Free Standing ERs vs Colorado Legislature: Keeping Personal Choice in the Equation

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America has a consumer attitude with which we approach life. There is no question, as a culture, we like choice. We like to have options so we can choose the types of food we eat, the clothes we wear, and the places we live. Choice is a major part of the American way of life. So tell me, why doesn’t this apply to all aspects of our health care system? Yes, we have some choices when it comes to who our general practice physician is or what insurance we have but we should also be able to have options when it comes to our emergency health care. Is it normal to have a choice when a person needs immediate medical attention? No, they go to the nearest hospital emergency room and hope they won’t be waiting for hours to see a doctor.

To give such a choice, an emergency care model was established and put into practice. Unfortunately, there is legislation brewing in Colorado that would put an end to the entire idea. Now, both sides of the issue are lining up to duke it out and it is looking to be one hell of a prize fight.

Let’s set the stage for this confrontation. Free Standing ER’s are locations that are open 24/7 that offer the public access to urgent or emergency health care. Now, don’t go thinking that they are Podunk ERs that practice hillbilly medicine; these are fully equipped, fully staffed, and certified Emergency Rooms where a person can receive a high standard of medical care.

Do you have questions about this emergency care model? Take the word of the Urgent Care Association of America on the subject: http://www.ucaoa.org/docs/Article_Freestanding.pdf

So what’s the problem?

If Free Standing ERs are allowed to exist, it breaks the health care monopoly of the hospitals. Period. In the past, hospitals could charge whatever they pleased for whatever services they provided because they had no competition! Now, with a change in the “health market”, they are doing everything they can to keep the monopoly in place and the big bucks rolling in.

The insurance community is also weighing into this fight because they believe they will lose money. Imagine an insurance company being greedy and keeping money in their coffers, it shouldn’t be too hard but I digress from the topic at hand. Let’s get back to the prizefight.

Enter the ring, politics and legislation: Senate Bill 16. Being sponsored by state Senator Irene Aguilar, the bill forces more restrictions on Free Standing ERs that would essentially put them out of business. How? By making them play by different rules, of course! All ERs that are connected to hospitals charge a “facilities fee” that allows for the doors to stay open 24/7 in order to provide services. This bill forbids Free Standing ERs to charge the same fee. This is the same as putting two boxers in the ring but not allowing one to use his fists.

This country was built on competition; it is high time that the emergency health care system received a dose of it. Don’t take my word for it, look it up: Free Market Principles. Expect to be reading for a few years.

Let’s examine some facts, shall we? Free Standing ERs do not have the overcrowding issue that hospitals have. They do not have the wait times. The CDC states that urban ERs have a mean wait time of over an hour; the larger the hospital, the longer the wait time. This means that smaller ER facilities akin to Free Standing ERs have shorter wait times due to the lesser patient volume. Think this is incorrect? Check out this graph that the CDC released.

cdc_graph

(1)Trend by annual emergency department visit volume is statistically significant. 
(2)Mean wait time in emergency departments with fewer than 20,000 annual visits is significantly lower than wait times in emergency departments in other volume categories. SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

Figure found at: http://www.cdc.gov/nchs/data/databriefs/db102.htm

Time is a major factor in emergency situations. Ever heard of the Golden Hour? Go look it up if you haven’t. My point is that if I or someone I love is in crisis, I don’t want to sit in an ER waiting room for an hour before receiving medical care.

Back to the prizefight at hand: hospitals are fighting tooth and nail to change the mode of emergency health care. Want to know something crazy? There is already precedence for Free Standing ERs in the United States! And, interestingly, it didn’t make the whole system come crumbling down. In fact, it works quite well; the system is Ambulatory Surgical Centers (ASC).

ASCs are outpatient clinics that allow for simple or non-invasive procedures to be done; taking pressure off the major hospitals in the area. The American Academy of Orthopaedic Surgeons (AAOS) boasts how ASCs have numerous benefits for patients through “…more convenient locations, shorter wait times, and easier scheduling”, less interruptions due to emergency cases, and the physicians choose their staff allowing for increased efficiency. The growing number of ASC’s in the United States is being called “A positive trend in Health Care” and is actually embraced by the medical community.

Want to see how much the AAOS approves of and supports ASCs? Go to their Ambulatory Surgical Centers Position Statement here: http://www.aaos.org/about/papers/position/1161.asp

So why are Free Standing ER’s getting so much condemnation for trying to do the same thing?? That’s easy to answer: Money. The groups that are fighting this change are the insurance companies and the hospitals that are losing money because patients are getting better health care.

So, who am I and why am I talking about this? I’m glad you asked.

I’m a grad student that is working my butt off in order to make a future for me and mine. I travel when I can and love to see how people live. I believe in basic human rights such as self-determination and good health. I believe these values are necessary for the world; imagine how much more I believe in them for my country, my state, my town, and my people. This legislation in Colorado would leave me with no choices if I ever needed immediate medical care. In fact, it takes choice completely out of the equation.

By all means, let the emergency system herd and pack in patients like they are sheep after making them wait obscene amounts of time.

Or we can allow for more choices, more competition, and potentially increase the quality of the health care system in the United States.

While I may be the girl next door, I have a brain and I know how to use it. In this situation, the choice is obvious: I side with the Free Standing ERs. I believe in their right to exist and to challenge the standard operating procedure that has been left unopposed for far too long.

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