20 things you should know about Steamboat’s new freestanding ER
STEAMBOAT SPRINGS — Steamboat Springs’ first and only freestanding emergency room opened to the public Wednesday. The new, for-profit business was opened by Dallas Bailes, an emergency room doctor who has been in practice since 2005.
While Steamboat Emergency Center located at 1600 Mid Valley Drive right off of U.S. Highway 40 is new to the community, Bailes is not. He moved to Steamboat in 2012 and was married at the top of the gondola three years later. Two weeks after getting married, he moved to Texarkana, Texas, with his wife to open the Texarkana Emergency Center along with his grandfather, who has been a physician for over 50 years.
Bailes decided to move back to Steamboat in March 2016 and open up an emergency room here. Questions about Steamboat Emergency Center have been raised by the community, and Bailes is answering them. Here are 20 things to know about this new medical facility.
How many freestanding emergency rooms have you opened, and how many do you own?
I’ve opened one and that is the only one that I have ownership in until Steamboat Emergency Center.
Where are the other locations, and how long have they been open?
Texarkana Emergency Center opened in October of 2015.
Are the emergency rooms you are associated with connected to any others in large metropolitan areas?
No. Texarkana has a population of around 100,000. They have two large hospitals and three total freestanding ERs currently. We were the first freestanding ER to open in that town.
Why did you decide to open a freestanding emergency room in Steamboat Springs, and why did you feel it was needed?
Honestly, my main motivation for opening was to practice emergency medicine in the town where I live and love to be. I have had to travel up to two times a month to work in Texas since moving here in 2012. I love my job and want to continue doing it. One of the main reasons that ER doctors started to build their own ERs is because, quite frankly, we felt that we could do emergency medicine better than our experience in hospitals. In hospital emergency medicine, there is usually a complicated organizational structure. Nurses and front desk don’t work for the physicians, they work for the hospital and the physicians are contracted by the hospital. So what happens frequently is that patients can wait for long periods of time before coming back to be treated if it is busy. Nurses and front desk staff have little motivation to move things and physicians who work by the hour aren’t usually incentived to work faster. Then patients complain, that goes through a committee in hospital administration, they come up with a plan to fix the process and make a change a month later that usually doesn’t help. None of these people are bad people; it’s just a bad system.
In our model we are physician-owned; therefore we have an owner in house at almost all times. If there is a patient in the waiting room, the front desk staff is trained to process that patient and get them to the nurse as quickly as possible, which is three minutes on average. If a change needs to be made with a policy, it can be done immediately.
How many emergency room doctors will be working at the the new Steamboat Emergency Center?
One at a time with one more on backup if it gets busy, so that we limit wait time. Our goal is that nobody waits more than eight minutes to see the doctor.
What kind of experience do your doctors have?
All of our owners are board-certified in emergency medicine with an average of 10 years of experience. All have worked in level 1 trauma centers as well as busy community hospitals.
Will the new Steamboat Emergency Center charge facility fees?
Yes, we do. All emergency rooms charge facility fees. Facility fees are what allows us to operate 24/7, have a full pharmacy and CLIA (Clinical Laboratory Improvement Amendments) certified laboratory, X-ray, CT scanner and ultrasound.
How much should patients expect to pay in facility fees?
It is completely different based on what the patient is treated for. But by comparison, our fees tend to be less than the median rates in the country using the Health Care Blue Book. Also, for patients without insurance, we can give a price quote before a single dollar is charged
How will billing be handled, and who will be doing it?
Our billing company is Tyvan. They are a boutique billing company that only works with our facility and 19 similar facilities. My partner started the company because his previous company had a high number of complaints.
What insurance will be accepted?
We accept all commercial insurance and honor all in-network rates
What networks is the new Steamboat Emergency Center a part of?
We are not contracted with any insurance but commercial insurance is required by law to reimburse in-network for emergencies.
Can you explain why you will not be taking Medicaid or Medicare?
