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Virginia Hospitals Expand Stand-Alone Emergency Care

The time it takes for Goochland County Fire and Rescue crews to pick up and transport a patient to a hospital emergency room, then return to base, ready to take another call, can be as long as three hours.

In the western reaches of the county, the closest hospital is more than 30 miles away.

A new, free-standing emergency room department scheduled to open in the West Creek office park off state Route 288 in Goochland this year will speed things up, predicts Chief William MacKay of Goochland Fire and Rescue.

"Our ambulances will spend a lot less time on the road going to distant facilities," MacKay said.

The Richmond area will get its first stand-alone emergency room departments -- facilities not attached to hospitals -- this year.

Bon Secours Virginia is building an emergency center in Watkins Centre in Chesterfield County, with a planned late fall opening date. HCA Virginia has broken ground for the West Creek facility, to open in advance of opening a full hospital at the site in 2016.

Both projects are just off state Route 288, a highway that loops through the growing Richmond suburbs of Chesterfield, Powhatan and Goochland counties.

Stand-alone emergency room departments have been around for some time. Both HCA and Bon Secours operate them in places outside of the Richmond region.

In rural areas, these stand-alone centers can provide the only access to emergency care for miles. In areas on the cusp of becoming population centers, the facilities provide access to emergency care until the area can support a full-service hospital.

Chesterfield's estimated 2010 population of 316,236 makes it the fourth-largest locality in the state. The county population grew 22 percent from 2000 to 2010, and median family income in 2009 was $82,291, according to the U.S. Census Bureau.

Goochland, with an estimated 21,311 residents, grew 29 percent from 2000 to 2010, census figures show. The county's median family income in 2009 was $86,023.

The West Creek Emergency Center will be associated with Henrico Doctors' Hospital, said Pat Farrell, chief executive officer of Henrico Doctors' Hospital.

"This will be a fully-equipped emergency department, so it will be able to handle anything other emergency departments handle," he said.

The Bon Secours project at Watkins Centre will anchor a hub that will include two medical office buildings. It will be affiliated with St. Francis Medical Center, located 4.5 miles away, which has its own emergency department.

Both projects, the developers said, will create jobs.

"We think it's a fantastic location," Kevin W. Barr, chief executive officer for ambulatory services for Bon Secours Virginia, said of the facility at Watkins Centre.

"It's an economic development zone and a critical point in Chesterfield County," Barr said. "The retail development across the road (Westchester Commons) has done well. The bank is across the street. ... We are 90 percent committed on both medical office buildings. Independent doctors who will lease the building have already made commitments."

Barr said a Bon Secours Virginia free-standing emergency center at its Health Center at Harbour View complex in Suffolk is doing better than expected.

"The one in Suffolk is doing outstanding," Barr said. "We just expanded the medical office building. We opened that expansion just a few months ago. It's full."

Stand-alone emergency room departments are not without critics.

Some worry they add to overuse of higher-cost emergency room care for maladies that can be taken care of in urgent-care centers such as Patient First or convenient-care clinics like those inside Walmart or CVS drugstores.

Some studies suggest that as many as a third of emergency room visits are for problems that could be taken care of in less costly settings.

Also, because these centers are developed as off-site facilities affiliated with approved hospitals, they often don't need to go through a state review process to see if they are really needed.

Virginia does not have any special regulations for free-standing emergency departments.

Hospitals are allowed to have off-site facilities, which are subject to the same rules as on-site facilities.

If a patient needs to be transferred to a full-service hospital or admitted, the stand-alone emergency centers will handle the transfer. Reimbursements and insurance coverage should be the same as for a regular emergency department.

Emergency room visits nationally are rising, according to the American Hospital Association. In 2008, more than 123 million visits were made to 4,613 emergency departments, up from 120 million visits to 4,565 emergency departments in 2007.

Some hospitals have started to address crowded emergency rooms with no-wait policies that take patients to treatment rooms right away. Emergency department crowding is one justification, supporters say, for more freestanding centers.

Insurance companies, however, are trying to reduce unnecessary emergency room use.

Anthem Blue Cross Blue Shield in Virginia in 2010 began a program to get plan members to consider urgent care centers and same-day doctor's appointments after a review of emergency room use in 2008 found that more than 60 percent of visits were "avoidable visits" for problems that could have been treated in an urgent-care or other setting.

The new free-standing facilities will operate 24 hours a day, seven days a week.

Among the requirements for emergency departments, which apply whether or not a facility is stand-alone, are:

a physician available at all times;

no less than one registered nurse assigned to the emergency service on each shift; and

ambulance services.

They also are subject to the federal Emergency Medical Treatment and Active Labor Act, which requires hospitals getting Medicare funds to screen and stabilize any patient who shows up.

Both facilities will take patients who come on their own and by ambulance.

"I think the West Creek center may pull some more urgent cases out of southern Goochland, but if an ambulance is coming down I-64 with a critical patient, my guess is that they would go to Henrico Doctors' or St. Mary's," said Karen Cameron, a health care consultant who formerly ran the state-supported health planning agency serving Richmond.

"A lot might depend on emergency care professionals' perception of the facilities' capabilities and, perhaps, how the facilities themselves define the range of their services," Cameron said.


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