| Course | HCM-5000 21st Century Healthcare Systems |
|---|---|
| Module | Module 3 |
| Paper type | Written assignment: system processes and delivery settings |
| Length | About 1,103 words, 7 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | Master of Science in Healthcare Management |
| Updated | October 2026 |
Free sample paper for HCM 5000 Module 3
A Freestanding Emergency Department or a Better Front Door? Choosing Where Unscheduled Care Is Delivered in a Growing County
Student Name
Master of Science in Healthcare Management, Thomas Edison State University
HCM-5000: 21st Century Healthcare Systems
Mentor Name
Month Day, Year
A Freestanding Emergency Department or a Better Front Door? Choosing Where Unscheduled Care Is Delivered in a Growing County
Where care is delivered has become a strategic question as much as a clinical one. Services that once required a hospital now happen in ambulatory surgery centers, urgent care clinics, retail clinics, patients' homes and on video. Emergency care has followed the same path through the freestanding emergency department, a facility that offers emergency services around the clock but sits apart from a hospital. This paper examines a decision facing a composite nonprofit health system in Ocean County, New Jersey, whose population has grown quickly in its western townships: open a freestanding emergency department in a growing suburb, or invest the same capital in extended-hour urgent care and virtual visits. It reviews what research shows about freestanding emergency departments, considers the stakeholders, and recommends a course of action.
The Problem the System Is Trying to Solve
The system's main hospital emergency department recorded about 92,000 visits last year, roughly 20% more than its design capacity, and patients waited a median of 41 minutes to see a clinician. A review of visit records found that residents of the fastest-growing townships, 15 to 25 minutes' drive from the hospital, made up a rising share of visits, and that about a third of those visits were for conditions that urgent care could have treated, such as minor injuries and respiratory infections. The system's planners see two goals: shorten the drive and the wait for people who need emergency care, and move lower-acuity care to a less expensive setting. The two options serve those goals differently.
What Freestanding Emergency Departments Do in Practice
Freestanding emergency departments grew quickly in the 2010s, concentrated in a few states. Schuur et al. (2017) built a national inventory of 360 such facilities in 30 states; Texas, Ohio and Colorado held two thirds of them, and slightly more than half were satellites of hospitals rather than independent businesses. In all three states the facilities clustered where household incomes ran higher and Medicaid enrollment ran lower, and in Texas and Ohio in areas with more privately insured residents. In other words, they followed a favorable payer mix more than unmet need.
Whether they substitute for hospital emergency care or add to it matters for a system's strategy and for the community's costs. Ho et al. (2019) studied market-level spending as freestanding emergency departments entered local areas in four states. In Texas, Florida and North Carolina, each new facility was associated with a 3.6 percentage point increase in emergency spending per insured person, and use rose in three of the four states; only Arizona showed no change in spending. The authors concluded that the facilities had mostly added to emergency care rather than replacing hospital visits.
There are financial consequences for patients as well. Marthey et al. (2025) compared counties that gained a satellite freestanding emergency department between 2011 and 2021 with counties that did not. Entry was associated with an increase of about $98 in median medical debt in collections and a two percentage point rise in the share of residents with such debt. A visit that a patient expected to cost like urgent care may be billed at emergency department rates, including a facility fee.
Regulation and Stakeholders
State rules shape what these facilities can be. Gutierrez et al. (2016) found that state regulation of freestanding emergency departments varied widely, from states that prohibited them to states that allowed independent facilities with little oversight, and that these differences affected where facilities opened, how fast they grew and what services they offered. A New Jersey health system would need to work through the state's licensing review and would almost certainly operate the site as part of its hospital rather than as an independent business.
The stakeholders see the decision differently. Residents of the western townships want shorter drives and waits. Commercial insurers and large employers worry about higher prices for visits that could have been handled in urgent care, and may steer members away or negotiate lower facility rates. Medicaid managed care plans are concerned about appropriate use. The hospital's emergency physicians favor a satellite they can staff, while primary care physicians argue that expanded urgent care and same-day appointments would keep patients in their practices. The system's board must weigh revenue, mission and reputation; a facility that is seen as chasing insured patients or generating medical debt could damage community trust.
Comparing the Options
A freestanding emergency department would cost about $14 million to build and equip and requires physician and nursing coverage around the clock. It would shorten travel for true emergencies and relieve some pressure on the main emergency department. The evidence suggests, however, that it would also attract lower-acuity visits billed at emergency rates, raise local spending and expose some patients to bills they did not expect. Its financial case depends on a payer mix that favors commercially insured patients, which is the pattern that drew criticism in other states.
Extended-hour urgent care at two existing outpatient sites, combined with a virtual visit service and a nurse advice line, would cost about a third as much. It would serve the third of visits that do not need an emergency department at lower cost to patients and payers, and could refer true emergencies to the hospital. It would not shorten the drive for patients with chest pain or stroke symptoms, who should call 911 in any case, and it would do less to relieve the main emergency department's crowding for higher-acuity patients.
