New emergency care is coming, despite critics

NEW DIRECTION IN HEALTH CARE: President and CEO Dr. Setul G. Patel, pictured in the background, helped found Neighbors Emergency Center in 2008. The free-standing emergency care business is entering the Rhode Island market, with two new centers in West Warwick and Bristol. / COURTESY NEIGHBORS EMERGENCY CENTER
NEW DIRECTION IN HEALTH CARE: President and CEO Dr. Setul G. Patel, pictured in the background, helped found Neighbors Emergency Center in 2008. The free-standing emergency care business is entering the Rhode Island market, with two new centers in West Warwick and Bristol. / COURTESY NEIGHBORS EMERGENCY CENTER

Free -standing emergency centers are entering the Rhode Island health care market, despite criticism from hospitals that the services don’t match demand and that health care costs could increase.

Texas-based Neighbors Emergency Center on April 4 received approval from the R.I. Department of Health to open two free-standing emergency departments, NEC Bristol Emergency Center LP in Bristol and NEC West Warwick Emergency LP in West Warwick. Dr. Setul G. Patel, president and CEO, helped found the company in 2008 and has grown it to 23 active centers, with another 10 on the way, located mostly in Texas, Colorado and now Rhode Island.

“The movement is sort of sweeping the nation,” Patel told Providence Business News.

But the company’s entrance into the Rhode Island market has ruffled some feathers in the health care sector. Dr. Nicole Alexander-Scott, state health director, approved the company’s license applications. But in an unusual move, she did so against the recommendation of her advisory board, the Health Service Council.

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When asked to explain her decision, Alexander-Scott declined comment to PBN. But spokesman Joseph Wendelken explained in an email that the director was not evaluating the company’s application based on what impact it would have on health care costs. Instead, she based it on whether Neighbors demonstrated “character and good standing in the community, financial viability, the ability to provide safe and adequate care and a commitment to providing care to traditionally underserved populations.”

Rhode Island law regarding free-standing emergency centers is less restrictive compared with the rest of the country. The centers are not required to receive a certificate of need, which is a more vigorous and expensive application process. The CON, as it’s known colloquially, was designed originally to give states greater power to try to restrain health care facility costs. Critics of the process say it unfairly restrains competition in the health care market.

Rhode Island is one of a handful in the country without the requirement, including Neighbors’ home state of Texas.

Dr. Michael J. Dacey, president and chief operating officer at Kent Hospital, is critical of the Neighbors model, saying the for-profit entity provides a lot of duplication of services in the area.

“A free-standing emergency department about two miles away from here is not needed,” Dacey said.

The Neighbors model is designed to cut down wait times in emergency rooms, which from 2003-2009 throughout the country increased 25 percent on average, from 46.5 minutes to 58.1 minutes, according to a 2012 study done by the Centers for Disease Control and Prevention. But Kent, located within a few miles of Neighbors’ soon-to-be free-standing facility in West Warwick, provides care for about 70,000 each year and has already cut its emergency-room waiting time down to between 15-20 minutes on average.

The “rapid assessment model,” as it’s called, has been expanded to Memorial Hospital of Rhode Island.

Patel, however, challenges those figures, saying reducing the time before a patient sees a doctor isn’t the same as reducing the time before a patient receives “meaningful treatment,” including more face time with a doctor, X-rays or other medical attention beyond waiting in inpatient care. Patel says Neighbors does this in fewer than 10 minutes.

Dacey feels Kent doesn’t have any issue meeting patient demand. He worries the addition of a new free-standing emergency room could increase utilization rates and health care costs and weaken the long-term financial stability of the hospital’s emergency department. The latter concern stems from the fact that free-standing emergency centers are not allowed to treat patients using Medicare or Medicaid, which generally provide lower reimbursement rates to providers compared with private insurers.

“I think the impact won’t be good on either patients or the hospitals,” Dacey said.

But Neighbors will never turn away “any patient requiring emergency care … [and will ensure] free care to patients whose income does not exceed 200 percent of the federal guidelines,” and will participate in Medicare and Medicaid should the law change, said Patel.

How the model grows in Rhode Island, however, will depend on legislation passed in the state Senate requiring free-standing emergency centers go through the CON process. The House must now consider the measure.

Neighbors’ West Warwick center is scheduled to open in the first quarter of next year, and the Bristol location will open sometime after that. •

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