Tuesday, November 29, 2011 Critics Condemn Free-Standing Emergency Departments A new trend in health care—the free-standing emergency department (ED)—is drawing criticism from lawmakers and advocates of affordable health care in Washington state who call the facilities "cash cows for hospitals," says an article in The Seattle Times. Hospitals throughout the Puget Sound region are building "spiffy new free-standing emergency rooms and entire hospital towers with expanded ERs, and drastically remodeling existing ones." In addition, the hospitals are aggressively marketing their EDs, promoting amenities from valet service to private rooms. Hospital-industry leaders say that building new EDs will save money by enabling better, more efficient care. Virginia Mason Medical Center's chief executive, Gary Kaplan, MD, argues that good design saves money by saving staff time, reducing the chance of errors, and allowing a faster, more complete patient workup, the article says. Virginia Mason recently opened an $8 million ED in a new pavilion in Seattle. Arguments by hospital leaders haven't won over critics concerned about health costs for the state's government and businesses. According to health economists, health care isn't like other commodities in which increasing supply drives down prices. Efforts to regulate hospital building and ED expansion haven't worked. The state, through its Certificate of Need program, lost in its attempt to block Swedish Medical Center's Issaquah expansion, and it has no power to curtail free-standing EDs. A bid by Medicaid officials to cut nonemergency ED costs was derailed after physicians and hospitals sued. Bills by lawmakers targeting hospital expansion and accountability didn't pass last session, says the Times.