Aspen Valley Hospital’s new orthopedic service squeezes out physical therapists |

Aspen Valley Hospital’s new orthopedic service squeezes out physical therapists

Rick Carroll/The Aspen Times

Aspen Valley Hospital’s recent establishment of an on-site bone and joint clinic has touched off frustration among private physical therapists who no longer can continue their decadeslong working relationship with a group of orthopedic physicians.

OrthoAspen opened in January following months of negotiations between the hospital and physicians from Aspen Orthopaedic Associates, a 58-year-old private practice that disbanded last year.

OrthoAspen is owned and operated by Aspen Valley Hospital, which recently absorbed a group of doctors from Aspen Orthopaedic Associates — Drs. Ann Golden, Tom Pevny, Mark Purnell and Leelee von Stade. It also has four orthopedic surgeons and three other doctors expected to join later this year.

Aspen Orthopaedic Associates opened a clinic on the second floor of the hospital’s new wing in 2012 following 55 years on Main Street. Previously, Aspen Orthopaedic Associates’ physicians had credentials to work at the hospital.

Now that they are under the hospital’s employ, changes have come with the new arrangement, including the hospital’s refusal to allow private physical therapists to make what are called “clinical rounds” at OrthoAspen. The hospital now relies on its in-house physical therapists to provide the service, which the private therapists did free of charge.

Physical therapists from both Aspen Sports Medicine and The Aspen Club were shooed away from OrthoAspen on separate instances last month, those involved said.

Both physical therapists were making their clinical rounds that consisted of “brace fitting, instructions in stretching, basic home exercises, improve doctor/therapist communications, be advocates for the patients, and improve overall patient care and rehabilitation. This elevated care offered to the patients is on a volunteer basis and is complimentary to the patients and the orthopedic doctors,” according to a letter that appears in the commentary section of today’s Aspen Times. The letter was signed by both Aspen Sports Medicine and The Aspen Club.

One of the therapists, Stan Cheo, who owns Aspen Sports Medicine, recently told the Times that concerns had been festering in the physical-therapist community about the hospital’s new orthopedic service. Cheo brought his concerns to hospital officials last year before OrthoAspen was formed, he said.

“We knew the writing was on the wall,” Cheo said. “Our concern is you can’t have this model of everything being under one roof, with all of the referrals being internal, and expect the quality of care we have always been able to offer people.”

Cheo said the pro bono service was offered in part to help boost the referral business for Aspen Sports Medicine. Under terms of the Stark Law, doctors can’t refer Medicare and Medicaid patients to a facility in which the physician has a financial stake; however, Cheo said Aspen Valley Hospital’s in-house physical therapists now have an advantage for referrals because they have a direct relationship with OrthoAspen patients.

When Cheo showed up at OrthoAspen last month, he said he was told to leave.

“I was told by the head of the hospital’s physical therapy department that they were going to staff all of the clinical rounds with in-house PT staff and we were no longer needed,” he said.

The Aspen Club’s physical therapist, who also was told to leave, declined to comment for this story. The person confirmed that the hospital said the therapist’s services were no longer needed or allowed. Other physical therapists did not return phone messages seeking comment.

B.J. Williams, also a physical therapist at Aspen Sports Medicine, said the hospital is basing its new model on national trends that are driven by profit motives.

“Everything is getting eaten up by the hospital to keep it all under one roof,” she said. “This is a small community, period. And the model doesn’t necessarily work here. It’s not in the patients’ best interest to have everything under one roof.”

Hospitals have been hiring an increasing number of physicians over the years. The American Hospital Association reported that between 2000 and 2010, hospitals saw the number of their employed physicians grow by 34 percent.

“There are a number of reasons hospitals want to employ physicians,” The Atlantic magazine reported May 27, 2014. “A major aim is to funnel patients to the hospitals’ facilities. By law, it is illegal for hospitals to offer physicians inducements to refer patients to their facilities unless the physicians are hospital employees.”

Aspen hospital officials said patient care is their chief priority with the new arrangement.

The hospital’s chief medical officer, Eric Stahl, who also is a retired orthopedic surgeon, said now that the hospital employs its orthopedic doctors, private physical therapists cannot directly work with them. Previously with Aspen Orthopaedic Associates, its physicians weren’t hospital employees, meaning the private physical therapists could work with them.

“These therapists are excellent therapists, and I know them firsthand,” Stahl said. “I think there was some miscommunication, from my understanding, the fact that they should have been advised that with the new ownership, the conditions were going to be different.”

“We can’t let anybody that wants to come in to see and treat the patients do that under the umbrella of the hospital,” Stahl said, explaining that physical therapists who don’t have credentials to work at the hospital can potentially expose the medical facility to liabilities.

Cheo, however, said Aspen Sports Medicine is fully insured. Since August 1993, Cheo also has licensed been with the Colorado Department of Regulatory Agencies, whose website shows there are 22 physical therapists with active licenses in Aspen.

Stahl said the hospital will continue to refer patients to outside physical therapists, but it is ultimately the patients’ choice to make.

Cheo said referrals are what keeps Aspen Sports Medicine in business. Losing the connection with Aspen Valley Hospital won’t help his business’s cause, he said.

“We’re a small business, and we’ve been doing this for a long time,” he said. “Our main referral service is word-of-mouth; that’s how we stay afloat. And the referrals from the local orthopedics was a huge part of our business.”

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