Dr. Dallas Bailes opened this successful freestanding emergency room in Texarkana, Texas, in 2015, and plans to open a similar facility in the former Staples building in Steamboat Springs.

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Dr. Dallas Bailes opened this successful freestanding emergency room in Texarkana, Texas, in 2015, and plans to open a similar facility in the former Staples building in Steamboat Springs.

New Steamboat Springs freestanding ER could open by late summer

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— The new owner of a building slated to become a freestanding emergency room at the intersection of South Lincoln Avenue and Mid Valley Drive said the business would offer competitive rates and employ Steamboat Springs-based doctors and staff.

Dr. Dallas Bailes, who has lived in Steamboat part-time for five years and worked in hospitals in Craig and Granby, as well as in Texas and New York, opened a similar ER in Texarkana, Texas in late 2015.

That business has been highly successful, allowing Bailes to become more of a silent partner and giving him time to create a similar operation in the former Staples building in Steamboat.

He purchased the building for $2.65 million earlier this month and expects to spend $3 million renovating and equipping the new ER facility.

Bailes said that freestanding ERs can benefit from not having complicated computer record-keeping systems or administrative oversight.

Doctors who work at the business will be part-owners and have the flexibility to run the practice as they see fit.

“We’re not a giant corporation,” Bailes said. “We don’t answer to anyone but ourselves and the community.”

He said patients who arrive for emergency care can expect to see a doctor in less than 10 minutes, regardless of the urgency of the emergency, and can expect to learn costs upfront and choose between services, if desired.

The ER, tentatively named Steamboat Emergency Center, would accept insurance or cash payments, but would be unable to accept Medicaid and Medicare, because freestanding ERs are not regulated by the federal government, Bailes said. The center could still see those patients, but they would be billed as cash-paying patients.

Bailes said the center doesn’t plan to be an ambulance receiving facility, and he is unsure whether a person getting into an ambulance could request to come to the center instead of Yampa Valley Medical Center.

“Our business is going to be visibility, and we’ll have a marketing director and rely on word-of-mouth,” Bailes said. “We don’t want to take away from the hospital. We have nothing bad to say about it. But we will be a competitor.”

In addition to Bailes, Dr. Matt Freeman, who has previously worked in Craig, plans to work at the new ER, and Bailes is in talks with other doctors from Northwest Colorado to join the staff.

One hiccup that could delay the opening of Bailes’ proposed freestanding ER is proposed legislation, SB17-064 in Colorado to create a new licensing program for the facilities.

Depending on whether the legislation is approved, Bailes is hopeful to open Steamboat Emergency Center between August and November.

To reach Teresa Ristow, call 970-871-4206, email tristow@SteamboatToday.com or follow her on Twitter @TeresaRistow

Comments

Dallas Bailes 1 month, 3 weeks ago

We agree with this criticism of Adeptus and UC Health ER's. They are publicly traded and operated by a remote corporation. They overcharge the standard rates and balance bill the professional fee in the hopes of earning more for their shareholders. In our model we are owned and operated by the physicians who are working the shifts, much like almost all physician practices. We charge insurance the standard rate for the region and never balance bill and we have cash rates for self pay patients that are significantly less than you will find in most hospital based ER's. In fact, we own our own billing company and they have a >95% patient satisfaction rate. Our business philosophy is that we may collect less money per patient, but we will have happy patients who come back again and again. We know that nothing will hurt us in this small community than alienating it with deceptive billing practices.

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Scott Wedel 1 month, 3 weeks ago

I don't see anything onerous in the proposed bill except the period between the bill passing and July 2019 when no new licenses are to be issued except in an area of medical need (whatever that means).

Requiring that the facility post their fee schedule online is a great idea that the owners of the facility should promise will be done regardless. It is also something that YVMC should have done for their emergency room.

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Martha D Young 1 month, 3 weeks ago

Not accepting Medicaid or Medicare is unacceptable. Sounds like more of a cash cow than a medical service to me.

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Carl Steidtmann 1 month, 3 weeks ago

The insurance for everyone model has been a total failure. It rewards higher costs and bill padding. There is a better way and this facility will be on the cutting edge of that change.

There is already a similar 'cash only' facility in Oklahoma City where the actual cost of an operation is about a quarter of the cost of similar procedures at local hospitals. You can read about it here:

http://time.com/4649914/why-the-doctor-takes-only-cash/

Or for those who prefer a video, you can see it here:

https://www.youtube.com/watch?v=0uPdkhMVdMQ

Competition is always good. It forces businesses to innovate and seek creative ways of keeping costs down while satisfying customers.

