BUSI 511 Week 5 Discussion Board Forum 5 Example

Discussion Board Forum 5: Outpatient Services, Primary Care and Hospitals

BUSI 511 Healthcare Administration, Discussion Board Forum 5

Thread by [Student Name]

The health system, its markets and the classmates are composites; the textbook, Scripture and the peer-reviewed sources cited are real.

Last spring a national pharmacy chain closed all eleven of the walk-in clinics it ran inside its stores in our region, and within a week our health system's board asked whether we should open convenient care sites of our own to capture the patients left without them. As vice president for ambulatory care, I was asked for a recommendation. The pressure to move quickly was real. A competing system announced two new urgent care centers the same month, our call center reported a jump in requests for same-day appointments we could not meet and our emergency department saw more visits for sore throats, ear pain and urinary symptoms on weekday evenings. The board's instinct was to build. Mine was to ask what problem new sites would actually solve.

Shi and Singh (2019) describe a long shift of care from hospitals to outpatient settings, driven by technology that made more procedures safe outside the hospital, by payment changes that rewarded shorter stays and by patient preference. They explain that outpatient services now span retail clinics, urgent care centers, freestanding surgery centers, hospital-run outpatient departments and physician offices, with primary care intended to serve as the point of first contact and coordination. Hospitals, they note, have responded by building outpatient networks to keep patients within their systems. Convenient care sites fit that strategy, but the authors also emphasize that primary care's value lies in continuity and coordination, which walk-in sites rarely provide. A patient seen once for a sinus infection by a clinician who will never see them again receives treatment, but not the ongoing relationship that catches high blood pressure or a missed cancer screening.

The research shows why convenience is popular and why it is not automatically efficient. Mehrotra and Lave (2012) found that retail clinic visits grew fourfold from 2007 to 2009, to an estimated 5.97 million visits in 2009, and that 44.4% of visits took place on weekends or during weekday hours when physician offices are typically closed. Patients were telling the system that access at night and on weekends mattered. But Ashwood et al. (2016) followed Aetna members through three years of claims for eleven minor conditions such as sore throat and pinkeye. Most walk-in visits, 58%, were care these members would not otherwise have sought at all, so instead of pulling patients away from offices and emergency rooms, the clinics added visits, and annual spending rose by roughly $14 per member. In other words, a convenient site often adds a visit for a cold that would otherwise have been managed at home, rather than replacing an expensive emergency visit.

For our system, those findings suggested that the problem was access to our own primary care, not a lack of walk-in storefronts. I recommended three steps before any new site: extend hours at our five busiest primary care practices to 8 p.m. on weekdays and open them Saturday mornings, hold same-day slots for established patients each afternoon and launch a nurse triage line and video visits for minor illnesses. We would measure same-day access, evening emergency visits for low-acuity conditions and new patient enrollment in primary care for a year, and revisit stand-alone sites only if those measures failed to improve. A retail-style site might still make sense in a growing suburb without a practice, but it should be staffed by clinicians who can schedule the patient into a primary care home.

Proverbs advises, "Prepare your work outside; get everything ready for yourself in the field, and after that build your house" (English Standard Version Bible, 2001/2016, Proverbs 24:27). The farmer secures the field that feeds the household before investing in the structure that displays it. A health system that builds storefronts before it can schedule its own patients has built the house before planting the field. Primary care is our field, and the convenient care sites a board finds exciting are worth building only on top of it.

Reply to Lauren

Lauren, your thread described the closure of the 25-bed hospital in your home county and the long drive residents now make to the nearest emergency department, and you argued that closures harm more than emergency care. Two recent studies support you. Zheng et al. (2026) mapped every licensed Texas hospital and the closures since 2012 across 6,883 census tracts and found that micropolitan, small-town and rural tracts were more likely than metropolitan tracts to see travel times to emergency care rise after closures. Among affected tracts, travel time to the nearest emergency department grew by several more minutes in micropolitan and small-town areas than in metropolitan ones, and travel to the second-nearest department, which matters when the closest is full or lacks a service, rose for even more tracts, 263 compared with 135 for the nearest. For a stroke, heart attack or major injury, minutes matter, and closures add them where distances were already long.

The effects reach routine care too, which is the part of your argument I found most important. Planey et al. (2026) studied 4,275 rural census tracts in the U.S. South and found that the average distance to the nearest hospital was already 15.9 miles, about 23 minutes. Location in a county with two hospital closures was associated with lower receipt of preventive services among older adults, by about 4.9 percentage points for women and 3.8 for men. A rural hospital often anchors the clinics, laboratory and imaging services around it, and physicians may leave when it closes, so preventive care declines even for patients who never needed the hospital's beds. Missed screenings today become later diagnoses, costlier treatment and avoidable deaths a few years from now.

