Health Reform, Convenience Driving ED Construction in Ohio

May 26--Expanded health coverage under the Affordable Care Act and hospital initiatives to provide faster, more convenient emergency services in rural and suburban communities have spurred a new wave of emergency department construction.

Kettering and Premier health networks -- the largest hospital systems in the area -- are spending millions of dollars on new, freestanding emergency departments as well as upgrades and expansions attached to hospitals throughout the region.

The networks are adding emergency department capacity, in part, to meet the pent-up demand of newly insured residents who have postponed treatment because they couldn't afford it, said Roy Chew, president of Kettering Medical Center.

"You have a whole bunch of people who are now insured and are going to be more willing to seek out medical help," Chew said. "If people have put off medical treatment for a while, at some point they're going to have to have those issues resolved. The emergency department is oftentimes the front door to that whole process."

More than 360,000 Ohioans gained health coverage this year by enrolling in private plans sold through the ACA's health care marketplace or qualifying for expanded Medicaid benefits.

More ER visits

Many of those new beneficiaries are expected to add to the surge in emergency department visits Kettering has already seen. Emergency visits rose 22 percent from 2011 to more than 247,000 visits system-wide last year, the company said.

Kettering's Raj Soin Medical Center in Beavercreek has seen so much traffic that it recently broke ground on an $8.2 million addition to the hospital's emergency department.

The two-story, 22,000 square-foot addition on the north end of the emergency department was always part of the plan when the medical center opened in 2012. But heavy patient volume moved up the timetable years ahead of schedule.

"When the hospital opened, there was a big vacuum and huge need for a health-care facility there, and people are flocking to it," said Nancy Pook, medical director of the emergency department at Kettering Medical Center, who said she lived in Greene County for more than 20 years.

Before Kettering's newest hospital opened, emergency and urgent care services in the community were scarce, Pook said: "Now people have a place where they can go where it doesn't take a half an hour or more just to drive to the emergency department, and then wait who knows how long to get in."

Cutting down on wait times and providing better, faster service for residents outside urban centers has been a driving force behind freestanding emergency centers being built to augment hospital emergency departments.

In addition to the Soin expansion, Kettering plans to build two emergency centers by 2015 -- in Eaton in Preble County, and in Franklin in northern Warren County -- at a cost of about $10 million each.

Premier, which recently announced plans for a $28 million, 96,000-square-foot addition to the emergency department at its Good Samaritan North Health Center in Englewood, is also utilizing the freestanding model.

The health network recorded 282,089 emergency department visits last year, and recently celebrated the one-year anniversary of its $6 million Miami Valley Hospital Jamestown Emergency Center -- a freestanding emergency center in Greene County.

Freestanding centers fill a critical need for patients whose conditions are urgent but not life-threatening, said Tom Parker, Premier's senior vice president, service lines.

Less waiting

Like hospital emergency departments, freestanding centers are fully equipped to diagnose and treat acute conditions and severe trauma. But freestanding centers don't receive patients arriving by ambulance, so patients with less severe emergencies get more immediate attention, Parker explained.

"One of the things that patients always tell us is that their satisfaction is very significant in a freestanding ED because the entire treatment experience is more patient friendly," he said. "From the moment you pull in and park, it's a shorter distance to walk, it's easier to navigate (than a big hospital) and you have shorter wait times."

Whether freestanding or not, the use of emergency departments is slowly supplanting primary care offices as the center of health care.

The use of emergency departments is growing faster than the use of any other part of the U.S. medical system, according to the American Hospital Association, which says emergency departments are now responsible for about half of all hospital admissions in the United States.

And the Affordable Care Act, which is expected to expand insurance coverage to an additional 32 million Americans by 2019, will continue to put pressure on hospitals to expand and upgrade their emergency departments, Parker said.

"The delivery model for health care in this country is changing dramatically ... and the responsibility we have is to anticipate the requirements of health care reform and to continue to develop a high-quality, cost-effective delivery system," he said. "Will that result in additional changes and projects we're not talking about? Undoubtedly it will."

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