CMS (Medicare/Medicaid) does not recognize emergency services not provided by a hospital. It is not that we won’t take them; they won’t pay us.
Some folks see that as taking the cream off the top. How do you address concerns that the hospital, or Urgent Care, will have to take on those who cannot afford to pay?
We will take care of any emergency that comes to our facility. We cannot by law, or by ethics, deny care on the basis of ability to pay. Everyone who comes to Steamboat ER will receive a free medical screening exam by a physician. If it is determined at that point that the patient is not having an acute emergency, then we can discuss payment before running up a bill. I don’t think it fair that we are criticized because the government won’t pay us. We really see a need in the community, and we are excited to help fill it.
If a patient needs to be moved to another facility what will that process be?
We have agreements with Classic Air, Health One hospitals including Swedish Medical Center, The Memorial Hospital in Craig and Routt County EMS. We have detailed policies and procedures in place to make the transfer process as smooth as possible. It is very common for small hospitals to transfer patients. Life-flight helicopters certainly haven’t waited to fly in the Yampa Valley until after we open.
Will the patients be transferred to the Yampa Valley Medical Center or to another location?
Patients with an accepting physician can be transferred to UCHealth Yampa Valley Medical Center when it is appropriate.
Can they be directly admitted to YVMC?
They cannot be directly admitted because we haven’t been able to get a transfer agreement with UCHealth Yampa Valley Medical Center. This is really more of a procedural issue for us and not the patient.
How will that transfer be completed?
We will find an accepting physician who has privileges at UCHealth Yampa Valley Medical Center who will then arrange for the patient to arrive. Then we will call Routt County EMS for transport unless the patient is stable enough and chooses to go in a private vehicle, so long as they have a driver.
What services are going to be available at the new emergency room?
We have 24/7 board-certified emergency physicians, emergency nurses and radiology techs; full plain X-rays, ultrasound and CT scanning; CLIA-certified laboratory and full emergency pharmacy as well as respiratory treatments and IV medications. We can observe patients overnight for patients who need more than just an emergency visit. We will also be doing outpatient labs and X-rays, ultrasounds and CT scans that are ordered by other physicians. This will not be billed at emergency room rates. These rates will be on par with Front Range rates for similar services.
We have trained ultrasound techs, and I am fellowship trained in ultrasound myself. I ultrasound almost everybody. We get final radiology readings within 30 minutes 24 hours a day and seven days a week. We can handle any crisis including mental health, heart attacks, strokes, major trauma, arrhythmias, major infections, diabetic emergencies, complex lacerations and any emergency. We do not have on-site physical or occupational therapy.
We have all heard the horror stories about folks who have gone to a freestanding emergency rooms only to be hit by huge charges after the fact. How does your emergency room compare to those facilities?
I’ve heard those too. Unfortunately, there are bad actors in this business. Much of that comes from what is called balance billing where the facility charges out of network for the physicians fee which the insurance company does not cover. We never balance bill. Facility fees are the same for all ERs, and they are based on usual and customary prices for certain areas. Bottom line, we are not more expensive than any other local emergency option. And since we own our billing company, we have great latitude in how we address the patient’s responsibility for costs.
At what point will the patient be made aware of costs and fees?
For CMS patients or self-pay patients, as soon as the physician sees them unless the physician determines that the patient is having an emergency. By law, no emergency department can persuade someone with an emergency to avoid treatment because of cost. This is a tricky situation for all ERs. Most ERs just treat all patients, then send them exorbitant bills via third-party billing companies, then eventually send them to collections. We do not send people to collections unless we know a patient was paid directly by insurance and just cashed the check that was meant for us.
For insured patients, we discuss with them that we are an ER and that they are responsible for their ER copay. Since each insurance plan is individual, there is no way to know right off what their deductible or coinsurance is. Our billers are experts at interpreting the explanation of benefits that insurance companies send to patients and help them navigate the costs. We can then work out a way that the patient can pay their share in a way that they can handle.
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