Free standing emergency department about to open in Wichita

A project in Wichita received substantial subsidy from taxpayers. How have public policy issues been reported?

Free standing emergency rooms are a recent trend in medical care. This is a facility that has equipment, personnel, and capability like a traditional hospital emergency room, but is not connected to a hospital. The first in Wichita is nearly ready to open, on Twenty-first Street east of Webb Road.

Regarding the Wichita facility, the Wichita Business Journal quoted Malik Idbeis, chief information officer for Kansas Medical Center: “We see a lot of patients from the northeast side of Wichita. We thought it’d be nice to bring our style of care closer to them. There are a lot of neighborhoods and families in that area.” 1

Here, the spokesman is promoting that facility is located convenient to (affluent) families in northeast Wichita. That wasn’t the argument made to the Wichita City Council last year when the facility applied for tax relief through the Industrial Revenue Bonds program. At that time, the facility was pitched as an attraction that would serve many out-of-town customers. City documents reported: “The current Economic Development Policy requires medical facilities to attract at least 30% of patients from outside the Wichita MSA. Kansas Medical Center reviewed the location of patients utilizing the emergency room in Andover, which revealed that 37% come from outside the Wichita MSA.” 2

It seems a stretch to assume that the demographic characteristics of a hospital in Andover would also apply to an emergency room in Wichita, but the city council accepted this reasoning.

Aside from this, the Wichita Business Journal article contains problems in its reporting of public policy issues. The reporter wrote: “Last summer, the Wichita City Council authorized issuing industrial revenue bonds for the project to help finance land and construction costs. With IRBs, the city serves as a pass-through entity for developers to obtain a lower interest rate on projects. IRBs require no taxpayer commitment.” (For background on IRBs in Kansas, see Industrial revenue bonds in Kansas.)

It’s not likely the facility will save on interest costs with IRBs. It might save if the bonds were non-taxable, but these bonds are taxable, according to the agenda packet for this item. The article is correct in that IRBs require no taxpayer commitment — at least superficially. Here, I believe the reporter is letting readers know that the city makes no guarantee as to the bond repayment. If the city guaranteed repayment, that would help the borrower obtain a lower interest rate. But there is no guarantee.

Instead, the benefit of the IRB program is lower taxes. The city estimates the first-year property tax savings to be $61,882, allocated this way: City of Wichita: $17,226. State of Kansas: $792. Sedgwick County: $5,520. USD 259 (Wichita public school district): $28,345. Savings like this would be realized for five years, plus another five years if employment commitments are met.

This property tax forgiveness is, in many ways, a “taxpayer commitment.” If we don’t recognize that, then we must reconsider the foundation of local tax policy.

In Wichita, as in most cities, the largest consumers of property tax dollars are the city, county, and school district. All justify their tax collections by citing the services they provide: Law enforcement, fire protection, education, etc. It is for providing these services that we pay local taxes.

But through the Industrial Revenue Bond program, properties don’t pay property tax. (In the case of this facility, the property tax abatement is limited to 88 percent of the full tax burden.)

Yet, this new facility will undoubtedly demand and consume the services local government provides — law enforcement, fire protection, and education. But it won’t be paying property tax to support these services (except for the 12 percent not abated). Others will have to pay this cost.

We’re left with an uncomfortable and awkward circumstance. City officials tell us that we must pay property tax so the city can provide services. (In fact, last year the Wichita city manager recommended increasing property taxes to pay for more police officers.)

At the same time, however, the city creates special classes of people who use services but don’t pay for them.

Often the justification for economic development incentives is economic necessity, that is, the project could not be built without the incentive. That argument was not made for this project.

Free standing emergency rooms

Free standing emergency departments are controversial. The notes to this article hold references to news articles and academic studies looking at the costs and usage of these facilities. 3 4 5 6 7 8 9 10

Researchers note that the emergency rooms are much more expensive than traditional doctor offices or urgent care facilities, yet many of the diagnoses made at the ERs are the same as made at non-emergency facilities.


Notes

  1. Heck, Josh. Medical group sets opening date for free-standing ER. Wichita Business Journal. Available at https://www.bizjournals.com/wichita/news/2018/04/06/medical-group-sets-opening-date-for-free-standing.html.
  2. City of Wichita. Request for Letter of Intent for Industrial Revenue Bonds (E Wichita Properties, LLC/Kansas Medical Center, LLC). City Council agenda packet for June 6, 2017.
  3. NBC News. You Thought It Was An Urgent Care Center, Until You Got the Bill. Available at https://www.nbcnews.com/health/health-care/you-thought-it-was-urgent-care-center-until-you-got-n750906.
  4. Carolyn Y. Johnson. Free-standing ERs offer care without the wait. But patients can still pay $6,800 to treat a cut. Washington Post, May 7, 2017. Available at http://wapo.st/2pUCskD?tid=ss_tw&utm_term=.21bb76a447aa.
  5. Rice, Sabriya.Texans overpaid for some medical services by thousands, study says. Dallas Morning News. Available at https://www.dallasnews.com/business/health-care/2017/03/23/texans-overpaid-medical-services-thousands-study-said.
  6. Blue Cross Blue Shield of Texas. Rice U. Study: Freestanding Emergency Departments In Texas Deliver Costly Care, ‘Sticker Shock’. Available at https://www.bcbstx.com/company-info/news/news?lid=j0s5sm9d.
  7. Alan A. Ayers, MBA, MAcc. Dissecting the Cost of a Freestanding Emergency Department Visit. Available at https://c.ymcdn.com/sites/ucaoa.site-ym.com/resource/resmgr/Alan_Ayers_Blog/UCAOA_Ayers_Blog_FSED_Pricin.pdf.
  8. Michael L. Callaham. Editor in Chief Overview: A Controversy About Freestanding Emergency Departments. Annals of Emergency Medicine, Volume 70, Issue 6, 2017, pp. 843-845. Available at http://www.annemergmed.com/article/S0196-0644(17)31505-6/fulltext.
  9. Ho, Vivian et al. Comparing Utilization and Costs of Care in Freestanding Emergency Departments, Hospital Emergency Departments, and Urgent Care Centers. Annals of Emergency Medicine, Volume 70 , Issue 6 , 846 – 857.e3. Available at http://www.annemergmed.com/article/S0196-0644(16)31522-0/fulltext.
  10. Jeremiah D. Schuur, Donald M. Yealy, Michael L. Callaham. Comparing Freestanding Emergency Departments, Hospital-Based Emergency Departments, and Urgent Care in Texas: Apples, Oranges, or Lemons? Annals of Emergency Medicine, Volume 70, Issue 6, 2017, pp. 858-861. Available at http://www.annemergmed.com/article/S0196-0644(17)30473-0/fulltext.

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