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Martha D Young 1 month, 3 weeks ago

My concern is access to healthcare for everyone. The proposed "emergency center", according to Bailes, does not qualify for Medicaid or Medicare reimbursement due to govt. regulations. So, will this facility offer a sliding scale or another payment method that makes it accessible to everyone?

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Scott Wedel 1 month, 3 weeks ago

Martha,

They will offer care to everyone willing to pay their prices. A sliding scale would mean them trying to figure out who can afford to pay more and who should be charged less. The point of these sort of facilities is to keep it simple so they can offer urgent care at a lower price than an emergency room.

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david niedermeier 1 month, 3 weeks ago

Jeff, thanks for the link. Fascinating and disappointing.

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Neil O'Keeffe 1 month, 3 weeks ago

Free market healthcare caveat emptor, predatory and profit driven above all else. If we can't make money on sickness, death and dying then we can't call ourselves a true democracy now can we?

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Carl Steidtmann 1 month, 3 weeks ago

What utter and total nonsense.

You want to see predatory health care, take a look at the NHS in the UK where you can't get a knee replacement unless you are in such pain you can't sleep:

http://www.dailymail.co.uk/health/article-4162300/Hip-operations-banned-sleep-new-NHS-rules.html

And if you are obese you go to the back of the queue.

But why look overseas. Just look at our government provided health care via the Veterans Administration where thousands of vets have died waiting for care.

As Adam Smith wrote in 1776:

It is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their own interest.

With so much evidence of the total failure of government provided health care, it is shocking to find that there are still people who are so blinded to the idea that there might be a better way.

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bill schurman 1 month, 3 weeks ago

Carl, hope that you are not on Medicare if you are eligible. A truly well run system.

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Carl Steidtmann 1 month, 3 weeks ago

I am on Medicare.

The problem with the system is that it is going to run out of other peoples money to spend by 2030.

http://www.politico.com/story/2015/07/date-for-medicares-insolvency-remains-2030-120490

I fear that the current dysfunctionality of the health care system will mean that it will go broke sooner than that.

The level of fraud in the system is also staggering. This is just one example:

http://www.washingtonpost.com/sf/national/2014/08/16/a-medicare-scam-that-just-kept-rolling/

So yes, if you like fraud and pending bankruptcy, Medicare is the system for you.

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Neil O'Keeffe 1 month, 3 weeks ago

Carl, anyone quoting Adam Smith as an argument for supporting unbridled capitalism especially when it comes to basic human rights has zero credibility. Oh let me guess, you don't believe in human rights either? Your Darwinian approach to economics has no intrinsic value when applied to basic human rights. Let me guess; you are going to quote Aynn Rand next to support your reptilian (fight or flight) viewpoint. LOL!

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Carl Steidtmann 1 month, 3 weeks ago

Neil

I have to assume that you have never read Adam Smith or you would not be making such uninformed comments. And don't just read the cliff notes of the Wealth of Nations. You won't get into the moral arguments for Capitalism until you dive into 'The Theory of Moral Sentiments.' Capitalism as described by Smith is by far the most moral system of economic governance. It is based on voluntary cooperation and win-win exchanges.

I am at a lost as to what is moral about forcing people to do things that from the perspective of those in control of government is in their own best interests. We can plainly see from history what a catastrophe that can become. Venezuela, Cuba and Zimbabwe are all modern day disasters of socialism. You want socialist paradise health care comrade? Here you go:

https://www.theguardian.com/world/2016/oct/19/venezuela-crisis-hospitals-shortages-barcelona-caracas

As for Ayn Rand, I read her in my teens and realized even then that she was not only a bad writer but also a purveyor of bad ideas.

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John Weibel 1 month, 3 weeks ago

Neil,

The underpinnings of a free market are a free currency. Today we do not have that. We also have a corporatism system, in which the government provides tax credits for people to borrow money on their home, a then tax credits for one to invest in the stock market, and a pension system that is guaranteed by the federal government that our new commerce secretary has utilized through the bankruptcy courts to shed bankrupt business', which then because of tariffs levied on steel imports was able to sell, the business, at tremendous profits. Got to love the crony corporatism system we have today as it is not a capitalistic system. If it were capitalistic, I would not be forced to pay into a milk marketing system that I do not support.

So many things wrong with the current system and yet the left thinks that it is capitalism, not really what ails it, the banking system and the corporations that have grown up around it, the rules and regulations that are imposed upon all making it ever harder for small business' to succeed as our system is based upon employment taxes, which those with enough money avoid by supplanting labor with technology.

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Ken Mauldin 1 month, 3 weeks ago

Neil - Adam Smith's "butcher and baker" analogy accurately portrays the basic economic concept of Utility, which describes how both individuals and economies reach optimal satisfaction in consideration of scarcity.

