by John Kiljan
[updated: March 31, 2014]
Dear CLRC members and friends,
Does Arvada’s free-standing emergency room provide lower-quality Doc-in-a-Box emergency care? Is this ER driving up healthcare costs? Does it engage in unfair billing practices? Does it turn away all but the well-off and well-insured? Or does it provide better customer service, lower healthcare costs through competition, the same bills as hospital emergency rooms do, freedom of patient choice, and free medical services to those who cannot afford to pay for it – all while promoting business development in central Arvada?
You may be able to find out the answers to these questions and what the impact of closing this new healthcare facility will be. All this, and perhaps more, will be discussed at a community forum being hosted by State of Colorado Senator Irene Aguilar (D- Denver) and by your local neighborhood association (the CLRC) in a community forum being held this Sunday.
Senator Irene Aguilar, Senate Bill 16’s sponsor, has graciously offered to speak to her bill in a short Sunday, March 30th community forum. The impromptu discussion was set up by CLRC President T.O. Owens and will be held in the Anne Campbell meeting room at the Arvada Police Station entrance to City Hall at 8101 Ralston Road. The meeting starts at 1:30 pm and should last a little over an hour.
Those who operate the new emergency room in the Arvada Triangle say that legislation now pending in the Colorado Senate will put them out of business. The bill’s sponsors say it will not, but they have not yet been able to gather enough support to pass the legislation in the Colorado Senate.
It’s an open meeting, please feel free to come and ask your own questions and to invite along any of your neighbors you think are interested in local healthcare issues.
Much has already been said about this bill in Senate committee hearings. To help our CLRC members and friends to become more informed about the issues at stake, here are some extracts from that Senate testimony held late in February when this bill first came before the Senate.
Also, if you are not able to attend this meeting and you have questions you’d like to see asked, please forward them onto me at the email address listed below and I’ll see if we can get them included.
[Update: About 47 people showed up for the community forum held on Sunday, March 30th. There was a vigorous give-and-take discussion. Most attendees seemed to be in opposition to the bill. The following morning in the Senate, the bill was laid over yet again and is now scheduled for its second reading on the morning of April 7th. Both video and audio recordings were made of the forum. The CLRC will continue to follow the progress of this bill through the legislative session. –JK]
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Quotes from the Senate Committee Hearing on SB 14-016
Held on February 27, 2014 by the Health and Human Services Committee
(audio/video maker times are shown in parentheses)
Senator Aguilar (D- Denver and SB 16 sponsor): “In Senate Bill 16 what we’re trying to do is make sure that the void in [health]care is not picked up by emergency care . . .” (1:49)
Senator Lundberg (R- Ft Collins): “. . . That’s not the bill in front of us. The bill in front of us is to try and take those folks out [First Choice ER’s] – to restrict them.” (1:50)
Senator Hill (R- Colorado Springs): “This bill shuts down competition. This bill shuts down the opportunity to say, ‘Let people decide for themselves – let them decide where they want to go.’ And we trust people to have that ability to decide for themselves, and I’m deeply concerned that somehow we can have quality without the profit motive, that we can have quality without the opportunity of people choosing, that a couple of people up here [on the committee dais], perhaps, can make this decision for them.” (2:09)
Senator Aguilar: “. . . Texas got F’s in all the quality measures. And one of the things I struggle to help people understand is that, unlike traditional markets, in healthcare, more competition actually often does not mean more quality, because what works best is to have people who are really expert at handling whatever it might be, and who are well supported. So the Texas healthcare system has declined in grading from this national organization [ACEP] since the proliferation of these [First Choice] emergency departments.” (2:10)
“I keep hearing that we are going to stop these people from practicing? But actually, the strike-below amendment doesn’t stop them from practicing, it just licenses them. . . . First Choice would qualify for this license.“ (2:17)
“You are right. The first bill I introduced would have stopped them [First Choice] from practicing. This bill does not.” (2:18)
Lauren Rowley (First Choice – Government Affairs): “Colorado got a C+ [on the ACEP report card], Texas actually got a D. Just so you know, free-standing emergency rooms [such as First Choice ER’s] were not included in that survey – only hospitals. . . . Access [to hospital care was] weighted most heavily. Colorado got a D+ in that [access] category. . . . [During that survey, a Texas] First Choice emergency room actually won the Press Ganey Guardians-of-Excellence award for first-in-class service for emergency care.” (2:20)
“This bill goes into effect upon signature. Which obviously would effectively put us out of business. Actually, we believe there is one other provision that will put us out of business, but this one clearly would.” (2:23)
Senator Aguilar: “We would need to allow a year or something for rules to be drafted and the department [CDPHE] to be able to do this. I am happy to change that.” (2:26)
Lauren Rowley: “The facility fee is more than just a hospital. A facility fee involves the infrastructure of the building. For instance, a hospital free-standing emergency department that’s affiliate with a hospital – like us , looks like us, acts like us – they are able to charge a facility fee for ambulatory patients, just like we would do. It’s for the infrastructure, it’s for the nurse, it’s for the diagnostics, it’s for the bricks and mortar. That’s what the facility fee is, and we follow ACEP guidelines in regard to that. So this provision effectively says that, since we are not participating in public insurance programs [Medicare/Medicaid], we cannot bill at all for services provided to patients. And, also, if we do, we’d be committing insurance fraud.” (2:27)
