
No hospital, just an emergency ‘department’. They’re popping up all over - howard941
https://www.tampabay.com/health/no-hospital-just-an-emergency-department-theyre-popping-up-all-over-20181210/
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squozzer
>But critics say that having too many emergency departments in one community
reduces the quality of care because it shrinks the amount of practice that
local trauma-trained physicians get when treating complicated injuries. A
similar argument was made when Northside Hospital tried to open a trauma
center earlier this year, but withdrew after two other area hospitals with
trauma centers contested the expansion.

A spin on the Roemer Effect it seems. Florida apparently has a Certificate of
Need policy.

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jrochkind1
I would guess the major motivation for this is that the ED is one of the most
profitable parts of the hospital? The article kind of hints at it, but doesn't
really go out and say that.

~~~
JshWright
In my experience it is often a "loss leader". ERs have to treat everyone,
including the large number of people who are never going to pay a cent.
However, by getting people in the door, you then control (for all intents and
purposes) where they go if they need to be admitted.

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tylerl
Stand-alone emergency departments are definitely a good thing. At least, the
kind we have in Redmond is.

The "main" hospital is about 5 miles away from the stand-alone ER, both run by
the same company. They have the full compliment of equipment and physicians
you'd expect, and can handle most serious scenarios there. And most
importantly, there is never a significant wait, while the hospital is usually
very busy. If you need to be admitted, they ambulance you to the main campus
at no charge.

There really is no downside. You get the part of the hospital that matters, in
more places. The only problem seems to be that people don't realize that
they're available, so the ER at the primary campus is still overcrowded.

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sys_64738
Are these ERs or Urgent Care depts?

~~~
hideo
FTA "... but residents should know that they can't stay there overnight for
care. Such facilities operate in a space between urgent care clinics and
regular emergency rooms, the latter where patients can be quickly admitted
into hospitals..."

So somewhere in between I guess?

I find it quite ridiculous to expect people to keep track of these nuances.
Especially considering this is people who are severely ill, or maybe panicking
about being ill.

~~~
howard941
The advertisements for these sites is unusual. Actual examples of appropriate
use according to one of the operators:

\- Stomach pain

\- Wounds that won't heal

\- Shortness of breath

\- Bleeding that doesn't stop (minor bleeding illustrated by the cartoon)

> maybe panicking about being ill

This, except for the shortness of breath.

EDIT: copyedit

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mr_toad
> Patients in states like Texas and Colorado have reported receiving bills for
> thousands of dollars from emergency departments

If you’re paying more than several hundred dollars for non-admitted treatment
you’re being swindled. Outside a few treatments such as dialysis and
chemotherapy anything that expensive warrants admission.

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afarrell
> swindled

Do people generally have a choice what ER they go to? I’ve definitely seen
people complain on the internet because they were passed out on the sidewalk
and someone called an ambulance on them which stuck them with a large bill.

~~~
mathgeek
This always raises an interesting question about the concept of charging
someone for a service that they did not have an opportunity to ask for or
consent to until after the fact.

On one hand, you have doctors wanting to save or improve someone's life. On
the other hand, especially when death is the result despite attempts to safe
the patient's life, the person/estate has now incurred a cost that was
potentially undesired.

~~~
JshWright
We (EMS) operate under "implied consent" in those cases. If someone is
incapable of consenting to treatment, we assume that they would want to
treated (because that's a better failure mode than not treating someone who
does want it).

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time-domain0
I saw these fake emergency rooms all over Texas in strip-malls. They shouldn't
be allowed because they don't have the staff or resources to provide adequate
care and delay life-saving interventional medicine.

~~~
pukeythrowaway
Yeah, I'm going to disagree. I visited one just today while traveling, and it
was a (figurative) life saver.

I deal with cyclic vomiting syndrome, and when an episode hits, about only
thing that stops it is a promethazine injection. Last night's episode had me
retching every 5 minutes, starting from around 8pm. I figured since the nearby
urgent care centers were closed, I'd suck it up and puke til 8am. By around
3am I gave up and was looking into where the nearest ER was. It turned out to
be an ED as described in the article.

Within 10 minutes of arriving, I was already through triage, and talking to a
doctor. Within 20 minutes, I'd been poked, and another 20 until I was out the
door. To top it off, I was expecting the $200 co-pay that comes from a normal
ER visit, but was instead met with only a $75 co-pay.

I'm gonna say this is a huge win over the alternatives.

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oliwarner
In the UK a _private_ prescription for this costs £1. It's IM so anyone can
administer.

And FWIW, get yourself a pack of the suppository version of this. Sounds like
it'll save you a lot of inconvenience and money.

