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Massachusetts implemented a sweeping healthcare policy in 2009, becoming the first state to ban routine ambulance diversion—meaning that hospitals could no longer divert patients away from busy emergency departments (EDs) and send them to another hospital simply due to overcrowding. Beginning this month, Indiana has adopted a similar measure to eliminate hospital ED diversion. In practice it means hospitals have to be operationally capable of addressing throughput, staffing, and overall capacity no matter what comes through the door. In the first 3 months after Massachusetts adopted its diversion ban, researchers found no clinically significant change in ED volume, admissions, length of stay, or patients leaving without being seen, according to the Journal of Emergency Medicine. So ED overcrowding did not appear to be a consequence of the policy, suggesting hospitals in the state were able to adapt without major deterioration in ED throughput. Indiana’s experience will play out in the months ahead.
Market forces: Could new capacity pressures on EDs create market opportunities for urgent care? History hints at the possibility but with a caveat. Massachusetts Health Policy Commission data shows that urgent care centers grew from roughly 15 rooftops in 2010 (a year after the diversion rule took effect in the state) to 173 rooftops by 2021. In terms of ownership, in 2010, most Massachusetts urgent care centers were hospital affiliated. By 2018, 61% were independent chains without hospital affiliation, according to the commission. However, it’s important to note that the 2010–2021 time period also brought major investment and market growth for urgent cares nationwide—not just in Massachusetts. Nationally, as of September 2024, just 39% of urgent care centers were affiliated with a hospital or health system. Read more about hospital affiliation from the JUCM archive: Size and Ownership of U.S. Urgent Care Centers