Wheat Ridge firm on ER pro­hi­bi­tion

The Denver Post - - NEWS - By John Aguilar

wheat ridge» Free­stand­ing emer­gency rooms may be on a growth streak in Colorado — there are around three dozen fa­cil­i­ties to­day from just a hand­ful a few years ago — but not ev­ery­one is rolling out the wel­come mat.

On Mon­day night, the Wheat Ridge City Coun­cil voted to ex­tend a year-long mora­to­rium it had placed on free-stand­ing ERs in 2016 for an­other year as it comes up with reg­u­la­tions for the med­i­cally ad­vanced, emer­gency care cen­ters be­fore the first sets up shop in the city.

Wheat Ridge ap­pears to be the only com­mu­nity in Colorado with a tem­po­rary ban on the ERs, which have been pop­ping up in sub­ur­ban strip malls and shop­ping cen­ters in and around Den­ver. In just a 10-minute drive through Ar­vada, for ex­am­ple, you can pass two UCHealth emer­gency room build­ings and an­other owned by Cen­tura Health.

The cen­ters typ­i­cally are staffed by board-cer­ti­fied emer­gency-medicine doc­tors and nurses and have labs, X-ray ma­chines and other com­plex tech­nol­ogy avail­able on site to treat is­sues as se­ri­ous as heart at­tacks and strokes.

Wheat Ridge’s main con­cern is with the around-the­clock nature of the fa­cil­i­ties, with bright lights burn­ing all night and traf­fic — in­clud­ing am­bu­lances — mov­ing in and out. City of­fi­cials ques­tion whether free­stand­ing ERs should be zoned the same as med­i­cal clin­ics and urgent care cen­ters, which don’t have the same in­tense uses and long hours.

“Is there a need in our com­mu­nity for ERs to be sprin­kled through­out our city?” asked Wheat Ridge City Man­ager Pa­trick Goff. “We want to be sure we have time to look at how to reg­u­late them.”

Stand-alone ERs have faced re­sis­tance in Colorado in the past few years. Crit­ics have blamed them for con­fus­ing con­sumers, who might think they are get­ting lower-cost care typ­i­cal of urgent care clin­ics when, in fact, they are get­ting charged much higher emer­gency room rates, even when their in­jury or ill­ness do not ne­ces­si­tate high-level care.

Free-stand­ing ERs, whether af­fil­i­ated with large hos­pi­tals or in­de­pen­dent op­er­a­tors, have flour­ished in Colorado be­cause it is one of only a few states that do not re­quire a cer­tifi­cate of need for a new hospi­tal build­ing. A New Eng­land Jour­nal of Medicine Cat­a­lyst re­port pub­lished last fall re­ported that the ma­jor­ity of the na­tion’s free-stand­ing ERs are in Texas, Ari­zona and Colorado — states with­out the re­quire­ment for a cer­tifi­cate of need.

Colorado’s leg­is­la­ture has at­tempted to write rules for the nascent sec­tor in the past few ses­sions, with a bill three years ago that would have pre­vented free-stand­ing ERs not un­der a hospi­tal’s li­cense from charg­ing pa­tients emer­gency-fa­cil­ity fees. It was de­feated.

Just last month, Se­nate Bill 64 went down in com­mit­tee. The bill, spon­sored by Sen. John Ke­falas, D-Fort Collins, would have pro­hib­ited new stand-alone ERs from open­ing un­til July 2019 while also re­quir­ing the cen­ters to post on­line the fees they charge pa­tients.

Ke­falas on Mon­day said he hadn’t heard about Wheat Ridge’s ef­forts to stop the open­ing of free­stand­ing emer­gency rooms, but he wasn’t sur­prised.

“It sug­gests that lo­cal com­mu­ni­ties and the state are con­cerned about the pro­lif­er­a­tion of free-stand­ing ERs,” the se­na­tor said. “If the state doesn’t take ac­tion on these fa­cil­i­ties, com­mu­ni­ties will.”

But Linda Gor­man, di­rec­tor of the health care pol­icy cen­ter at the lib­er­tar­i­an­lean­ing In­de­pen­dence In­sti­tute, cast doubt on Wheat Ridge’s stated rea­sons for putting the stop on free­stand­ing ERs. She said there is no ev­i­dence ex­ist­ing ERs are caus­ing any more dis­rup­tion to neigh­bor­hoods than reg­u­lar com­mer­cial busi­nesses do. And, she ar­gued, am­bu­lances typ­i­cally don’t serve the cen­ters.

She said free-stand­ing ERs are con­ve­nient and more user-friendly than hos­pi­tals — and that’s why they are mul­ti­ply­ing. Gor­man won­dered if the city isn’t act­ing un­der the pres­sure of Lutheran Med­i­cal Cen­ter.

“One has to ask whether Wheat Ridge has other rea­sons for ban­ning them,” she said. “It sounds like they’re try­ing to pro­tect their lo­cal hospi­tal ER from com­pe­ti­tion.”

At Mon­day’s meet­ing, the only per­son to give tes­ti­mony dur­ing pub­lic com­ment was Carol Salz­mann, vice pres­i­dent of com­mu­nity and gov­ern­ment af­fairs for Lutheran Med­i­cal Cen­ter, which is in Wheat Ridge. She suc­cess­fully urged the coun­cil in­crease its mora­to­rium ex­ten­sion from six months to a year.

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