Debate over freestanding ER will continue into January

By Kelcy Dolan
Posted 12/10/15

The debate over the proposal for a freestanding emergency room in West Warwick continues after the project review committee, a subcommittee of the Health Services Council, decided to push making a …

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Debate over freestanding ER will continue into January

Posted

The debate over the proposal for a freestanding emergency room in West Warwick continues after the project review committee, a subcommittee of the Health Services Council, decided to push making a decision until their next meeting in January.

Neighbors Emergency Center, based out of Texas, is currently seeking initial licensure from the council to open a facility at 325 Quaker Lane on Rt. 2. The facility would expect to create 25 jobs, employ local construction and architecture organizations and run under a $3 million budget after start-up costs.

The organization boasts putting the patients first, with shorter wait times and fewer parking concerns than a traditional emergency room, but many within the medical community have concerns about this type of facility, whether or not they would work for the underserved, as well as the strain it may or may not put on the healthcare system and costs.

Patricia Rocha, a Rhode Island lawyer representing lawyers, argued that since Neighbors doesn’t require a “certificate of need” for operations, the council had to follow the narrow criteria for an initial license, whether or not the business is competent, in good standing while providing adequate care, financially viable and provides care for the underserved. The final criteria, and whether or not Neighbors actually meets it, is what most of the public comment and review committee was concerned with.

Rocha and Maureen Fuhrmann, chief business development officer for Neighbors, pointed out that in Texas, unlike Rhode Island, Neighbors is not required to provide charity care, and yet throughout their facilities they have previously.

Under federal law, Neighbors is not allowed to participate in Medicare or Medicaid, but Fuhrmann said the company would be happy to and hope to see that change in the future. She explained that in true emergencies patients coming in with these insurance plans are considered their charity care. Otherwise, these patients are evaluated and given the option to either pay out of pocket or be transferred to a primary care physician, hospital or urgent care center.

“It is the patient’s choice,” Fuhrmann said. “They are informed at the time of service how much it will cost and given the choice of what they would like to do.”

Committee member Tarah Provencal asked if Medicare or Medicaid patients are considered the underserved population, and Neighbors doesn’t serve these patients, who would be the underserved population they would work with?

She offered that in Rhode Island emergency rooms see a lot of patients struggling with behavioral health, overdoses and substance abuse issues. She questioned how Neighbors would serve these patients, and how it would be any different from what ERs are doing already.

John Barry, also a committee member, said he was “not convinced” Neighbors would provide proper access to any underserved population and wanted more time to review the information and give Neighbors time to present further on their plans.

Furhmann said that no matter what, every patient receives a screening from a physician. Neighbors’ centers provide a “safety net” to healthcare systems in Texas and would like to have similar partnerships here in Rhode Island.

“We do take all patients,” she said. “We don’t want to pass any burden.”

Dr. Anthony Crillo, who works in the emergency department at Lawrence + Memorial Hospital, argued Neighbors wouldn’t be part of the state’s healthcare system but do the opposite and hinder it.

“The reality is the ER will be there for all patients no matter what, not just the easy ones,” he said. “This won’t provide more access. There won’t be more patients and more visits just because you’re here.”

He believes Neighbors will just “cherry pick” the best insured patients, taking that away from hospitals, which are already struggling financially.

Peter Graves, an emergency physician at Kent Hospital, which is less than three miles from the proposed Neighbors facility, said the freestanding ER would appeal to Rhode Islanders for “all the wrong reasons.” He believes they provide extraordinarily expensive care under “the guise of convenience,” especially when the majority of patients can be discharged the day of those same patients could receive cheaper care from an urgent care center or primary care physician.

“This is a barrier to primary care services,” Graves said. “We are all trying to improve our services and the collaboration in the system and a facility like this undermines all that work.”

Kent CEO Dr. Michael Dacey, who opposed the ER in testimony, attended Tuesday’s meeting but did not speak.

Rocha believed that despite all of the comments, it doesn’t change that Neighbors meets all the requirements for licensure.

The project review committee will meet with Neighbors again on January 19 and is expected to make a recommendation to the full council, which will then present that to the director of the Health Department.

Comments

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  • RISchadenfreude

    In other states, such as Texas, freestanding ER's are everywhere. You can bet the hospital staff and nurses' unions are behind the opposition and that hospital administrators are worried about their bottom line, not the patients' welfare.

    First of all, it's a walk-in clinic; anyone who's been to a hospital ER knows that if you walk in with a minor injury, you may sit there for hours if there are more serious cases ahead of you- having a freestanding ER would alleviate some of the pressure on hospital ER's; also, if you're transported by rescue / ambulance for an emergency, you are still going to a hospital.

    Never mind that many residents of West Warwick do not own a vehicle and having an ER nearby would be more convenient than getting to KCMC; the hospitals want to keep their monopoly under the guise of their concern for the patient- at least Dr. Crillo was honest enough to say that Neighbors would hurt their "bottom line".

    The tone of this article seems to indicate that Kelcy, and by association the Beacon, side with the hospitals and not the patients.

    Friday, December 11, 2015 Report this

  • therock147

    We need to call this what it is, an URGENT CARE FACILITY!!!! This is no ER, try going there with no coverage and see what happens!! I am all for new buisness in RI but don't try to pull the wool over our eyes, this in no way will be an ER like a hospital ER, its a walk in, plain and simple.

    Sunday, December 13, 2015 Report this

  • RISchadenfreude

    As I stated above, it is an ambulatory ("walk-in") facility; as such, you are likely to be waited on much quicker than in a hospital if you do not have an emergency. If the hospitals' concern were for the patient rather than for their bottom line, you would think that they'd be pleased that patients did not have to wait to be treated for a minor injury- their biggest concern is competition.

    Friday, December 18, 2015 Report this