DENVER - Sen. Irene Aguilar, a Democrat and doctor from Denver, plans to introduce legislation next session that she says would close a loophole allowing small emergency departments to be licensed like hospitals without having to accept indigent, Medicare or Medicaid patients.
There are two stand-alone emergency departments in Colorado that would be affected by Aguilar's proposed bill, including the First Choice Emergency Room on North Powers Boulevard in Colorado Springs.
"Technically, it doesn't have to treat everybody who comes to it," Aguilar said of the emergency department in Colorado Springs. "It still has to stabilize them and in our state, right now, it has to have a transfer agreement with a hospital. They can in theory say you aren't really emergently ill, and you don't have any money, so go away."
Aguilar's bill would require facilities labeled as emergency departments to be affiliated with a hospital or to become urgent care facilities that are more like traditional doctors offices with extended hours for nonemergency treatment.
"To the average citizen, you walk into this facility, it just looks like a clinic and they don't realize that it actually has a higher cost," Aguilar said.
"I've always been one of the quiet voices in the background saying it is OK that emergency rooms charge so much because they do something we need them to do, but I think this is distorting that. To me this is urgent care, which they are welcome to do in our state, but by labeling and meeting the criteria, just barely, for what we have right now in our regulations to be an emergency care center they are being able to charge the enhanced price."
Calls and emails to the First Choice Emergency Room corporate office in Texas and the local Colorado Springs marketing office were not returned.
Randy Kuykendall, director of Colorado's Health Facilities and Emergency Medical Trauma Services division, said he's interested to hear the conversation at the Capitol in the upcoming session regarding stand-alone emergency departments.
Kuykendall's department is charged with licensing more than 2,000 types of medical facilities in the state, including hospitals and emergency departments. Licensing allows a facility to operate legally in the state, ensuring a basic level of patient safety and care.
His department also oversees federal certification for facilities that wish to be eligible to receive payments from Medicare and Medicaid - national health insurance for the elderly and poor.
He said the First Choice Emergency Rooms in Colorado Springs and Arvada are licensed but have chosen not to be certified for Medicare and Medicaid.
"Consequently, they are aimed at a segment of the population that either pays for their health care with cash or have third-party private insurance," Kuykendall said. "One of the catches to certification is that when you take federal money, then you automatically are required to operate under EMTALA and take any emergency patient that walks in the door."
EMTALA, or the Emergency Medical Treatment and Active Labor Act, was passed in the late 1980s and prohibits hospitals from denying emergency care to anyone regardless of ability to pay or citizenship.
Kuykendall said the Colorado Department of Health doesn't have a position on the issue. Some states allow emergency departments to not be certified, while other states require Medicare and Medicaid certification, he said.
"This is a little bit different model than we've seen in Colorado," Kuykendall said, pointing out that there are two other emergency departments in Colorado but they are in rural areas and are managed by quasi-governmental agencies. "Obviously, that has generated some interest from the Legislature."
Aguilar's bill would not affect rural facilities 25 or more miles from a hospital.
The argument can be made that the stand-alone emergency centers are increasing access to care overall, whether that serves the needs of the uninsured is another question, Kuykendall said.
While state law requires that emergency departments be able to accept ambulance traffic, it is a local decision whether ambulances will take emergency patients to the facility.
The 911 contracted ambulance service in Colorado Springs - AMR El Paso County does not deliver patients to First Choice, said Tawnya Silloway, spokeswoman for AMR. She said it's a decision made by the El Paso County Medical Society based on what facilities can meet emergency needs.
In other words, First Choice is a walk-in only facility.
"We do transfer patients from there almost weekly," Silloway said.
The legislation is in draft form, Aguilar said, and will be finalized leading up to the opening day of the legislative session Jan. 8.
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