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We Build Alaska

Free standing emergency rooms are not a field of dreams

Do you remember not so long ago when Alaska Regional Hospital ran a campaign called, “Get treated, not seated?” The thrust of the campaign was that a patient could be seen quickly at Alaska Regional in the Emergency Department (ED) compared to other hospitals.

Around the same time as that campaign, Providence Alaska Medical Center had a campaign with the words, “I choose Providence.” Anecdotally, it seems most people choose Providence.

It was clear when Jennifer Opsut, CEO of Alaska Regional, sent me a graphic of closures of area emergency departments due to volume. It included hospitals in the Mat-Su and Kenai Peninsula. Providence was the only hospital consistently overflowing. Alaska Regional typically has the problem when Providence is full. After 20 years in private practice in Anchorage, it reaffirmed what I see all the time.

Alaska Regional wants to build a free-standing emergency room (FSER) in South Anchorage. This issue came up in 2015 when Alaska Regional wanted to build two FSERs, with the other in Eagle River. The state rejected the proposal.

It’s no surprise that in 2023 Alaska Regional and its emergency department physicians support the current FSER proposal. Predictably, Providence and its emergency department oppose it. Make no mistake, the motives are all about the Benjamins.

Why do I say that?

I have looked everywhere and found no studies showing FSERs improve care. I asked physicians in the ED at Alaska Regional in 2015 for studies. None of them produced. I asked my brother who was tasked with planning a FSER in Texas in 2019. He told me there were none. I have asked Jennifer Opsut recently and she told me she would provide some. That was weeks ago and it’s been crickets since.

Smoke is being blown by everyone on this issue. After all, Providence owns FSERs in the lower 48.

There is data that FSERs increase costs to a community. Much of that data is from studies sponsored by insurance companies. Is that biased? Maybe, but insurers would be first in line to support the cause if money was being saved.

Why do FSERs increase costs? The reasons are simple. Emergency rooms can charge more for the same service that a physician’s office or urgent care center provides. If someone choses an FSER instead of other locations, the bill multiplies.

How big is the difference? It can be over ten times as expensive to go to a FSER. And there is a 75% overlap by diagnosis between the FSER and urgent care centers. Multiple studies have reached similar conclusions. Colorado is willing to pay hospitals to shut down FSERs due to the high costs.

Areas with more urgent care centers and primary care offices have less utilization of ER services. Medicaid patients have been shown to utilize emergency rooms more than any other group, including the the uninsured. Access is a major issue that can be solved with better insurance and more non emergent facilities.

A FSER is based on the “Field of Dreams” principle. If you build it, they will come. Some patients will not understand the cost difference. Patients with Medicaid can utilize the facility with little financial hit. The most fertile place for the field is where the payment mix will be the best.

Well insured patients in Anchorage tend to cluster in certain areas of town. South Anchorage is one of those areas. So is Eagle River, although not targeted this time. That explains why FSERs are built in affluent areas elsewhere. Drive around Las Vegas and you will see FSERs mere blocks from hospitals.

I live in South Anchorage. It is 17 minutes to Alaska Regional according to Google. It is 15 minutes to Providence. It is ten minutes for me to get to intersection of the New Seward and O’Malley. When you correct for an emergency vehicle, the time differences for travel are nominal.

There remain many conditions that would be inappropriate to bring to a FSER. Myocardial infarctions (heart attacks) need a catheterization lab. Gastrointestinal bleeds need an endoscopy department. There are acute surgical conditions that will need an operating room. And those patients will generally need admission to the hospital. There is not any data that a FSER is detrimental to care but why take acute patients there at all?

There is another access issue in Anchorage. A logjam exists downstream where patients cannot be discharged from the hospital. It is a result of lack of coverage or availability for long-term care and skilled nursing facilities. Beds remain occupied and admitted patients have to remain in the ER. It is a constant issue at Providence where patients never seem to move upstairs, and it has been for years. The ticket upstairs for my patients tends to be a trip to the endoscopy lab.

I am a stupid stomach doctor. I have no financial dog in this fight. There is concern for the financial health of my community. Health care costs too much in the United States. Who cares if there are FSERs everywhere else or if Providence has them in the lower 48? Do we really need to jump off the bridge like everybody else? We need a coherent argument on this issue.

We should be taking actions to lower cost, not increase them. And we should not be taking actions that show no demonstrable improvement to care.

We need better access outside of the emergency room. People need to know they can access those options. In addition, we need better options to get patients out of our acute care hospitals to prevent back-ups in the ERs. How about Alaska Regional and Providence spend some money on that problem? And maybe the chiefs of staff at both hospitals who happen to be ER physicians could encourage that effort.

Would more ER beds be helpful. Probably. But it’s clear to me that we do not need a FSER.

Dr. Brian Sweeney has practiced gastroenterology in Anchorage for 23 years, with the first three at JBER. The views presented here are his own and are not made on behalf of any organization.

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Cletus Nose
8 months ago

The Good Dogter should become a regular contributor here

Cartman 3:16
8 months ago
Reply to  Cletus Nose

Pheonix, is that you?

Jimbob
8 months ago

He says, I’m a stupid stomach doctor. 🤣 I love the sense of humor from this guy. He has valid points about FSERs, hopefully his advice gets taken.

Cartman 3:16
8 months ago
Reply to  Jimbob

He does make good points. He often does. But just as often they get lost in excessive verbiage and the doc’s obvious infatuation with his own voice.