Why this proposed emergency room annoys the hospital industry
Two years after a federal kickback scandal engulfed Sacred Heart Hospital, two physicians want to transform the shuttered facility into an outpatient medical complex anchored by a free-standing emergency center.
But the plan, which could cost up to $30 million, requires a change in state law and must overcome opposition from competing hospitals and an influential industry lobbying group.
Free-standing emergency centers are popping up around the country as consumers demand quicker care closer to home instead of enduring long waits after trekking to a hospital. Some Chicago-area hospitals are responding by posting their emergency room wait times on smartphone apps and on billboards along highways.
APGME, a Chicago-based for-profit that arranges training opportunities for foreign medical graduates, scooped up Sacred Heart for just $250,000 in late 2013 after the West Side hospital was forced to close. The venture is led by Drs. Sameer Suhail and Mane Paulpillai.
Former Sacred Heart owner Edward Novak and two former top administrators were convicted in March of bribing doctors in exchange for patient referrals. Prosecutors also accused doctors of performing unnecessary tracheotomies and overly sedating patients at the 119-bed facility, though those charges were never leveled against any defendants.
APGME’s plans call for converting the current hospital buildinginto an outpatient center with both primary care and specialty services. A free-standing rapid treatment center would be built on the site of the hospital’s parking lot, where Suhail says patients would be treated more quickly than at rival hospitals. Nearly 25,000 patients walked away from hospital ERs within five miles of Sacred Heart last year, he notes. “The community no doubt needs some health care services there,” Suhail says.
APGME initially wanted to re-open Sacred Heart as an in-patient hospital, but it didn’t think state regulators would approve the plan given the thousands of empty hospital beds in Illinois. And under federal health reform, insurers are rewarding hospitals and physicians financially to treat people in the least expensive way, which often is outpatient.
APGME is modeling its freestanding rapid treatment center after one at Lehigh Valley Hospital-Muhlenberg in Bethlehem, Pa. Dr. John Wheary heads emergency medicine there and is helping APGME develop its center.
In a traditional ER, a patient can be shuffled among triage, registration and the waiting room before being treated by a physician and eventually sent home. In a rapid treatment center, a team surrounds the patient, registering, assessing and treating him or her at the same time. “This is where we gain efficiency,” Wheary says.
He says it’s akin to a race car heading into the pit and being swarmed by a crew that fills the gas tank and changes the tires before sending the driver back into the race. At Lehigh, the process has shaved the average time it takes for a patient to see a physician to 20 minutes from an hour, he says.
Not many such centers exist around the country, though experts say hospitals are trying to make their ERs more efficient to reduce wait times.
“There is unquestionably a much bigger customer-service focus within medicine,” says Dr. Elaine Rabin, an assistant professor of emergency medicine who practices at Mount Sinai Health System in New York.
State Rep. Pamela Reaves-Harris, D-Chicago, is sponsoring a bill that would allow freestanding emergency centers in areas with at least 1 million people. Now, the state only allows such facilities in areas with 50,000 or fewer residents, and they must be affiliated with a hospital. State regulators would still have to determine that there is a legitimate need for the facility.
The Naperville-based Illinois Hospital Association says the proposed emergency center would jeopardize patient care and hurt nearby hospitals that are struggling financially, according to an advocacy alert the IHA sent to its member hospitals. An IHA spokesman declines to comment further.
“If you’re concerned about losing market share, then partner with” the new owners of Sacred Heart, Reaves-Harris responds.
Norwegian American Hospital, just more than a mile from Sacred Heart, opposes the plan. “You might need to transfer patients, which requires re- evaluation and a potential delay in care,” says Dr. Abha Agrawal, chief medical officer and chief operating officer. She adds that a large number of the patients who leave the ER before being treated aren’t experiencing emergencies and use it in lieu of a doctor’s visit.
Sacred Heart’s owners have a significant ally: Illinois House Speaker Michael Madigan is working to pass the bill before the legislative session ends on May 31, his spokesman Steve Brown says.