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On HSS and a new home

Aspen Times writer

Editor’s note: This is the fourth in a series of four questions answered by candidates for the Aspen Valley Hospital board of directors. Two seats on the five-member board will be chosen by AVH district voters on Tuesday, May 4.

Today’s question: Two of the biggest moves by the current AVH board have been to pursue an affiliation with the Hospital for Special Surgery in New York and to look at a new site for the hospital. Please offer your thoughts on these actions by the board.

Name: Barry Mink, M.D.

The HSS concept has moved along inappropriately in my opinion. An affiliation such as this not only impacts the orthopedists, but also impacts strongly on other physician and nursing specialties at the hospital.

Patients that need joint replacement commonly have other medical problems that need to be addressed by primary care physicians, anesthesia, physical therapists, patient care unit and operating room nurses, lab demands, surgeons, cardiologists, etc. These people need to contribute to the decision-making process and they haven’t.

Problems with transporting patients to altitude for surgery and dedicating a special operating room need to be considered by medical staff for deliberation without excluding staff input. This matter has not been brought before the surgical service, the medical staff executive committee, or the general medical staff for input. This way of doing business at AVH would not have happened in previous years.

Another criticism that I have is that to affiliate with a much bigger hospital sells your soul a bit to the bigger guy. We are a small community hospital and we don’t need to have our destiny affected by the internal and external problems that HSS has or will have.

Finally, I understand that a large sum of money is needed to be paid by AVH in consulting fees to HSS, which would be inappropriate in our current financial situation. This whole topic needs to be scrutinized more than it has.

Name: Greg Balko, M.D.

HSS is a potential source of increasing revenues for our facility. All discussions regarding this merger have been behind closed doors, so I cannot remark on the validity of the proposal.

I do strongly feel that orthopedics is one of our best opportunities to expand our revenues. My perspective is that we need to foster our relationship with our orthopedists in a way to make it a win-win relationship for both parties. The hospital should provide the needed physical plant and help in marketing their services, while the orthopedists should perform all diagnostic and operative procedures at the hospital. The verdict is still out on whether we should do this through a partnership with HSS, someone else, or on our own.

Any consideration of a new facility at this time would be irresponsible. We must first correct our cash flow and accounts receivable issues before we renovate or build a new facility.

The issue in my mind is not about whether to build a new facility; but rather, where will it be located? It is imperative that the hospital remains an integral part of the community. When the time comes, a new facility should be the way to go.

Our current facility was originally designed for taking care of inpatients and not for the volume we now see in outpatient visits. A new facility will be more technologically advanced, cheaper to maintain, and it will probably be easier to raise contributions toward its construction.

Name: Bob D’Alessio

I was one of two board members who went to HSS in New York City to conduct initial discussions on the subject of their having a relationship with AVH. I felt then, and I still feel, that HSS needs to bring patients to AVH in order to have value to us.

We already have fine orthopedic surgeons who deal with normal and very complex injuries that occur in the valley and especially on the mountains. HSS needs to introduce other surgeries to AVH that go beyond what we do now, not replicate them.

HSS may need to supply their trained physicians or expand our local capabilities to deal with these cases.

This potential affiliation is still in the discussion stage. There are a myriad of issues to be resolved between AVH, HSS, and a key practice here at AVH, Orthopaedic Associates, before we have a viable situation.

Regarding the possibility of a new hospital, I am opposed to considering it until a few things fall into place. First, we need to be financially healthy before we think about any significant construction aside from the plans that deal with keeping our facility in full conformance with the national medical reviewers standards. What we don’t need is to spend monies on a structure while we are trying to come out of a financial crisis.

Second, the district voters need to be shown an analysis of the options to either build a new facility or modify the current facility. It should be conducted by a qualified and totally independent engineering firm that specializes in hospitals. The study must include projected details on costs for engineering, land, site preparation, construction, outfitting, moving equipment, and all other pertinent costs. The selected engineering firm needs to compare these costs to the costs for remodel and addition to the existing structure and all other costs associated with that comparative project.

Armed with this information and costs associated with land sale and/or exchange of the current hospital site, only then should we make a decision. But currently we are far from any decision other than caring for our current site as needed.

Name: Richard F. Jacobs, M.D., MBA

The efforts by the present board to look and think “outside the box” with respect to new business relationships and future physical plant needs are to be applauded. It takes courage to even suggest change in Aspen.

A fundamental part of a vital and dynamic organization is the creation of what I refer to as a “fertile field.” That is a place where new ideas can be freely presented, planted, allowed to germinate and prosper. Aspen is, traditionally and culturally, extremely change resistant. In order to address the HSS relationship and AVH physical plant, these conflicting values must be reconciled.

The name recognition of the Steadman clinic and the leakage of patients from Aspen to Vail undermine AVH’s ability to “build business.” A relationship with HSS is desirable: it would build business. The more frequently we do something the better we get at doing it. Read that as: Increased volume is a good thing.

Operationally, the HSS business can ease the pressure to “flex” the staff down during the “offseasons.” An HSS relationship would allow AVH to achieve additional expertise and potentially improve staff morale.

Ultimately, sustainable, win-win business relationships that provide high-quality cost-effective care are the goal we are all striving to achieve. Negotiated fairly for all concerned, given what I know thus far, I am highly in favor of an HSS relationship.

The physical plant needs of AVH must be addressed in the same objective business-like manner. The needs and desires of the community and the services provided by AVH have changed radically since the current facility was completed 30 years ago. It should not be a shock that the present physical plant has critical deficiencies.

It is the responsibility of the board and management to obtain a realistic, unbiased, and accurate projection of future AVH needs. A responsible board must consider and present all options for meeting those needs.

In Aspen, the ultimate decision on what will actually get done resides with the community. Any recommendation to change the hospital will fail unless the community clearly understands and strongly supports the plan.


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