Lawnwood owner branches out with freestanding ERs

HCA, owner of Fort Pierce’s Lawnwood Regional Medical Center, is moving forward quickly with plans to build a freestanding emergency room in southern Indian River County.

If completed – as soon as next summer, provided permits are forthcoming – it could become the only 24/7 healthcare facility in the county other than the two hospitals: Indian River Medical Center and Sebastian River Medical Center. Currently no urgent care centers here offer round the clock care.

The facility also marks the entry of hospital giant HCA into the Indian River County market, giving it a toehold on a long stretch of central Florida coastline; currently HCA has no presence between Fort Pierce and Jacksonville.

Last fall, HCA made it to the final round in the bid to take over Indian River Medical Center. After entertaining Vero hospital leaders at its Aventura and Coconut Grove hospitals – Lawnwood was notably not on the tour – HCA lost out to Cleveland Clinic in a vote last January. The Cleveland takeover has been approved by local hospital leaders and is moving through government regulatory hurdles in the months ahead.

Freestanding ERs have been a trend for the past decade; one expert tallied 400 in 32 states in 2016, and projected another 800 to 1600 in the future.

Costs at freestanding ERs are significantly higher than urgent care centers because like a hospital ER, they charge a facility fee as well as fees for professional services. HCA’s freestanding ERs are required by the federal law known as EMTALA to accept all patients with life-threatening emergencies regardless of ability to pay. Typically, though, such off-site ERs tend to treat less severe conditions and symptoms, more in line with what an urgent care would treat.

The project got an initial green light last Thursday from the Indian River County Planning and Zoning Commission.  “We’re waiting for site plan approval and the building permit,” said Rick MacDonald, project executive at Proctor Construction. “The site plan department is looking at it right now, and there have already been comments sent to the civil engineer of things they want corrected.”

The 11,000-square-foot, single-story facility is expected to take eight months to build once permits are issued, according to MacDonald. It will include an ambulance bay, a CT scan, X-ray rooms, and a bariatric treatment room.

Demolition has already begun on the site, which is zoned for general commercial use and is adjacent to the South Vero Square shopping center anchored by a Publix. According to county records, two parcels totaling 1.29 acres were sold to Lawnwood in July for a total of $1.99 million.

Last year, HCA Holdings announced a broad expansion of its urgent-care and free-standing emergency departments in 14 of its biggest markets, including Orlando. HCA had a record capital budget that year of $2.9 billion, and planned to open 19 new locations by the first part of this year. With multiple HCA marketing personnel not responding to 32963 inquiries, it’s not clear whether the Vero project is tied to that expansion, which was to have added 48 urgent care clinics and 19 freestanding ERs system-wide by the end of 2018.

HCA is the largest investor-owned healthcare company in the nation. It has 169 hospitals and posted revenues of $41.5 billion in 2016. The company courted IRMC aggressively with the largest capital outlay promised if they took over: $386 million over 10 years, plus an additional upfront payment of $75 million.

The south Vero facility will be the first freestanding ER affiliated with Lawnwood. HCA’s other hospital in St. Lucie County, St. Lucie Medical Center, has a freestanding ER 10 miles away in western Port St. Lucie. Built three years ago, the 11,000-square-foot facility at Darwin Square has a bay for ambulances, separate pediatric rooms, a lab, and imaging and diagnostic equipment including a 32-slice CT scan.

In addition to freestanding ERs, HCA owns the urgent care clinic brand, CareNow, a privately-held company acquired by HCA in late 2014. Along the Treasure Coast, there are five CareNow clinics in south Fort Pierce, Port St. Lucie and Jensen Beach.

Those clinics, as well as the freestanding ERs and hospitals, are run from HCA’s East Florida division headquarters, known to Vero healthcare interests for its efforts to partner with Indian River Medical Center. HCA was the only for-profit system among Vero’s four finalists.

“While we can’t predict the impact this will have on healthcare specifically to any one hospital or health system, the healthcare landscape is changing everywhere,” said Cleveland Clinic spokeswoman Heather Phillips. “Our focus remains on our commitment to advance care and access across southeast Florida and work together for the benefit of patients.”

While Cleveland Clinic Florida hasn’t built freestanding ER’s in Florida, it is about to acquire one in its takeover of Martin Health Systems, announced the day before Vero’s approval of the IRMC deal. The Martin Emergency Center at St. Lucie West was built in 2009.

While other healthcare systems are scaling back on freestanding ER construction, HCA’s president Sam Hazen – soon to become CEO, it was announced last month – pinned its expansion to heavy volume in its hospital ERs, according to Modern Healthcare.

Freestanding ERs have generated considerable controversy in the healthcare industry. Unlike urgent care centers, the nation’s 400 freestanding ERs can charge hospital prices, and, according to one analysis, patients with the same diagnosis can be charged 10 times the fee they would pay at an urgent care facility.

Contrary to HCA’s move in Indian River County, freestanding ERs are typically going up in middle- to upper-income neighborhoods where residents are more likely to have commercial insurance – and providers are more apt to be paid.

Though the freestanding ER will be affiliated with Lawnwood, it is not known whether patients needing more intensive treatment or overnight stays would be taken exclusively to Lawnwood, a Level II trauma center with a pediatric ER, or if they could opt for Indian River Medical Center, which is considerably closer, not only for emergency transfer but for visiting family members.

At HCA’s Port St. Lucie freestanding ER, there is an arrangement with an ambulance company to transport patients needing more extensive care or an overnight stay to the ER’s affiliated hospital, St. Lucie Medical Center, and requests to go elsewhere may require extra arrangements and incur added costs, according to a staffer there.

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