How do residents benefit from expansions in medical services and facilities? Do the changes affect the level, quality or cost of medical care patients receive? How can residents know which facility best meets their needs?
Central Ohioans have no shortage of options for immediate medical care.
Numerous standalone emergency departments, urgent-care facilities, small clinics and mini hospitals have sprung up around the region in the past decade, joining more than a dozen traditional hospitals in proximity to Columbus, as well as the primary-care physicians who maintain practices here.
This changing landscape has been highlighted by competing health-care organizations building similar facilities in the same community.
Reynoldsburg, for example, is home to satellite facilities affiliated with all three of central Ohio's largest health-care providers: Mount Carmel Health System, Nationwide and OhioHealth.
In Hilliard, OhioHealth recently opened a freestanding emergency department and an urgent-care facility, but the city also was in line for a Mount Carmel "microhospital" until the project was put on hold after its building partner, Adeptus of Lewisville, Texas, entered bankruptcy protection in the spring.
And in Grove City, the burgeoning southwest Franklin County community that has been on the rise in population and business growth since the turn of the century, has hospitals under construction by both Mount Carmel and OhioHealth that are expected to open next year. Both providers already have urgent-care centers in the community.
But with the bevy of options come several questions, including: How do residents benefit from these expansions in services and facilities? Do the changes affect the level, quality or cost of medical care patients receive? How can residents know which facility best meets their needs?
The answers lie in understanding for whom these facilities are designed and how they operate, according to medical professionals.
By the numbers
The sheer number of medical facilities in central Ohio can be overwhelming:
* OhioHealth has four traditional hospitals in Franklin County -- Doctors Hospital, Dublin Methodist Hospital (the only one not in Columbus), Grant Medical Center and Riverside Methodist Hospital -- and one in Delaware County, Grady Memorial Hospital, according to Katie Logan, media-relations manager for OhioHealth.
It also is building a 26-bed community and surgical hospital with an emergency department in Grove City that will be smaller than the others in the network, she said. It will be named Grove City Methodist Hospital and is expected to open in late 2018.
OhioHealth operates eight urgent-care centers in central Ohio -- Delaware, Dublin, Gahanna-New Albany, Grandview Heights, Grove City, Hilliard, Polaris and Reynoldsburg -- and four local freestanding emergency departments, which often are referred to as FSEDs, in Hilliard, Lewis Center, Pickerington and Westerville.
Hilliard's is the most recent to open when it began operations Sept. 13 and it represents the first of six new OhioHealth FSEDs being built as part of a $52 million expansion. The next of the five to open will be Reynoldsburg on Dec. 13, with the rest in 2018: Obetz and Powell in February and New Albany and Worthington later in the year.
All the OhioHealth FSEDs will have on-site primary-care offices, except for those in Hilliard and Reynoldsburg, which already have primary-care offices and urgent-care centers near the FSEDs, Logan said.
* Mount Carmel Health also has four traditional "acute-care" hospitals in central Ohio: Mount Carmel East, Mount Carmel West, Mount Carmel St. Ann's and Mount Carmel New Albany, according to the organization.
A fifth full-service hospital is under construction in Grove City and is scheduled to open in 2018.
The system includes a few smaller hospitals, including Diley Ridge Medical Center, a joint venture with Fairfield Medical Center, in Canal Winchester; Mount Carmel Rehabilitation Hospital, a partnership with HealthSouth that opened earlier this year in Westerville; and Mount Carmel Behavioral Health Hospital, which is being built with partner Acadia Healthcare on the east side of Columbus.
Mount Carmel also operates two urgent-care facilities on East Broad Street in Columbus and in Grove City and two FSEDs in Grove City and Lewis Center.
In addition to these facilities, the Mount Carmel Medical Group division has 23 primary-care locations, 53 specialty-care locations and three "health stations."
* The Ohio State University Wexner Medical Center operates seven hospitals and two trauma centers in Columbus, according to university officials.
Ohio State does not operate any FSEDs or mini hospitals, but it does have two AfterHours clinics, its version of urgent-care centers.
Ohio State also is affiliated with many of Kroger's Little Clinics, which are staffed by nurse practitioners or physician assistants and patient-care technicians and are inside Kroger stores throughout central Ohio.