Recommendation
The system should invest first in extended-hour urgent care, virtual visits and same-day primary care access, and measure their effect on lower-acuity visits to the main emergency department over 18 months. If crowding of higher-acuity patients persists and population growth continues, the system can revisit a freestanding emergency department with clear commitments: transparent signage and pricing that distinguish emergency from urgent care, a financial assistance policy applied at the site, and public reporting of the site's payer mix and use. This sequence addresses the most common unmet need at the lowest cost, protects patients from unexpected bills and preserves the option to expand emergency capacity when the evidence supports it.
Conclusion
The movement of care out of hospitals can improve access and lower costs, but only when the new setting matches patients' needs. Research on freestanding emergency departments shows that they tend to follow insured patients, increase spending and contribute to medical debt. For a growing county whose main gap is lower-acuity care, a better front door through urgent care and virtual visits is the stronger first step.
References
Gutierrez, C., Lindor, R. A., Baker, O., Cutler, D., & Schuur, J. D. (2016). State regulation of freestanding emergency departments varies widely, affecting location, growth, and services provided. Health Affairs, 35(10), 1857-1866. https://doi.org/10.1377/hlthaff.2016.0412
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), Article e2522876. https://doi.org/10.1001/jamanetworkopen.2025.22876
Schuur, J. D., Baker, O., Freshman, J., Wilson, M., & Cutler, D. M. (2017). Where do freestanding emergency departments choose to locate? A national inventory and geographic analysis in three states. Annals of Emergency Medicine, 69(4), 383-392.e5. https://doi.org/10.1016/j.annemergmed.2016.05.019
Reading the HCM 5000 Module 3 assignment instructions
HCM-5000 runs in three modules, and the third turns to the processes of the system, meaning the settings where care reaches patients and how it gets there. It draws on objectives four, five and six: critiquing recent trends in financing and delivery, differentiating stakeholders and their roles, and examining reform. The course has three written assignments worth 30% together, four discussions, a live team presentation late in the term and a final paper on reform and the iron triangle. The Module 3 written assignment generally asks you to analyze a delivery setting or a shift in where care happens, such as ambulatory, home-based, virtual or retail care, using current articles from the New Jersey State Library. Write in graduate APA style.
How this HCM 5000 Module 3 example is built
The paper is organized as a decision, which suits a graduate management course. It opens by placing freestanding emergency departments within the broader move of care out of hospitals. The problem section uses visit counts, wait times and the share of low-acuity visits to define what the system needs. Evidence is grouped by question: where the facilities go, what they do to spending and what they do to patients' finances. Regulation and stakeholders get their own section, with each group's interest named. The comparison section gives cost, benefits and risks for both options. The recommendation is sequenced and conditional, which shows judgment under uncertainty rather than a simple yes or no.
HCM 5000 Module 3 rubric: what earns full marks
Mentors in TESU's graduate healthcare management courses assess written work for depth of analysis, use of current scholarly evidence, accuracy, application to a realistic organization and professional writing. For this module, a strong paper analyzes a delivery setting critically, recognizing both its promise and its costs, and connects it to trends in financing and to stakeholder interests. Evidence should be recent and peer reviewed, with designs and findings reported accurately. Recommendations should follow from the analysis and address risks. Graduate papers are also expected to synthesize sources rather than summarize them one after another, and to follow APA format closely. Mentors trust a paper that marks where the evidence runs out more than one that overstates it.
HCM 5000 Module 3 help from the desk
Graduate papers on delivery settings often describe the setting enthusiastically and skip the evidence on cost and use. Look for studies that test whether a new setting replaces older care or adds to it, since that decides its value. Naming stakeholders is not enough; say what each one stands to gain or lose. Students also make recommendations that ignore regulation or financing. If your organization has data, use it to define the problem before comparing options. Keep in mind that the final project asks about cost, quality and access together, so practice that framing here. Share your Module 3 prompt and the organization you picture, and we will write to that brief.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
More HCM 5000 and Master of Science in Healthcare Management sample papers
- HCM 5000 Module 1: U.S. Health System Overview Paper
- HCM 5000 Module 2: Healthcare Resources Paper
- ORR 5100 Module 1: Written Assignment: Why a Turnover Question Calls for Qualitative Inquiry
- HCM 5020 Module 6: Team Analysis Paper
- HCM 5010 Module 4: Providers Written Assignment
- HCM 5030 Module 2: Adverse Events and Patient Involvement Paper
HCM 5000 Module 3 questions, answered
Where can I find a free HCM 5000 Module 3 sample paper?
The complete delivery settings paper is on this page, with its problem analysis, evidence review, stakeholder section, recommendation, references and margin notes. It shows how a graduate paper argues a decision.
What is a freestanding emergency department?
A facility that provides emergency care around the clock but is physically separate from a hospital. Some are satellites owned by hospitals and others are independent, depending on state rules.
Do freestanding emergency departments lower healthcare costs?
Research in several states found that their arrival was usually associated with higher local spending on emergency care, suggesting they added visits rather than replacing hospital emergency visits.
What does Module 3 of HCM-5000 cover?
It covers system processes, meaning how and where healthcare services are delivered, along with trends in delivery and the roles of stakeholders.
How long is the HCM-5000 final project?
The syllabus describes a 2,500 to 4,500 word paper, about 10 to 15 pages, on how current reform efforts affect cost, quality and access, the iron triangle.