Free (Grand) Standing ERs

are growing like weeds in affluent neighborhoods. The idea is to bring the mountain to patients. However, the phenomenon is creating problems and getting the attention of state legislators whose constituents feel misled about prices and about how free-standing ERs are different from other newly created care delivery channels like urgent care centers, advanced practice professional-run primary care clinics, and retail based clinics.

How free-standing ERs will fit into the sick-care distribution mix remains to be seen. Here are some things to watch:

1. Legislative and regulatory intervention

2. The mixed message: We’re told ERs are over-utilized and expensive. Meanwhile, billboards now beckon you to come to our convenient new ER in the strip mall nearest you.

3. Business models that are designed to maximize revenues under existing reimbursement and payment rules. Maybe, some day, we'll see offshore, tax exempt holding companies running the shows.

4. More and more patients getting angry and more in debt due to unpayable ER bills

5. The continuing lack of patient education and awareness about options and choices when they think they need care. Some should just wait out their illness (no, you can starve or feed it, but, in most cases, don't treat it with antibiotics at your retail based clinic), others can go to other less expensive options.

6. The misguided notion that most patients are good sick-care consumers

7. The failure of most ER-to-outpatient hand offs and the lack of effective physician referral management systems

8. The continued lack of transparent pricing

9. Cherry picking the highest payor mix when choosing sites

10. Truth in advertising and the patient's right to know their obligations when choosing a point of care

All these things represent opportunities for clinical entrepreneurs to create better products and patient-defined value. However, as long as we continue to let the reimbursement rules’ tail wag the care delivery model dog, expect to see that whopping bill in your mailbox because you placed your chips on the wrong number playing high stakes sick-care roulette.