Op-Ed: Satellite Emergency Departments — Saving Time, Money, and Lives

Leila Sadeghi | September 26, 2017 | Opinion
SEDs are an idea whose time has come, but success means carefully considering several deployment issues, such as distance from and availability of medical resources

Leila Sadeghi
Satellite emergency departments are sprouting across the country in response to a rapidly changing healthcare environment. These facilities can be owned by hospital systems or medical groups to create efficient care centers that accept Medicare and Medicaid insurance. Satellite emergency departments (SEDs) are freestanding buildings — separate from hospital systems — that are open 24/7 and provide needed services with less wait time.

The birth of satellite emergency departments could not come at a better time. With the high demand for emergency services, coupled with longer wait times, physician shortages, and financial drains on hospitals, hospital systems are reconsidering their business models. This is where SEDs play an important role. On the one hand, they can alleviate overcrowding and reduce wait times, while improving the quality of care that is delivered to each patient. On the other hand, satellite emergency departments help to mitigate the financial burden of emergency departments on the hospital. Emergency departments are the costliest unit of hospitals because they require more human capital, and they have higher rates of uncompensated care.

Opting for opening

The decision for a hospital to open a satellite emergency departments should be focused on meeting several criteria: First, is the proposed site one where the population is in critical need of an emergency-care facility because they do not have one or the nearest ED is too far away? Second, if the proposed area is near a hospital, is the burden on the ED constraining enough to require an additional emergency-care station. Third, is the proposed site replacing a hospital that has closed? These criteria are critical in determining when and where SEDs should be developed.

In New Jersey, there are many areas of the state that could benefit greatly from an SED — in particular, areas that are most densely populated, and/or areas with higher rates of poverty and child poverty. Taking Hudson County as an example, 17.9 percent of the population lives below the poverty line (higher than the national average) and 32 percent of children are in poverty, yet there is only one SED in the entire county. Two of the county’s more violent, gang- and drug-infested, poverty-stricken areas, are Greenville and Bergen/Lafayette in Jersey City. These areas also have larger minority populations in comparison to other parts of the city. Despite these statistics, Greenville Hospital was closed in 2008 due to financial reasons and was never replaced with an emergency-care facility. This is a disservice and tragedy for residents. Many have limited access to transportation and are socio-economically disadvantaged. The closest hospital is in Bayonne, which is roughly three miles away and can take twenty minutes to reach in light traffic.

Adding insult to injury, more recently, the New Jersey State Department of Health authorized the opening of Barnabas Health of Bayonne, an SED several blocks away from a full-service hospital, Bayonne Medical Center. The Jersey City Medical Center, a hospital over seven miles away from Bayonne in downtown Jersey City that is owned by Barnabas Health, used the argument that in 2016, the JCMC had 87,000 emergency department visits, well over their intended capacity of 57,000 patients. They further stated that “…over 33,000 of those visits come from Greenville and Bayonne”. Given this data, one could question why the SED was approved by the NJDOH to be built in a town that is already equipped with a hospital, given a majority of the overflow is coming from Greenville.

Acute services nearby

To further complicate the matter, according to state regulations, a satellite emergency department must be part of a system with a nearby acute-care hospital. In the example above, the Barnabas Health of Bayonne SED is part of the Barnabas Health System. The nearest Barnabas facility, the Jersey City Medical Center, is over seven miles away, and it can take upward of 30 minutes to get there from Bayonne.

Most recently, Carepoint Health submitted an application to open an SED in Greenville, Jersey City. Given the high demand for emergency care in Greenville and the neighboring areas, it behooves the state to approve this application. New Jersey should be on the cutting edge in terms of healthcare and access to quality emergency care. If the state strategically places SEDs where they are most needed, we can serve as a model for other states across the country. Satellite emergency departments are the wave of the future, and in order to be a healthier America, we must efficiently identify areas where SEDs will best serve the population.