Free-standing emergency rooms may be coming to Georgia patients.
Four hospitals — three owned by a private company and one nonprofit hospital — have told the state Department of Community Health that they’d like to set up one or more of the facilities. They would place free-standing emergency rooms in five sites, all in metro areas in Georgia with above-average incomes.
“As our communities grow, Memorial Health is making sure that our neighbors have access to emergency care where they live,” Savannah-based Memorial Health said in a statement. “These ERs will provide access to emergency care where it is needed.”
Memorial is owned by the for-profit company HCA Healthcare, and its proposed ERs would be in Pooler and Richmond Hill, both in metro Savannah. Two other HCA hospitals have also proposed the facilities, in Evans and Bonaire. University Hospital has also proposed one in Evans.
Free-standing ERs can have different setups. Memorial says the two it wants to open would each have board-certified emergency medicine doctors and emergency nurses, with a total of 32 staffers to provide care 24 hours a day. Each would have 12 beds and one trauma bay.
To open the facilities, the applicants must convince the state that they are needed — that they won’t just be poaching paying patients from hospitals where they can already get care. If the state agrees, it would issue the applicants a “certificate of need,” or CON, a much-valued approval allowing them to do business.
For-profit companies have fought in the Legislature for years to loosen the state’s CON regulations. They have applied to open up free-standing ERs before, but only recently did the Legislature spell out in the law that the state can issue a CON for such a facility.
Legislators have said CON needed to be loosened to give Georgians more options and to help provide solutions for rural health care, where several financially struggling hospitals have closed.
All five of the proposed free-standing ERs would be in metro areas, and all five are areas with average incomes well above the state average.
But there are still uninsured people in each of them. Although they’re well placed for profit, the ERs would still likely be required to serve everyone who walks in the door, including the uninsured, said Ethan James, a lobbyist for the Georgia Hospital Association. That’s because hospitals are applying for them as extensions of their hospital work. A Memorial Health spokeswoman confirmed that.
The free-standing ERs are a business proposition, said Jesse Weathington, a lobbyist for insurance companies. Insurance companies often fight with hospitals over high medical prices.
“They’re chasing patients with insurance coverage,” Weathington said. “It’s about competing with the other hospital in that metropolitan area.”
As for patients, he said, hospital prices for things such as MRIs tend to be higher than they are in independent MRI offices. However, he said, the sites may be a boon for patients dealing with the “golden hour” after trauma or a stroke when treatment can be most effective. “It’s definitely an upshot to access for trauma patients. Because it may take 25 or 35 minutes of your golden hour to get to a Level 1 center.” Those are the highly equipped hospitals able to treat trauma victims; there are only a few Level 1 facilities in the state.
Memorial’s free-standing ERs, if approved, will be able to treat such stroke patients, said Dr. Jay Goldstein, the medical director of emergency services for Memorial Health, “administering (a clot-busting drug) to stabilize the patient and then transfer to the hospital for additional care, if appropriate.”
Several health care companies and nonprofits have filed with the state to open free-standing emergency rooms in Georgia. Two filings have expired. As of the latest weekly report, these five remain open. They are listed here by county.
Proposed site: Richmond Hill, Bryan County
Applicant: Memorial Health University Medical Center (HCA)
Status: Pending review/incomplete application
Proposed site: Pooler, Chatham County
Applicant: Memorial Health University Medical Center (HCA)
Status: Pending review/application complete
Proposed site: Evans, Columbia County
Applicant: Doctors Hospital of Augusta (HCA)
Status: Pending review/application complete
Proposed site: Evans, Columbia County
Applicant: University Hospital
Status: Letter of intent filed
Proposed site: Bonaire, Houston County
Applicant: Coliseum Medical Centers (HCA)
Status: Pending review/application complete
Source: Georgia Department of Community Health
SERVING METRO AREAS
The median household income for Georgia is about $55,000, and 13.7% of its residents lack health insurance. The rate is highest for working-age adults, since the elderly are generally eligible for Medicare and poor children are generally eligible for Medicaid. These are the median household incomes where the freestanding emergency rooms would be built, and the percent of the population without health insurance.
Bonaire (metro Warner Robins): Lacks separate census data. Its 31005 ZIP code: $77,000, 9.2%.
Evans (metro Augusta): $103,000, 5.1% estimated.
Pooler (metro Savannah): $78,000, 8.3%
Richmond Hill (metro Savannah): $68,000, 13.5%
Source: U.S. Census. Jennifer Peebles assisted with this data.
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