“Keep in mind this bill creates very stringent requirements, some probably more stringent than hospital emergency rooms. Yet, if we look the same [and] are expected to perform exactly the same services, we cannot bill facility fees under this law. We believe it creates a double standard that hospital ED’s [emergency rooms] that look exactly like us, perform exactly like us, are able to [bill for] and we cannot. ” (2:28)
Dr Drew Kosmowski (First Choice – Colorado Springs Medical Director): “We treat 25% of our patients for free. . . [the Committee is] under the impression here that we kick [our patients] to the curb without any treatment, like we don’t care about them. . . . but that’s not what we do. We care for all of our patients. We are not going to let anybody die on our doorstep.” (2:37)
“Facility costs are all the other things other than the doctor’s cost. In most of our ER’s in Colorado and around the country, you have ER groups of physicians that staff those for the hospital. They are a subcontractor of physician support. The facilities fees is everything else. It’s all the IV’s, medications, nursing support – everything else. It’s not some reward to the hospital for rent for the building or anything. It is basically the cost of everything else other than the physician’s cost. . . . The reason we don’t accept Medicare/Medicaid/TRICARE is that they don’t accept us. . . and I’ve tried to change that.” (2:42)
Dr Nils Albert (First Choice – Arvada Medical Director): “I took this job with First Choice Emergency Room not because it was an increase in pay from what I was making. It’s because it’s an incredible opportunity to provide really unique patient care, a wonderful service, and actually, in fact, compared to what my job was with Lutheran Hospital – back in the day – it [pays] less. And I’m working more hours. So, I just want to share that with all the other physicians with whom I work. The reasons [I work there] are really because it’s a job I really want to do and not because we’re going to find our pot of gold.” (3:02)
Senator Lundberg: “. . . I understood that, without that facility fee, they [First Choice providers] go away, because that pays for the lights. It does pay for the nurse. It does pay for the lights. It does pay for the other things, you know, unless they find some other scenario where it’s one flat fee.” (3:10)
“Believe me, I’m the first one who thinks that ER visits are way over-expensive. . . I think that’s obscene, but I’m also just as amazed that there is a bill out there, like this one, that says these [First Choice] emergency rooms should be able to operate for free, whereas the hospitals will get that profit margin.” (3:11)
Senator Aguilar: “Now if you are just paying for what you actually use – pay for the doctor, you pay for any tests you get, I don’t have a problem with that. What I’m saying is that we shouldn’t be giving you extra money because you are an emergency room. We should just be paying you for what is used when you to there.” (3:24)
“My concern is that part of how hospitals make up for the people they see who don’t pay, is they charge more for everybody else. So if we have somebody skimming the high-paying people, that means the hospital gets less of those high-paying people and their costs for other things go up.” (3:36)
“I also think that I heard pretty clearly that they [First Choice ER’s] have the ability to bill for each and every service that they provide at what they consider a reasonable rate and don’t have the need for a facility fee.” (3:45)
Senator Lundberg: “I believe I’m accurate in stating that, with this bill passing, you essentially reduce these free-standing emergency facilities to urgent care facilities. . . . An urgent care [facility] is for very small things and some triage to then send you onto the others. That’s what this bill reduces the free-standing emergency room [to]. Don’t kid yourself that it’s an emergency room at all. It’ll close up if you drop the price to a fraction of the others. But, I’ll say no more. I’d just as soon vote.” (3:57)
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WHERE TO FIND OUT MORE
To see the Denver Business Journal’s coverage of this committee meeting go to this link
ACEP is the American College of Emergency Physicians. They are an advocacy group for emergency room physician and they rate emergency care at hospitals across the United States. Their website can be found at http://www.acep.org .
Press Ganey’s website is http://www.pressganey.com/ .
The Arvada First Choice website is at
TRICARE is the health care program for U.S. service members (active, Guard/Reserve, retired) and their eligible families. Think of it as Medicare on steroids for military families. If you are eligible for TRICARE, you know who you are, and you know you have one of the best insurance programs in the world. I wish I had TRICARE. I wish everyone had TRICARE.
To hear the entire Senate committee hearing on February 27th, go to this link
Sorry, but even though it is only audio, it is recorded by the General Assembly in an MP4 video format and you normally have to have software that plays MP4 videos to listen to it. That software may not be preloaded into your computer, and it can be hard to find online. I use RealPlayer, which plays both MP4 and the more-common MP3 audio format, to listen to these recordings. If the General Assembly website is up and working, you may be able to get their website to play the recording for you with the correct icon clicks. The Senate Bill 16 audio portion starts at the 1:29 mark on the video.
If you have a medical background and like reading pending legislation with all its legalese, you can read the whole bill, with its current amendments, at this link
A recent CLRC summary article on this issue may be found at
Secretary for the Citizens for a Livable Ralston Community
6185 Field Street
Arvada, CO 80004
Facebook: CLRC Arvada
March 28, 2014
[updated March 31, 2014]