rooms but keep your eyes open for maybe more of this to develop. 

The only difference that I saw with one example was the staff, scheduling etc. but the charges won’t be much or any less for many of them.  Now hospitals are competing with insurers wanting to own some of this business…here’s United Healthcare…its hard to keep up on who owns who or who has 51% controlling interest in healthcare companies. Look at this one below as you have a partnership with Surgical Care Affiliates and United to create Beach Surgical..hmmm..pretty tangled we weave sometimes with companies, so add that in here too as hospitals compete. 

So where do surgeons come from that perform procedures in these facilities, groups like I just described below or from the hospitals.

There’s also some investing and ownership with with surgical centers.  We are all aware of hospital systems buying up surgical centers and there’s also insurance company subsidiary action here too.  Via the MemorialCare subsidiary of Optum, the subsidiary of United HealthGroup created a new venture or subsidiary called Beach Surgical Holdings, LLC in February of 2013

“Beach was created in February when the foundation entered a joint venture with Birmingham, Ala.-based Surgical Care Affiliates LLC.”

In addition hospitals are now facing competition from insurers such as United Healthcare setting up their own Urgent Care centers and in some states doctors can work directly for a hospital or facility but not in California for one example.  This kind of goes along with hospitals buying up physician practices too as again it comes back to money and in those instances a lot of hospitals make more money with a “facility fee”.  All the big ones seem to be doing it and as a patient you get a bill and say “what’s this”…what’s a facility fee.  Here’s where United is opening their urgent care clinics, so far 3 of them and again this is competition for the ER room facilities.  It kind of gets a little fuzzy distinguishing exactly what kind of a facility you have as this a facility that would compare to a retail clinic, do they actually do surgical procedures at the facility and so on.  Pretty soon I might be asking myself “what an ER” (grin). 

United Healthcare Now Entering the Urgent Care Clinic Business To Help Keep Patients Out of the ER, Two More Opening In Houston–Subsidiary Watch

When you think of hospice services you always seem to think they are non profit, but not the case with Evercare, an owned company of United Healthcare. 

Hospice In the “For Profit” Sector As Subsidiaries of Health Insurance Companies-Subsidiary Watch

I guess we’ll be figuring this all out as to how we can fully identify which is what in time as more pop up.  It’s all about money of course as to where you will get to go and get the care you need.  When you look at the insurer involvement here too with competing with hospitals do you wonder about “what’s in network” in other words will the insurer subsidiaries have impact here too?  Typical urgent care centers don’t offer CAT scans, radiology and lab services and the stand alone ERs will.  So this is new hurdle for us up and coming to figure out where to go as more of these pop up and who and what’s in network with who for insurance coverage.  Here’s yet one more link from a couple years ago so some history here to see how this is evolving.  BD 

ER Building Boom By Hospitals in Some Parts of the US Taking Place–Cash Cows for Hospitals to Lure Insured Patients in Affluent Areas–Bigger Exposure to Re-Admissions

CLEARWATER — When Largo Medical Center executives wielded golden shovels this week to break ground for a standalone emergency room on one of Clearwater's busiest thoroughfares, they were mirroring a national trend: hospitals carving out highly profitable ER niches in each other's territory.

Hospitals want standalone ERs because they can charge hospital prices without the overhead of a massive campus. They can build them without having to prove a public health need to the state, as they must with hospital construction. And the ERs are a useful funnel to the main hospital if patients need more care, experts say.

That's the tack taken by executives of Largo Med and its owner, HCA, at Wednesday's groundbreaking for the $8 million, 10,600-square-foot ER the hospital estimates will serve 18,000 a year on the site of a former car lot at 2339 Gulf-to-Bay Blvd.

Peter Marmerstein, president of HCA's West Florida Division, pointed out that hospital ERs are often overcrowded here, especially during snowbird season.  But it won't be a cheaper alternative. Fees will be the same as at the hospital-based ER, a Largo Med spokeswoman said.


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