As for Human Rights: ignorance of basic economics, and advocation of the unsustainable economic policies that ignorance allows, is a greater threat to Human Rights than free-exchange could ever be.

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Scott Wedel 1 month, 3 weeks ago

The limit on profits is the ability of the buyer to choose. As long as someone can choose whether to go to YVMC or this place then both places have to pay attention to their prices and quality of service. Thus, the profit motive pushes them to offer good service at a good price. It rewards those able to find a better way to do something.

Though, as it has been noted, there have been problems when pricing has not been accurately disclosed and thus the customer has been prevented from making decisions based upon price. That is part of the proposed Colorado law. Regardless of whether that law is passed, the owners of this facility should promise to post their pricing.

This business operation is not making any judgement on whether healthcare is a basic human right. The owners, in making this investment, believe they can offer a good service at a good price that will attract customers.

Things that are considered as fundamental human rights are the responsibility of government to figure out how will be guaranteed. Food to not starve is generally considered a human right does not mean that farmers, ranchers, grocery stores and restaurants cease to be market based enterprises seeking to make money. Instead we have government distributing food stamps to those in need so that they are able to buy food in grocery stores.

We have Medicare and Medicaid as our system of providing health care to those otherwise unable to pay. Unlike food stamps, that payment system is not simple equivalent of cash. There is a system of determining the diagnosis to determine the reimbursement. Thus, there is no requirement that a health care provider accept Medicare or Medicaid unless they receive certain federal funding.

Nearly 30 years ago I was treated in that sort of facility to get some stitches caused by a guy hitting me with his car. It was run by ex military doctors that had served at Vietnam field hospitals. I got 13 stitches, was checked for a concussion and was out in 45 minutes. The bill was $200! They didn't fool around and didn't spend time itemizing the bill. The guy who hit me then paid for it.

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Neil O'Keeffe 1 month, 3 weeks ago

I agree Scott, just fed up with the " Government is Bad" argument from so many on the right until it comes to: Out of control Military Spending (multiples beyond the next ten industrialized nations combined) Control over women's reproductive rights Control over who can marry Control over who can vote Oh and don't touch by government controlled healthcare (Medicare) or Pension (Social Security) while you are at it.

I am all for a combination of free enterprise and government partnerships especially when the almighty dollar gets in the way of the greater good (affordable health care, clean air & water, safe roads and bridges; FOR ALL). But our current form of government seems incapable of finding this balance largely due to special interest and ineptitude. Hopefully that will all change one day, but I'm not holding my breath. Until then, HYPOCRISY WILL CONTINUE TO RULE THE DAY!

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Scott Wedel 1 month, 3 weeks ago

Neil,

So then focus on those specific topics where your argument is strongest. When you make a statement that medical care should not have profits then that is too easy for your ideological opposites to criticize as a silly statement.

As a general philosophy, private and public partnerships are a horrible idea as now the government is picking a winner receiving government funding. That it is much better for government to figure out how to effectively use free market competition to provide essential services. For example, food stamps is basically a debit card for food and the person receiving aid has incentive to buy for sale items at the lowest price grocery store.

In contrast, YVHA's Elk River project gave a ton of money to one developer to build units. If YVHA had put out to bid that they wanted say 5 two bedroom units to rent at 50% of AMI which is currently $750 or whatever a month so that any developer could say how much cash they'd need to build that then they probably would have paid a whole lot less.

Universities have done similar things for student housing where they say that they need X rooms at $Y per month for Z years and then see which developer says they need the least amount of money to build those units.

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Neil O'Keeffe 1 month, 3 weeks ago

Talk about picking "winners and losers" our most recent abomination in the White House is now deciding which religions are acceptable, but I'm sure that is AOK for the minority of US citizens that voted for him. Totally ludicrous! After all HYPOCRISY RULES THE DAY! Thanks for the advise Scott good point!

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Jeff Kibler 1 month, 3 weeks ago

Syrian Christians were already effectively banned:

https://stream.org/lets-real-obama-barred-syrian-christian-refugees/

Also Iraqis in 2011, Iranians in 1999-2000, etc.

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Scott Wedel 1 month, 3 weeks ago

As for this facility, I think the building modification with signage is more than allowed by zoning and I would be concerned that it is false advertising that could cost a life. It looks like a full blown ER in which someone bringing in a family member suffering a stroke or heart attack may go to instead of YVMC's emergency room. If they don't plan on having an ambulance receiving station then they are not wanting to treat critical patients.

The term "Emergency Room" has a well understood meaning of which this place does not meet.

