Is AVH exchanging beds for bucks? |

Is AVH exchanging beds for bucks?

John Colson

A local doctor claims Aspen Valley Hospital is operating under an “administrative policy that is compromising hospital health care access,” and that a “scam” is being perpetrated on the Medicare system.But hospital CEO David Ressler countered that the doctor’s concerns are misplaced. He said AVH is carefully monitoring the situation to avoid inconveniencing or endangering patients, and that the “scam” allegation is groundless.Dr. Mallory T. Harling, an obstetrician and gynecologist with the All Valley Women’s Care in Aspen, maintains the hospital “has several times compromised patient admissions for needed, nonelective procedures like surgery and obstetrical deliveries” (see Letters to the Editor on page A12).He claims patients have experienced delays in being assigned to in-patient rooms because the hospital has been designated a “Critical Access Hospital” in order to get better reimbursement deals with the federal Medicare health insurance system. At AVH, that meant a reimbursement of an estimated $1 million in 2005.The CAH designation is given only to hospitals with 25 or fewer beds. AVH originally was a 40-bed facility. It would now have a maximum of 32 beds without the CAH limitations, because several in-patient rooms have been converted to other uses. But the hospital’s administration agreed to hold its bed count to 25 in order to gain the designation.Aside from limiting the hospital’s bed count, Harling maintains the designation is being misapplied at AVH.”It’s a scam,” he said, “because the CAH was really intended for impoverished rural hospitals. It’s an inappropriate manipulation of the system.”AVH sought the special designation in 2004, when the administration was trying to pull the facility out of a deepening financial hole that resulted from fiscal mismanagement by a previous administration.”Now that the hospital is financially solvent,” Harling wrote in his letter, “… the hospital administration and board need to be encouraged to rescind the Critical Care designation and look for other alternative cost-saving measures so that we don’t have census restrictions that do truly hinder critical care patient admissions.”Ressler said last week that difficulties like those Harling cited have happened “only two or three times in two years” and were taken care of promptly and without endangering patients.About a month ago, a patient was transferred from the AVH emergency room to an in-patient room at Valley View Hospital in Glenwood Springs because of a lack of beds in Aspen, according to Ressler.And last week, one of Harling’s obstetrics patients needed to be admitted to AVH, and “there were a couple of hours when it was touch and go” as to whether a bed would be available, Ressler said. However, another patient checked out and Harling’s patient was admitted.”She was being cared for the whole time,” Ressler added.The hospital’s chief nurse, Barrie Harms, said that patient told Harms she was not upset with the situation. She added that such complications are “a possibility for any facility” and that the bed-limit issue does not affect the hospital’s emergency room “in any way. Our emergency room is open 24 hours a day.”Conceding that the hospital nears capacity on occasion, Ressler added that overcrowding is “very rare” and that it is “only a potential problem during the season,” when Aspen’s tourist population is at its maximum. On Monday, AVH was “nearing the 25-bed limit,” according to Ressler.Still, Ressler said the hospital’s “average daily census” of patients is around 13 or 14 at most times of the year and the facility has received no formal complaints from patients about the situation,As for Harling’s “scam” allegation, Ressler noted, “I can’t agree with that. We’re small, we’re rural, we meet all the criteria” for the CAH designation.”Why should we leave a million dollars on the table?” he asked. “The board made this decision two years ago, and I think it was the right decision.” But it is one that is regularly reviewed, he added.Lou Ann Wilroy, director of the Colorado Rural Health Center, which is in charge of determining whether hospitals meet the criteria for the federally controlled CAH designation, agreed with Ressler.She said that of the 25 hospitals in Colorado that have CAH designation, Aspen is the only one in a resort area, because “all the other resort hospitals are way too large,” with 50 beds or more. The Aspen facility, she said, met all the criteria for CAH status, including reports on financial eligibility, average daily census figures and an average hospital stay of 96 hours or less per patient.Ressler noted that the hospital is planning an expansion that will boost its capacity “in the neighborhood of 40 beds.””We don’t plan to stay in Critical Access status forever,” he said.John Colson’s e-mail address is

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