The 17 Little Clinics throughout Franklin County and in Delaware and Pataskala are owned and operated by Kroger, and Ohio State has physicians collaborating with nurse practitioners in a dozen of them, said Alexis Shaw, an Ohio State spokeswoman.
* Walgreens representatives said the pharmacy operates eight health-care clinics in and around Columbus, and CVS has 12 MinuteClinic locations in Franklin County and four in Delaware County.
* Many other medical facilities exist, not the least of which are Nationwide Children's Hospital and its satellite locations. Other organizations also operate urgent-care facilities and clinics throughout central Ohio.
The services the facilities provide are the first way patients can differentiate among them.
Primary-care physicians -- family doctors, essentially -- diagnose and treat common illnesses and medical conditions at their practices. They also provide general health screenings, physical exams and similar services.
Traditional hospitals render all types of acute-care services, including inpatient services, surgeries and emergency care.
Specialized facilities offer such services as surgery and rehabilitation, and trauma centers are for such cases as severe burns, gunshot wounds or injuries sustained in a serious car accident.
Walk-in clinics like those operated by Walgreens and CVS offer care that includes treatments for skin conditions and minor illnesses and injuries. Like primary-care physicians, they also offer physicals and health screenings.
But perhaps the most important distinction in services patients should recognize is the difference between FSEDs and urgent-care centers.
"Urgent care should be used for non-life-threatening injuries, such as minor cuts or flu symptoms," said Mark Foran, senior medical director of ambulatory care for OhioHealth.
Emergency departments are for severe or life-threatening conditions, such as a stroke, chest pain or severe bleeding, he said, in addition to such injuries as sprains, broken bones and moderate to severe burns.
Half the battle
Emergency rooms at hospitals -- and the higher treatment costs to patients that usually are associated with them -- have existed for decades, but as evidenced by the current construction trend, FSEDs are relatively new additions to the Ohio health-care scene.
Because of that, medical providers say they are trying to educate patients on when to go to these emergency centers and when primary-care physicians or urgent-care centers would be better options.
"Both (urgent-care centers and FSEDs) are important on the spectrum of health care," said Dan Like, executive director of ambulatory services for the Ohio State University Wexner Medical Center. "People want access and convenience to health care.
"If you asked a lot of people in the general public, many of them might believe an FSED is an urgent care, and (they) can go there for urgent-care kinds of things. You can, but you're going to pay a lot more."
The distinction is understood in the medical profession, he said, "but in the general population, it's not."
Now that most health-insurance plans have higher deductibles, most patients have greater out-of-pocket expenses than in past decades, so consumers often learn where to seek treatment based on billing, Like said.
"The first time you go and see the bill, then you realize maybe (you) should not have gone to an FSED," Like said.
Patients need to realize that improved access doesn't necessarily mean better value, said Bill Wulf, chief executive officer of Central Ohio Primary Care Physicians.
The group, locally known by the acronym COPC, is the largest independent physician-owned primary-care corporation in the country, Wulf said. It is independent, meaning that it works with health systems rather than being owned by a specific system, he said, and its goal is to help its patients find value within multiple health systems.
"It's important that patients choose the facility that's appropriate for their condition," he said.
FSEDs will drive up the cost of care because the wrong patients will go, Wulf said. Employers and physicians need to educate patients on where to go for what kind of care, he said.
Wulf used the phrase ambulatory-sensitive conditions to define a group of conditions that would require outpatient care only -- such conditions as urinary-tract infections, upper-respiratory infections, diabetes, back pain and strains and sprains.
Other conditions, such as chest pain, stroke-like symptoms and acute shortness of breath, would require emergency care, Wulf said.
OhioHealth also has been proactive in its efforts to educate patients, Foran said.
"We are working to ensure consumers get the right care, in the right place, by educating (patients) on how to appropriately utilize emergency care as part of our continuum of services that includes primary and urgent care," he said.
"We are using a combination of traditional media, digital (outreach) and direct mail in each community to create awareness and integrate education about when to choose primary care, urgent care and emergency care," said Lewis Sanderow, senior director of marketing for OhioHealth.
