Innovative ER Facility May Become New Model
Stand-Alone Center In Montgomery Eases Hospital Load

By Susan Levine
Washington Post Staff Writer
Tuesday, August 7, 2007; B01

Even without road signs pointing the way to its door in Germantown, Maryland's only stand-alone emergency medical facility treated more than 22,000 patients in its first year -- about 30 percent more than initial projections and an impressive enough number to raise interest in its use as a model statewide.

From broken bones to heart attacks, the Shady Grove Adventist Emergency Center at Germantown appears to have done exactly what supporters promised. It has relieved some of the pressure on the state's second-busiest emergency department while allowing ambulance crews to get back on the road twice as fast after a call. And it has increased access to care for much of upper Montgomery County, where traffic congestion from burgeoning development makes the distances between hospitals seem even longer.

By their second anniversary next August, the center's doctors and nurses are braced for upwards of 28,000 patients.

"They have been very successful," said Pamela Barclay, who heads hospital services at the Maryland Health Care Commission.

The $7.5 million facility opened a year ago today with a full complement of board-certified emergency physicians and specially trained nurses, 21 private treatment rooms, around-the-clock service and most of the accouterments and lab capability of "any big-city, high-tech ER," as Michael Cetta, the center's first medical director, puts it.

Just no inpatient beds.

How widely the center should be replicated is uncertain. A study of its costs, complexity of cases and ultimate impact will be presented in December to the General Assembly, which had to write special regulations to allow the facility's bedless operation. But a similar pilot program on the Eastern Shore is already in the planning stage because of the early success in Germantown. In Queen Anne's County, major growth and worsening traffic are fast becoming real medical concerns.

"We want to try to understand what is the role of this type of center," Barclay said. "Can this model be adapted in other areas of Maryland where it would really meet community need and provide care that's appropriate and that would alleviate overcrowded emergency departments?"

Funding remains a key question. Because of Maryland's unique way of setting rates for hospital services and the center's novel status, the federal government has so far refused to reimburse costs through Medicare and Medicaid. Adventist officials have appealed the denial. With one in five patients at the center covered by either of those programs, it lost $3.8 million in its first year.

"It's a pretty significant issue," stressed Robert Jepson, associate vice president of government relations and public policy for Adventist HealthCare.

Eight percent of people seen at the Germantown facility were transferred elsewhere, most to Shady Grove Adventist Hospital in Rockville, which it is linked to electronically. The hospital's emergency department treated nearly 87,000 patients in 2005. Although that total dropped to 82,500 in 2006 because of the new center, it still exceeded the count of most hospitals in the state or even on the East Coast -- and explains why the Shady Grove ER will expand its number of beds by nearly a third by spring 2009.

Del. Nancy J. King (D-Montgomery) remembers the "groundswell" of local support when regulators were weighing the Germantown facility. As travel times grew exponentially on Interstate 270 and secondary roads, whether south to Shady Grove or north to Frederick Memorial Hospital, "people just felt the upcounty needed something more," she said. The County Council gave unanimous backing. King believes that the center has proven all of them right.

"They've handled everything from 'I've been . . . stabbed' to 'I have a splinter in my finger,' " said Michael McAdams, assistant fire chief with Montgomery's emergency medical services. Before the center opened, he sometimes had half a dozen area ambulances unavailable simultaneously because of hours-long hospital backups or diversions. "Operationally, we were really stressed."

Fourteen-year-old Connor Clune of Frederick County became the first patient to be helicoptered from the Germantown center's parking lot after a sledding accident last winter. His mother took him there on his pediatrician's recommendation, expecting to be told that he had cracked a rib. Instead, within minutes of arriving and getting his ID bracelet, Connor was undergoing a diagnostic scan and his mother was hearing that he had lacerated his liver and had internal bleeding. He was flown to Children's Hospital in the District.

"It was very impressive," said Gabriele McCormick, who brought Connor back to the center in June after he flipped an ATV and broke his ankle. They were seen almost as quickly.

Friday was more typical at the center, with a nonstop assortment of injuries and maladies by midafternoon. Physician Joel Buzy ticked off the particulars: A 26-year-old woman with a corneal lesion. A 38-year-old "weekend warrior" with a ruptured Achilles tendon. A 7-year-old girl with chest pain. And a 50-year-old man who had suffered a concussion when the hood of his car fell on his head while he was doing mechanical work.

Moderate cases, none requiring a lights-and-siren ride in or out. "But a lot of these can end up being things that are worse," Buzy said.

Indeed, just several days earlier, a middle-aged woman had walked in complaining of shortness of breath. Barely 20 minutes later, having been evaluated, tested and given a diagnosis of a failing liver and severe congestive heart failure, she was on a breathing machine and being taken to Shady Grove in an ambulance.