Aspen ‘hospitalist’ cost is ‘money well spent,’ says AVH CEO
The Aspen Times
Aspen CO, Colorado
ASPEN ” Aspen’s hospital will cough up about $185,000 next year to subsidize the work done by Dr. Mike Goralka, who has held the relatively new job of hospitalist for about the past year and a half.
“And that’s money well spent,” Aspen Valley Hospital CEO Dave Ressler said.
He added that with the planned expansion of the hospital, a $100 million project that will take the hospital from its current 25 beds to 39 or 40, it may ultimately made sense to hire one or more additional hospitalists to deal with the increased number of patients.
The job, which was created in 2006 at least partly at the suggestion of the hospital’s medical staff of doctors, was first filled temporarily by Dr. George Fallieras until April 2007.
Goralka, 41, came here from Nevada and took over after Fallieras.
He lives in a condo in Snowmass Village with his wife and children, and said, “We’re here for the long run. We love it here, our kids love the schools.”
The idea of hiring a hospitalist, which is a growing trend in health care nationally, was to have a doctor working strictly at the hospital, without a separate office elsewhere in town or in the valley, who would be able to take some of the pressure off the medical staff.
By working directly with patients at the hospital, Goralka frees up the doctors to focus on the patients coming into their offices for appointments, and is more available to hospital patients than a doctor whose office is in Aspen, Basalt or even farther away.
In addition, Goralka said, he is right at hand if an orthopedic surgeon needs a “consult” or discussion about a patient’s history and condition prior to surgery, whereas a doctor with office hours might be anywhere from 20 minutes to an hour away. Goralka is on hand if an emergency patient arrives by ambulance and needs to be admitted right away.
“Mike is a rare commodity,” noted Ressler, explaining that Goralka is certified in pediatric care as well as internal medicine, which requires additional training and certification over and above that of doctors who specialize in one field.
But, Ressler emphasized, Goralka’s presence does not translate into added costs to a patient, because a patient being billed for a visit from the hospitalist would be billed the same amount for a visit from their “primary care physician,” or PCP.
Goralka is on duty five days a week and on call Wednesdays and every other weekend. When he’s not there ” weeknights, weekends, vacations ” nearly a dozen doctors have been certified to fill in for him, rotating in either pediatrics or internal medicine. The doctors on rotation are paid a stipend by the hospital for their work, which is included in the hospital’s subsidy calculations.
Both Goralka and Ressler said that generally, only larger hospitals have full-time hospitalists on staff, because a large number of patients can be more easily justified in terms of both need and cost.
Dr. Steve Ayers, chief of medical staff at AVH, said of the program, “It’s been incredible.” He said that there are about 35 PCPs in active practice with hospital privileges at AVH, along with a couple of emergency room physicians, whose lives have been vastly eased by Goralka’s presence.
“They [hospitalists] don’t have a practice to worry about,” said Ayers. “This is their practice.”
Ayers recalled that when the medical staff first ran the numbers and came up with the subsidy estimates, “It economically didn’t look like it made sense.” He said that typically, a hospital should have an average of 13 in-patients year-round to justify having a hospitalist on staff, “and we just didn’t have those numbers.”
But after talking the matter over with the board, Ayers continued, “we all said, ‘this will be fantastic for patient care, so let’s do it anyway.’ And as far as good will and patient care … it’s worth whatever the hospital is spending.”
“It’s about a $500,000 program,” said the hospital’s chief financial officer, Terry Collins, explaining that roughly $315,000 is projected to be covered by patient charges in 2009.
“The $185,000,” he said, “is the money the hospital has to pay for the program.”
Overall, Collins said, the hospital pays out approximately $19.3 million annually in salaries, and about $4 million for employee benefits.
One benefit of the program, said Ayers, is that given the fact that technological advances have speeded up the pace of medical care in the hospital setting, having a doctor on hand at all times has helped accelerate tests and treatment and shorten the length of stay for many patients.
“You can get something done in two days that used to take a week,” Ayers said.
Dr. Barry Mink, a member of the hospital’s board of directors, agreed the hospitalist has been “a fantastic addition … taking the pressure off the primary care docs.” He noted that close communication between Goralka and doctors means that, after a patient is released, follow-ups and check-ups can be seamless and painless.
And in some cases, he added, doctors who have outside offices will still do the admission procedures “on some old-time patients they know very well that that need their attention.”
Goralka said there is no sign of tension between his role and the community of doctors, as has sometimes occurred in other locales, where doctors might resent an intrusion into long-established relationships or worry that the presence of a hospitalist might cut into the established doctor’s income.
Saying the local medical community is “pretty cohesive,” Goralka said, “I think more and more they’ve been willing to turn their patients over to me” while they are in the hospital.
Although the number of hospitalists nationwide has been growing for a decade or so, some area hospitals have not gone the same route as AVH.
At the 78-bed Valley View Hospital in Glenwood Springs, for example, the hospital’s medical staff takes turns rotating into and out of the role.
But at St. Mary’s Hospital in Grand Junction, a 350-bed facility, there are six hospitalists on the staff, which eliminated the need for a fill-in rotation staffed by outside doctors, although the hospital’s public relations department said Grand Junction doctors still make rounds in the hospital.
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