Later in the day, an emergency room doctor from Johnson City Medical Center offered a counter-opinion on the freestanding emergency department plan.
Dr. Cory Siffring and Andi Hooper both touted the project, which faces a certificate of need (CON) hearing in Nashville on March 26, as a safe, effective way to meet area patients’ needs and provide them with more choices in emergency care.
Hooper, of Holston Valley Medical Center in Kingsport, said she began studying freestanding emergency departments about a year ago, including one in Raleigh, N.C., and one near Myrtle Beach, S.C.
“I was very impressed with what they were doing,” Hooper said. “It’s an excellent concept, it’s been done multiple places, and it actually helps to decompress the main campus of the larger facilities (such as Holston Valley’s busy emergency room).”
Hooper said from a nursing perspective, the concept appeared to be a boon to patients at the same time it eased pressure at busier hospitals.
“People could get into the freestanding ED, be seen, treated and sent home,” she said.
Siffring said the concept is not new, it presents him with no safety concerns, and competition of this sort could also improve care by Mountain States Health Alliance, which is opposing the CON request.
“Ninety percent of what comes into an emergency room is walk-in anyway, and I believe the people that bring the other 10 percent (EMS) know where to take people, so I’m not worried about that whole (safety) issue,” said Siffring, who has run HVMC’s trauma department since November 2006. “I find that stabilization and treatment is not going to be any different anywhere.”
Dr. Clay Runnels said he does not see it that way. Runnels, who has worked in the JCMC emergency department for seven years, said the choice of the Boones Creek site could be unsafe for people who are actually having severe problems such as heart attack or stroke. He added that many pediatric emergencies end up coming in by car because the symptoms may not seem as severe as they turn out to be.
“If you hold out a sign and say, ‘We’re an emergency department,’ people are going to come there sometimes even when their type of emergency really requires a trauma center or hospital-based emergency room,” Runnels said.
He said freestanding emergency departments are useful in areas that require long transport times to trauma centers where short-term stabilization is important, but that HVMC and JCMC both are quickly accessible from most anywhere in the Tri-Cities.
Runnels said he has no problem with Wellmont competing in Washington County, but he believes there is much to be concerned with about this particular plan. He even used his own family as an example of what he believes the facility is really aiming at.
“Having an emergency department in that area would be convenient for me and my family because we live in that area, but I don’t think it’s the right thing. It’s no accident that they’ve chosen the wealthiest part of Washington County,” Runnels said, adding that his emergency group writes off about 15 percent of its bills because people can’t pay — people he said are unlikely to arrive at the doorstep of the Boones Creek facility.
“Where they’re building this is not easily accessible by any low-income area, and it’s well-designed to provide boutique emergency medicine to the wealthy,” Runnels said.
“I don’t think that it does the entire county any good to have the emergency system (at MSHA) have a significant number of the insured siphoned off to another system when we’re trying to provide the community as a whole with a high-quality emergency system.”
Siffring offered a completely different view Wednesday, saying MSHA could benefit from competition, just like Wellmont has in Kingsport where MSHA’s Indian Path Medical Center competes with HVMC.
Without competition, Siffring said, “there’s no impetus to get better, and there’s no impetus to customer care, and I think that’s always bad for a system.”
“I’ve tried to bring change into single-hospital-system towns, and it’s very difficult to get anyone from administration to see why they need to change anything — they’re happy with the way it is.”
Siffring also said he thinks states without a certificate of need process are approaching health care in a better way than places such as Tennessee.
“I think that the marketplace is probably a better way to do it than to have a CON process that says, ‘We think in Nashville that we know what you need in the Tri-Cities area.’ I personally don’t think that’s a very good system,” he said.