Shi and Singh (2019) describe the financial pressures that make small rural hospitals vulnerable, including low patient volume, a high share of Medicare and Medicaid patients and difficulty recruiting staff. Given those pressures, some communities cannot keep a full hospital open, but they can protect the services that matter most. A practical step for your county would be to ask whether the closed building could reopen as a rural emergency hospital, the Medicare designation created for facilities that keep emergency and outpatient services without inpatient beds, paired with a primary care clinic and mobile screening. The decision also has a workforce side. When a hospital closes, nurses, technicians and physicians often leave the county with it, and the clinic that remains may struggle to staff evening hours. Recruiting through loan repayment programs tied to rural service, sharing staff with the regional system that receives the transferred patients and using telehealth for specialist follow-up can keep a smaller facility viable. Has anyone in your county studied which services residents lost first after the closure?

Reply to Andre

Andre, your thread welcomed the freestanding emergency department that opened near your suburb, describing shorter waits and a modern building, and you suggested it could relieve crowding at the main hospital. The evidence suggests caution. Ho et al. (2019) used insurance claims from Arizona, Florida, North Carolina and Texas from 2013 to 2017 and found that in three of the four states, emergency care spending in a local market climbed 3.6 percentage points with each new freestanding emergency department, along with more emergency visits per enrollee and higher out-of-pocket payments. The authors concluded that, rather than substituting for hospital emergency departments, these facilities increased local spending on emergency care. Only North Carolina, where such facilities must be affiliated with hospitals and operate under stricter rules, showed no spending increase.

The financial effects may reach patients directly. Marthey et al. (2025) compared 48 counties where hospital-owned satellite freestanding emergency departments opened between 2015 and 2021 with 1,320 counties without one and found that once a facility opened, the county's median collections balance for medical bills grew by about $98, while the portion of people carrying medical debt in collections went up by two percentage points. The counties that received these facilities were wealthier and more urban, with median household incomes near $53,000 against about $46,500 elsewhere, which suggests, though the study cannot prove motive, that the facilities are built where insured patients live and where emergency-level fees can be collected for problems an urgent care center could treat.

Shi and Singh (2019) explain that hospitals have expanded outpatient networks to compete for insured patients, and freestanding emergency departments fit that pattern. The problem for patients is that the building looks like an urgent care center but bills as an emergency department, and a family choosing it for a child's fever at 9 p.m. rarely knows the difference until the statement arrives, with facility fees many visitors do not expect. A practical step for your community would be to ask the hospital to post its facility fees and network participation at the entrance and online, to offer an urgent care pathway with lower charges for minor problems and to report how many visits are for conditions that urgent care could handle. Your crowding argument deserves a fair test as well. If the satellite site truly relieves the main hospital, waiting times and patients leaving without being seen at the main emergency department should fall after the opening, and the hospital can report both. If those measures stay flat while total emergency visits rise, the facility is adding demand rather than redistributing it, which is the pattern the research predicts. Would the hospital that owns your new facility be willing to publish those numbers after its first year?

References

Ashwood, J. S., Gaynor, M., Setodji, C. M., Reid, R. O., Weber, E., & Mehrotra, A. (2016). Retail clinic visits for low-acuity conditions increase utilization and spending. Health Affairs, 35(3), 449-455. https://doi.org/10.1377/hlthaff.2015.0995

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Ho, V., Xu, Y., & Akhter, M. (2019). Freestanding emergency department entry and market-level spending on emergency care. Academic Emergency Medicine, 26(11), 1221-1231. https://doi.org/10.1111/acem.13848

Marthey, D., Ukert, B., & Andreyeva, E. (2025). Medical debt and entry of satellite freestanding emergency departments. JAMA Network Open, 8(7), e2522876. https://doi.org/10.1001/jamanetworkopen.2025.22876

Mehrotra, A., & Lave, J. R. (2012). Visits to retail clinics grew fourfold from 2007 to 2009, although their share of overall outpatient visits remains low. Health Affairs, 31(9), 2123-2129. https://doi.org/10.1377/hlthaff.2011.1128

Planey, A. M., Wong, S., Winata, F., Daaleman, T. P., & Ko, M. J. (2026). Rural hospital closures, hospital spatial accessibility, and preventive care receipt in the US South: A cross-sectional ecological study. Journal of General Internal Medicine, 41(8), 2237-2247. https://doi.org/10.1007/s11606-025-09885-w

Shi, L., & Singh, D. A. (2019). Essentials of the U.S. health care system (5th ed.). Jones & Bartlett Learning.

Zheng, H., Horel, S., & Blackburn, C. C. (2026). Hospital closures increase emergency care travel time: Rural-urban disparities. Inquiry, 63, 469580261454514. https://doi.org/10.1177/00469580261454514