The evolution of Senate Bill 16 shows how those who want to control your health care misuse government power and misrepresent their aims. At first, state Sen. Irene Aguilar’s SB 16 made life worse for sick people by banning any new privately owned emergency rooms within 25 miles of a hospital. Then the bill was revised to put Colorado’s two privately owned ERs out of business.
People at a recent meeting in Arvada asked Sen. Aguilar, D-Denver, why she wanted to close the private ER in their neighborhood.
“It’s because it’s new,” she said, “and because we have the opportunity to stop it now…”
Thankfully, she was not around to protect us when penicillin, ambulatory surgery and CAT scans were new.
Privately owned freestanding emergency rooms are like the freestanding emergency rooms owned by hospitals. Like their hospital-owned counterparts, freestanding ERs are open 24/7, with laboratory facilities, advanced imaging and rapid transport or referral to hospitals and specialists if needed.
They are staffed with the same board-certified physicians who staff hospital ERs.
Both kinds of ERs provide the same services for the same price. SB 16 would have made it illegal for Colorado’s privately owned freestanding ERs to charge facility fees. Aguilar and her coalition imply that only hospital ERs deserve facility fees.
In fact, Medicare and private insurers routinely pay facility fees to providers of capital intensive services regardless of ownership. Privately owned freestanding ambulatory surgical centers are paid the same facility fees as hospital-owned freestanding ambulatory surgical centers. So are privately owned colonoscopy centers, centers that maintain conferencing equipment for long-distance consulting and treatment and different kinds of residential care facilities.
A facility fee is like a gym membership — it pays for the capital equipment. Enabling some gyms or medical facilities to charge higher rates just because lawmakers like some owners better than others sustains cronyism and invites corruption.
The pro-SB 16 coalition claims primary care could substitute for new emergency rooms. This is nonsense. People have unexpected physical crises requiring immediate treatment. Even if a crisis occurs during business hours, neither urgent care centers nor primary care physicians are equipped to properly deal with seizures, broken bones, fainting, loss of vision, severe pain, severely impaired breathing, extreme vomiting, excessive bleeding or blows to the head.
Privately owned freestanding ERs increase access to care by locating in places without freestanding hospital ERs, and where access to adequate emergency care is difficult due to long waiting times at existing hospital ERs.
Claims that ERs are overused are overblown, especially for privately insured patients with large plan deductibles and stiff copays. A 2013 Journal of the American Medical Association study found that just 6.3 percent of ER visits in the 2009 National Hospital Ambulatory Medical Care Survey were diagnosed as “primary care-treatable” visits.
The problem is the symptoms displayed by the people diagnosed as “primary-care treatable” were the same as the symptoms displayed by 88.7 percent of all people visiting the ER. Although severe acid-reflux is a “primary care-treatable condition” once diagnosed, a heart attack is not. A person with chest pain in the middle of the night often can’t tell which is which.
Because severe trauma cases are dispatched directly to trauma centers, most people who go to an ER do not need a hospital. About 84 percent of people who visit ERs are treated and go home.
Colorado’s privately owned emergency rooms increase access to necessary care. They reduce the cost of care by reducing waiting time while charging the same price as hospitals. Though not yet approved providers for Medicare, Medicaid or TriCare, the physicians staffing them have the authority to waive charges and treat anyone who needs immediate care. When they do that, they reduce overall health care expenditures.
Thanks to legislators who understand the potential benefits privately owned emergency rooms offer, SB 16 probably will not pass this session. But the coalition supporting it still appears willing to misuse government power to shutter an existing business simply because it provides necessary health care in a new way.
Linda Gorman directs the Health Care Policy Center at the Independence Institute, a free market think tank in Denver.
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