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DisruptiveInnovation inEmergency Medicine:Freestanding Emergency Departments(FSEDs)James “Mike” Muzzarelli, MD
October 15,2016
George Washington UniversitySchool of Medicine & Health Sciences
Optimizing Patient Care at Innovative Freestanding ERs
Optimizing Patient Care at Innovative Freestanding ERs
What is a FSED?A brief history of FSEDsWhy now? The Perfect Storm.Innovative, Disruptive, Controversial?

What is a FSED?ACEP defines a FSED as a facility that is structurally separate and distinct from a hospital and provides emergency care.Two types:iFECa handful of states (DE, RI, CO, TX…)HOPD45+ states
A Brief History of FSEDs
1970’s initial FSEDs were HOPDs located in underserved or rural areas –largely unsuccessful.2000’s The TX story.TX Ch. 131, June 1, 2010.Over 500+ FSED nationwide, 220+ in TX.
Why Now?
The Perfect StormIncreased ED patient volumes -why?Decreased number of EDs –why?ED physician dissatisfaction/burnout –why?New Technology –what?Maverick, Entrepreneurial Physicians –who?
Why Now?
The business model itself is innovativeAn ED without a hospital? Come on?The “Retailization” of Emergency MedicineThe patient care itself is innovative in it’s “old fashioned, traditional style”Decentralized Care Model
Has there been anything bigger or more disruptive in Emergency Medicine than FSEDs in the past decade?
One simply needs to Google FSED and the controversial articles are everywhere.
Free-Standing Emergency Rooms Causing ControversyCritics say simple ERs create more demand and drive up costsWed, Jul 31, 2013-JEMS -Journal of Emergency Medical Services
Freestanding emergency departments: The model we need to studyJoshua Elder, MD, MPH|Policy| June 6,
FreestandingEDs: The New Hospital Front DoorMarch 4, 2016 by RobbyAull-HealthCare Design
StateRegulation Of Freestanding Emergency Departments Varies Widely, Affecting Location, Growth, And Services Provided-HealthAffairs
Modern Healthcare July 4th, 2015“Conferenceorganizers acknowledged the controversial nature of their industry with a session called “FECs—Boon or Bane of Emergency Medicine?” That session was billed as a “debate-like” panel discussion exploring an “admittedly disruptive”emergency medicinepractice model.”






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7_1 muzzzarelli Urgent Matters Disruptive Innovation - FSEDs Muzzarelli backup (1)