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Dallas Bailes 1 month, 3 weeks ago

This facility will be licensed by the state of Colorado as an emergency room like every other emergency room in the state. As such it must meet a number of standards including having an onsite emergency physician 24 hours a day, CT scanning, lab, pharmacy and the ability to manage and stabilize any emergency that comes to the facility including stroke and heart attack. Free standing ER's see these types of patients every day and treat them the same way that most critical access hospitals treat them: with thrombolytics and anticoagulants when appropriate and transfer to a tertiary center with a Neuro ICU or CCU after stabilization. The reason that we opt out of receiving ambulances is because many patients arriving by EMS have Medicare and nothing could be more frustrating to a patient than finding out an ambulance took you to a facility that cannot bill your insurance.

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Jeff Buffetti 1 month, 3 weeks ago

What you mean to say is we only want people with good paying insurance to enter our facility. Its hard to squeeze money out of poor people. These free standing for profit ER's are placed in areas with high incomes, and well paying insurance, and are about profit first, and community health second.

“Freestanding EDs have the potential to increase access in several ways: they can be located in areas without emergency care, like a rural area, or they can open in an area without adequate emergency care, for example, where hospital EDs have chronic long waiting times,” said lead study author Dr. Jeremiah Schuur of Brigham and Women’s Hospital and Harvard Medical School in Boston.

YVMC has neither of these problems.

http://www.dallasnews.com/business/health-care/2016/08/02/free-standingemergency-rooms-helping-wealthy

http://www.reuters.com/article/us-health-access-freestanding-er-idUSKCN0ZZ2PA

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Dallas Bailes 1 month, 3 weeks ago

What we mean to say is that most ER doctors we know are frustrated practicing emergency medicine in hospitals and working in a freestanding model has opened up a new paradigm for our careers. We see patients almost as soon as they walk through the door and provide concierge level care. We make follow up appointments for patients and call in prescriptions for them. We follow up on them in ways that we were never able to do in hospital based practice. If you look at reviews left on the Facebook page for our ER in Texas we have a 94% 5 star rating by our patients. So with happy doctors and happy patients, we have a hard time understanding your hostility to our business.

Would we prefer to only have patients with good paying insurance as a business owner? Of course we would. Just like any business owner would like to have a business that makes money. But as physicians we know that is not always the case which is why we have a transparent pricing structure for self pay patients which is almost unheard of in medicine. We also have given away thousands upon thousands of dollars in unreimbursed medical care to emergency patients who could not pay. All patients who walk through our doors will be seen by the physician and those with emergencies will be treated regardless of their ability to pay. We hope you’ll keep an open mind and give us a chance.

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Lock McShane 1 month, 3 weeks ago

As I understand it, Adam Smith's free market required both sides of a transaction to have the same information, so that both parties could make rational decisions regarding the deal. This is definitely not true concerning the ER at YVMC where the patient has zero information as to the cost of the care being provided. Therefore, the free market of Adam Smith doesn't apply to this situation. The new ER will at least have prices available up front.

Health care is not like typical markets; you can't wait until the price comes down before you buy. You also can't buy something less expensive if what you need costs too much. You don't have many choices when you are sick; you need what will make you well.

All systems of insurance, whether private or government run, works off of “other people's money.” You put your money into the system with no guarantee of getting anything back. Some get the payout, where “other people's money” covers what you can't. Others pay into the system without full return of their money.

If the health insurance pool consisted of everyone in this country, then we wouldn't have the great differences in the price of health insurance.

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Scott Wedel 1 month, 3 weeks ago

"As I understand it, Adam Smith's free market required both sides of a transaction to have the same information, ..."

That is a completely wrong assumption. First, the seller may have secret methods of manufacturing and so on that are not going to be shared with buyers. There is even a whole field of economics of the implications of different knowledge among buyers that explains pricing of stock options and other contracts. Likewise, buying without known pricing is well studied part of economics. Short answer is that it is a function of need and reputation (that final price will be viewed by buyer as being fair). The ambiguity of not known price is an opportunity for abuse and thus tends to be regulated by government forcing price disclosure.

Health care is like many markets such as food, housing and gasoline in which it is needed now and cannot be put off until cheaper. And actually, a whole lot of health care is routinely put off such as knee replacements. That is one of the big challenges facing Medicare of people putting off treatments until eligible for Medicare. That is why Obamacare could take money from Medicare and yet leave Medicare in a stronger position by treating issues prior to the person joining Medicare.

Anyway, ability of buyer to choose is what defines a working free market. Whether or not buyer needs to buy some food does not prevent food from being a free market with competitive pricing.

