Regulation of fast growing freestanding EDs varies among states

Freestanding EDs (FSEDs) are a growing alternative to traditional hospital-based emergency care but come with controversy. FSEDs began in the 1970s as a critical care option for rural areas, but have recently grown across the nation. FSEDs can be independent or affiliated with a hospital. A new study published in this month’s Health Affairs finds that those two types vary substantially in size, reimbursement options, types of services offered, and integration of care. The study also found that states vary considerably in whether and how they regulate FSEDs. For instance, states that require Certificate of Need approval, have fewer FSEDs. State regulations also vary in FSED location, staffing and services.


CSG-ERC states considerably both in the number of FSEDs and state decisions to regulate them. As of December 2015, New Jersey has the most FSEDs in the region and both regulates them and requires an affiliation to an acute care hospital. But two out of three FSEDs in the CSG-ERC region are in two states, Connecticut and New York, with no FSED regulatory policies. Five ERC states do not yet have FSEDs.

Number of FSEDs Policies re. FSEDs? Require hospital affiliation?
CT 5 N Y
DE 2 Y N
MA 4 Y Y
MD 3 Y Y
ME 0 N Not addressed in regulation
NH 0 Y Y
NJ 9 Y Y
NY 7 N Y
PA 0 N Y Not addressed in regulation
RI 0 N
VT 0 N N

Wide variation among CSG-ERC states in smoking rates and disparities

According to new numbers for 2014 from the Centers for Disease Control and Prevention (CDC), tobacco use is the leading cause of preventable disease and death in the US Tobacco use is blamed for 480,000 premature deaths and over $300 billion in direct healthcare costs each year and, unfortunately, CSG-ERC region states are not immune. In good news, the rate of smoking is dropping; 18.1% of adult Americans were current tobacco smokers in 2014, down from 21.2% three years before. Within our region, Delaware and Pennsylvania are tied for the highest rate at 19.9% while New York is lowest at 14.4%. More men than women smoke in all fifty states, but the gap between them varies considerably by state. Nationally, white adults are more likely to smoke but there is also wide variation prevalence by in race/ethnicity among smokers in our region.

2014 Cigarette smoking % adults Cigarette smoking, male vs. females Highest prevalence by race/ethnicity, cigarette and/or smokeless tobacco use
US 18.1% 4.5% White
CT 15.4 4.0 Hispanic
DE 19.9 6.9 White
ME 19.3 3.2 Other*
MD 14.6 4.2 White
MA 14.7 3.8 Hispanic
NH 17.5 1.7 Other*
NJ 15.1 5.2 Black
NY 14.4 5.0 White
PA 19.9 2.1 Hispanic
RI 16.3 4.9 Black
VT 16.4 2.8 Black*
* indicates missing information

New England health policymakers meet to consider the future of hospitals

Last weekend NESCSO, the Millbank Fund and the New Hampshire Department of Health and Human Services convened a group of twenty-two state executive and legislative branch health policymakers in Portsmouth, NH to consider the future of hospitals in the region. All six New England states were represented. Hospital roles are evolving quickly with national and state health reforms, implementation of the Affordable Care Act, community health needs assessments, and value-based purchasing. The group discussed hospital and payer consolidation, payment reforms, quality improvement, and the states’ role in protecting capacity while controlling costs. The group also emphasized the need for simple communication tools to help legislators and the public understand complex shifts in the region’s health care system. Congratulations to CT’s Medicaid Director, Kate McEvoy, who now chairs the NESCSO Board of Directors.