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Stand-Alone Emergency Centers Aim for Treatment Without the Wait

Posted on: Monday, 22 August 2005, 21:00 CDT

Aug. 21--From children in need of a few stitches to heart-attack sufferers complaining of chest pain, Dr. Frank Genco is used to treating patients' emergencies.

For 14 years, he cared for thousands of patients in various hospitals' emergency departments across the Metroplex. He patched their wounds, diagnosed their illnesses and often listened to their gripes about lingering for hours in crowded waiting rooms and competing for weary caregivers' attention.

The repeated complaints bothered Genco, who grew so frustrated with hospitals' traditional approach to emergency medicine that he took a drastic step this summer.

He invested his family's money to create an independent emergency center in North Richland Hills, where Genco believes he can give patients more attentiveness and quicker treatment than typical ERs.

His free-standing EMC Emergency Medical Center -- which isn't associated with a hospital -- features cardiac monitors, oxygen equipment, a defibrillator and much of the gear associated with hospital emergency departments.

"We have the ER capability, the ER experience," Genco said. "But we don't have the ER wait."

Although Genco's practice is unconventional, the center is among numerous free-standing ERs that have appeared locally and nationwide in recent years.

In fact, Genco spent about a year working for Emergency Care Center, a company that runs several stand-alone ERs, including facilities in Southlake and Coppell -- before launching his center in June.

Many other stand-alone emergency centers are associated with hospitals, which seek to expand in growing communities without adding inpatient beds.

For example, Tyler-based East Texas Medical Center Regional Healthcare System runs three free-standing ERs: one in southern Tyler and two in outlying areas.

The centers have given the company a foothold in growing communities. And the south Tyler facility allows patients to access emergency care without queuing behind people with more severe injuries at East Texas Medical's trauma center, said Jim Parisi, the system's vice president of trauma.

"It's a really customer-friendly place, where you get to see a physician and hopefully get in and out of there in an hour," Parisi said.

Although many hospitals view their ERs as a financial drain, East Texas Medical sees its stand-alone facilities as integral, Parisi said.

"One of the ways to attract patients to your hospital is to have a good, customer-friendly ER. It's your window to your community," he said.

Dr. Nancy Auer, former president of the American College of Emergency Physicians, said free-standing emergency centers can allow health care providers to make inroads into a community and ease crowding at other hospitals' ERs.

Seattle's Swedish Medical Center, where Auer is chief medical officer, opened its stand-alone ER in March, despite resistance from competitors who questioned whether the center could handle trauma patients. Swedish Medical ultimately agreed to accept only the least severe ambulance cases and to collect more data for several months, Auer said.

"It did cause a bit of a firestorm with some of the other hospitals, because it's a new entity and nobody else had one of these," she said.

Most recently in Raleigh, N.C., WakeMed Health & Hospitals opened a free-standing ER last month at a campus on the city's north side.

Administrators had expected to treat about 280 patients during the facility's first month of operation. Instead, they quickly had to add staff as more than 1,000 patients turned up, said Carolyn Knaup, executive director of WakeMed North Healthplex, which includes the free-standing ER.

"That part of our county is actually growing by leaps and bounds. It used to be very rural, very countryside. And it's become very populated," she said. "The demographics were such that these folks didn't want to leave their neighborhood to consume health care."

So far, Genco is seeing only a handful of patients daily at his six-bed center. But he believes that he and the staff, which includes three nurses and several clerical workers, could handle as many as 30 patients each day without creating long waits.

Genco sees privately insured and uninsured patients, although he doesn't accept payment from Medicare and other federal government programs.

Some other limits: The center doesn't receive ambulances. It's closed between 8 p.m. and 10 a.m. And because Genco doesn't accept federal dollars, it doesn't have to abide by rules that require traditional ERs to treat all patients who walk in the door.

Still, Genco said demand for emergency services is so great that he expects to fill a niche in the fast-growing, affluent area near Colleyville and Keller.

His target patient: An ailing man in his 30s or 40s, who hates visiting doctors and health care hassles but is dragged to the ER by his wife.

"That's who we're trying to please," Genco said. "If we can please him, we can please anybody."

In more serious cases when patients need to be admitted to a hospital, Genco said doctors at two nearby hospitals have agreed to admit his center's patients without requiring a pass through their own ERs first. And he's hoping to reach deals with more physicians.

Genco, a 42-year-old New York native, contends that his center can attract patients because most traditional hospital ERs force patients to endure unnecessarily long waits for care.

"They need to be challenged," he said.

Dinah Welsh, director of state affairs at the Texas Hospital Association, said many hospital ERs struggle with overcrowding and with serving patients who can't afford to pay for their care.

"It's a money loser, because Texas has the highest uninsured population in the country. Therefore, the emergency room is often used as a primary-care facility for many people," she said. "They see the big blue H, and they know that they can go there and get care if they show up in the emergency department."

Welsh noted that traditional hospitals can't turn away any emergency patients, stretching the resources of ERs -- especially busy trauma centers that must handle more serious cases first.

"There oftentimes is a significant wait for stitches, or a broken finger, or non-life-threatening injuries, which is frustrating," she said. "It's the readiness resources that are tapped, to an extent that you just cannot provide the immediate care for every single patient that walks in the door."

Genco concedes that his center generally doesn't grapple with the strain of serious trauma cases or nonpaying patients. But he insists there's a place in the market for a center where patients with heart failure, respiratory infections and less-serious troubles can get quick care.

"There's this great unmet need," he said.

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Source: Fort Worth Star-Telegram (Fort Worth, Texas)

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