Nor is your explanation of insurance market accurate. A true market for insurance is most definitely using your money to cover your risk. Insurance is based upon the idea that there is risk of catastrophic loss such as someone's ship sinking between NY and England. But that the number of ships that sink per year is relatively low. Thus, ship owners are willing to pay insurance to cover their risk. The insurance groups charge enough to cover their outlays and so charge less for better ships with reputable captains and may refuse to insure others.

The fundamental concept of insurance is that after an underwriter does their work to avoid insuring fraud or incompetence that there is a random chance of loss for which odds and the resulting expense can be calculated to determine the insurance premium.

The basic trouble with health insurance is that too much of needed health care is predictable and not random. So pre existing conditions are not insurable in terms of shared risk because there is not random need to treat. Thus, an insurance company operating as an insurance company is going to refuse to insure some people and have riders to refuse to pay for pre existing conditions in other people.

Thus, the ACA created risk pools and so on where the insurance risks of individuals is no longer allowed to be considered when selling health insurance so that people with pre existing conditions will be covered by insurance. That forces healthy people to pay more.

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Lock McShane 1 month, 3 weeks ago

Scott, so you agree with me that opaque pricing at the ER cannot be free-market since the patient has no knowledge of the prices being charged. Your “secret methods” point is not relevant here; I don't need to know how the MRI machine works, but I need to know how much the MRI costs.

As to food, housing and gasoline, you have many more options than in health care. You can buy ramen instead of lobster; you can find a cheaper place to live, maybe farther away; you can bicycle rather than drive. You rarely have such choices in health care.

As to what you said about insurance, that is why insurance fails in the health care market. It has been shown that regular visits to the doctor reduces costs by treating problems before they become acute, saving much in the long run. It has also been shown that being able to go to the doctor, without complicating and time consuming procedures like dealing with insurance companies, increases routine care which reduces costs. Costs may increase in the short term, which is what the insurance companies saw in the past few years, but in the long run, savings will occur. The insurance companies that dropped out of the market seemed to have been more concerned about short-term profit and loss than long-term viability.

That is why the for-profit health insurance industry is destined to fail. If it was a viable system, then there would be examples of success in other countries. But no other industrialized country has this system and they have better outcomes at half the price.

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Scott Wedel 1 month, 3 weeks ago

Lock,

Most healthcare spending is not on emergency care so there is choice even when there is only one local hospital. People can decide where to get their knee surgery and so on.

Pricing for health care is very often very opaque. Part of that is tricks so that patients pay more in their copayments. The trick (some states taking steps to call it fraud) is that a 20% copay is on the retail list price while the insurance company has negotiated a rate say half of list price. So for the $1,000 list price procedure the patient with a 20% copay pay $200, but the cost to the insurance company is $500 so the insurance company is left paying just $300.

And then Medicare with their set prices per procedure create another whole bunch of market distortions. They will pay thousands for prostrate cancer treated with a high tech PEP beam, but will pay far less for just as effective surgery.

The health insurance model is doomed because healthcare need is not random enough to be insurance for too many patients. Health care as a service makes sense a business model because as a good service it is beneficial to patient health and reduces overall costs if there is good preventative care. But as a model that says there will be $X spending on preventative care for all people and then there is risk of catastrophic care for these previously healthy people. It leaves unresolved as to how to deal with preexisting conditions other that letting them die for what they cannot afford.

As for the "half the price" - that is not the result of health insurance. Other countries subsidize doctor education and training far more so they don't graduate with huge debts and then aren't even that well paid as interns. So they don't have to pay their doctors as much to attract doctors. In the US, becoming a doctor is a high risk high stakes endeavor because those that don't make it have huge debts and even those that make it spend the start of their careers paying off their debts. And then we pay far more for fancy tech that we expect to be in every hospital.

It is true that when there is one pay health system then that payer is much more willing to focus on efficiency. Just look at all of the TV ads for various prescription drugs to see how much money there is to be made by having patients going to doctors to ask for this or that drug. Likewise, the advertising for healthcare promotes all of the wonderful services they offer, not that they are cost effective.

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Martha D Young 1 month, 1 week ago

On Saturday evening my adult granddaughter fell playing soccer, breaking her fibula and tearing tendons in her ankle. She was taken to a local E.R. and sent home. On Monday she contacted a local orthopedic surgeon and got an appointment for Wednesday. She was told that surgery had to be done within 5 days of the injury. This took place in Boise, ID. At YVMC, there's always an orthopedic surgeon on call for the E.R. Fractures and other orthopedic injuries are attended to immediately. We are very fortunate in our small city to have the services of YVMC Emergency.Room staff.

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