Patient education is critical, Logan said, because federal law prohibits staff members at any emergency department to offer unsolicited suggestions -- based on any symptom -- whether a patient should consider treatment at an urgent-care center or with a primary-care physician.
In other words, if someone walks into an FSED with a cold, he or she cannot be turned away for treatment.
That is because of the Emergency Medical Treatment and Labor Act, which is a separate federal law from the better-known HIPAA -- Health Insurance Portability and Accountability Act of 1996 -- that shields personal information, she said.
"When a patient comes in, our staff (at an FSED) is trained to say, 'Are you here to see an emergency physician?' If the patient says yes, they are brought back for care. (But) if a patient says, 'No, I was looking for urgent care,' then we can direct them there," Logan said.
The natural question is why facilities with a relatively narrow focus on emergency care are multiplying when primary-care practices or urgent-care centers provide more general and common services. Medical professionals offered a few explanations:
* The growth of FSEDs and other types of independent-care facilities has been caused partially by patients' lack of access to primary-care physicians, such as during early morning hours, Wulf said.
Although small urgent-care centers or FSEDs serve a good purpose, they typically don't offer integrated care because medical professionals there generally don't have access to patients' records, he said.
When patients go to facilities that are outside of the health-care system in which their primary-care physician works, medical professionals might not have access to such information as stress tests or lab results, Wulf said. Patients who are treated within one health-care system, in comparison, have a better continuity of care, he said.
To remedy this situation for COPC patients, the organization has opened four SameDay Centers -- its name for urgent-care facilities, Wulf said. The centers are open evenings and weekends and COPC patients who are unable to see their primary-care physicians are able to receive treatment within the same health-care system.
The SameDay Centers include a pediatric unit on Cleveland Avenue in Westerville and three adult centers, he said.
One is off Schrock Road in Westerville, the second is near Bethel and Olentangy River roads in Columbus and the third is on Main Street in Reynoldsburg.
Patients are seen at an office-visit rate and co-pay, even after hours, rather than the higher rates usually associated with such facilities, Wulf said.
* Community-based FSEDs also are multiplying because they allow doctors to treat patients closer to where they live, Foran said.
That allows physicians to coordinate follow-up care, improving continuity of care and thereby reducing future visits and hospital admissions, he said.
"These new (FSEDs) increase convenience and bring a broader spectrum of care," Foran said. "It is more convenient for our patients by providing emergency care where they live and work and reduces the wait time for patients.
"FSEDs are not just a Midwest or large-city trend. They are opening nationwide and serve both rural and urban communities."
The facilities also improve access to routine emergency care and alleviate the overcrowding that can occur in hospital-based emergency departments, Foran said.
Hilliard's OhioHealth FSED, for example, is seeing an average of 21 patients a day since its Sept. 13 opening, according to OhioHealth statistics.
In addition, more than 90 percent of transports to FSEDs are patient-initiated and not by ambulance, Like said.
Both Mount Carmel and OhioHealth officials said if admission to a hospital becomes necessary after a patient arrives at one of their satellite facilities, those patients generally are transferred to their preferred hospital, unless severe conditions or emergencies dictate they should go somewhere that specializes in care for critically ill patients with a particular condition, such as accident-related trauma.
* Like said "demand" and billing practices have contributed to FSEDs' popularity.
"FSEDs tend to create demand," he said. "They probably create more demand than actually decompress demand somewhere else. I think that's why you see so many FSEDs pop up locally and nationally."
Like also said FSEDs can be licensed as part of a larger hospital and receive more favorable hospital-based billing rates than most off-site facilities, such as clinics or urgent-care centers. He cited Section 603 of the Bipartisan Budget Act of 2015 as the law behind that practice.
"I would not say that this act contributed to an increase in FSEDs but it certainly did not slow their progression," he said.
More or less?
Despite the recent popularity, the rapid increase of FSEDs might already be waning.
Like said Ohio State officials have no plans to open an FSED "in the fashion we've seen in this market."
Foran said OhioHealth always is assessing community needs but no additional FSEDs are being considered at the moment.
Mount Carmel did not respond to questions concerning its two FSEDs or plans for others.