Aspen hospital employees get raises, patients’ bills will be higher

An across-the-board wage increase of 6% takes effect Jan. 1 for employees at Aspen Valley Hospital, which plans to tap local nursing talent in response to an industry-wide staffing shortage.

Nearly 25 full-time jobs will be added to the hospital’s payroll in 2023, and five full-time positions will be eliminated, including three from medical records and billing because of the October rollout of the Epic, an electronic health-records-keeping system. Patients also take notice: The hospital plans a 6% increase in all of its fees and costs identified in its “chargemaster.”

The hospital’s 2023 budget, unanimously approved by the board of directors Monday, plans for a roster of 471 full-time staff.

Local challenges and industry trends, however, made the budget forecast especially daunting, said hospital CEO David Ressler during the presentation to the board.

“We are faced with such strong headwinds this year … based on our internal needs, as well as the forces externally — inflation and the historic staffing crisis in our industry,” he said.

Those same challenges were touched on by hospital CFO Ginette Sebenaler in her written remarks to a budget summary provided to the board.

“We are also continuing to experience significant wage inflation and are responding as necessary to maintain our competitive position in the employment market place,” Sebenaler wrote. “Hospital nurses and techs are still leaving their employment to take positions as agency personnel making multiple times more per hour than they make as an employee of the hospital, or they are chasing signing bonuses and higher wages. We are also experiencing intense local competition and wage inflation for our non-licensed and entry level staff.”

Sebenaler said the staff-wide wage increase, which doesn’t include the hospital’s employed physicians, “will be the highest increase in at least the past 25 years.”

Wage increases aren’t the only approach the 25-bed public hospital is taking to fill the void.

Chief Operating Officer Elaine Gerson said the hospital plans to hire nurses who graduate in May from Colorado Mountain College’s nursing programs as part of a newly formed nurse-residency program partnership with CMC. CMC offers an associate’s degree in nursing that sets up graduates for an RN license, and it has a four-year program for a bachelor’s of science in nursing degree.

The CMC grads will get started at Aspen Valley Hospital in August, Gerson said, working in the obstetrics/gynecology and progressive care units, as well as the emergency room and hospital’s urgent-care clinics in Basalt and Snowmass Village.

“Some of the students that are in nursing school are already working for us as patient-care techs, so they’re familiar with our hospital, how we do things,” she said. “We’re very excited to grow our own and have them work at AVH, hopefully for a very long time.”

The hospital has $23.6 million budgeted for capital improvements next year, which includes $3 million to renovate the old ambulance barn into employee housing and $725,000 on upgrades to other employee residences.

Ressler said, “We are going to continue to invest in our staff, who are the reason we’re successful.”

Other hospitals in the state cannot say that, like the eight-bed St. Vincent Health in Leadville, which avoided closing only thanks to outside financial help to pay its employees.

“If you’ve seen the news. You’ve seen that they are not able to make payroll and are struggling day by day to stay open, so these are very very tough times that we’re facing,” said Ressler. “And, of course, we have our own internal dynamics as well.”

The budget projects the hospital will have $113 million coming in and $115.8 million going out in 2023.

“Our goal was to get to a cash break-even, which would actually be pretty stupendous,” Ressler said, “and we got very close.”

The hospital also is budgeting for the creation of five new full-time jobs at the Steadman Clinic, which opened in April at the Willits in Basalt. The clinic is a partnership among Steadman Clinic/Steadman Philippon Research Institute, Aspen Valley Hospital, Vail Health, and Orthopedic Care Partners, a Florida-based private-equity firm and holding company for Steadman.

The surgery center is part of the 65,000-square-foot Steadman Clinic downvalley. This year’s budget planned for up to a 70% drop in the hospital’s in-house surgical revenues with the clinic’s opening, but the surgery center did not become fully operational until recently. The hospital’s unplanned revenue from orthopedic surgeries for 2022 added another layer of complexity in the 2023 budgeting process, creating “an undesirable dynamic with our Medicare reimbursement,” according to Sebenaler.

That’s because Medicare reimburses Aspen Valley on a cost-to-charge basis and the hospital has $23.6 million more in charges this year compared to 2021, while this year’s expenses are $12.5 million lower than 2021.

That should be offset in 2023, according to Sebenaler, who noted “this cost-to-charge basis has dropped yet again” but the hospital has projected “that most of the commercial surgeries will migrate to the surgery center (Steadman Clinic), which translates to a much higher Medicare share of our revenues for next year.”

rcarroll@aspentimes.com