Valley down to one facility for health-care indigent
When Aspen Valley Hospital and other regional hospitals closed their indigent care programs, some say it left a gap in the valley for people without medical insurance or Medicaid. In late 2003, AVH closed the Aspen-Basalt Care Clinic, a move that clinic co-founder Lisa Robbiano said was disastrous for the medically indigent. “It’s a huge problem,” she said. Robbiano believes AVH turned a “blind eye” to the indigent in the valley and as a result is getting a bad reputation. “They’re ignoring the working poor and that’s who they need to serve,” she said.The Aspen-Basalt Care Clinic used to serve about 500 patients a year. There are more than 4,000 medically indigent people a year in the valley, according to Aspen Valley Hospital statistics from 2004.The clinic’s closure left just one oasis for indigent care in the valley: Mountain Family Health Center in Glenwood Springs.Mountain Family Health Center is the only federally funded Colorado Indigent Care Program center in the Roaring Fork Valley. The Colorado Indigent Care Program gives discounts to people in need.When the Aspen-Basalt Care Clinic closed, patients were directed to Mountain Family Health Center, which charges patients on a sliding scale, depending on income. Although the health center will see a patient without charge, if a patient needs a referral for treatment from a specialist – for cancer, for instance – it’s often difficult to find free treatment, let alone specialists who have an open time slot.Each doctor at Mountain Family Health Center sees about 30 patients per day, up almost 25 percent from last year. “We got eleven new clients just last Friday,” noted Janice Y. Caro, enrollment specialist at the center. The clinic sees people described as the “working poor” who travel from Aspen, Vail, Grand Junction and points in between. Many patients have seasonal jobs that offer no health insurance. Sixty percent are Latino. The patient load increased when Mountain Family Health Center added a pharmaceutical program, which can offer a three-month prescription for $10, and Healthy Beginnings, a program for pregnant women.Robbiano admires Mountain Family Health Center but thinks it can’t handle the number of indigent people in the valley.Robbiano said many indigent people don’t use Mountain Family Health Center because “it’s absolutely impossible to get an appointment unless you schedule three months ahead. Mountain Family does a wonderful job, but there are not enough hours or staff. Plus, not everyone can get down to Glenwood.”Furthermore, Robbiano thinks people do not use the health center “because they can’t help the chronically poor.”But Dr. Chris Tonozzi of Mountain Family Health Center refuted that statement.”We’ve still got room for new patients. In the last six months we’ve hired a physician and family nurse practitioner. We believe our staffing is adequate.” Robbiano said many indigent patients go to Alpine Medical Group in Basalt, where she works as a family nurse practitioner with her husband, Dr. Glenn Kotz. “Chronically ill patients come to our office pleading for discounts,” she said.She said 25 percent of the office’s patients are indigent.”We try to help them out; we’re providing a community service without reimbursement.”Tonozzi said Mountain Family Health Center is able to care for chronic illness care. “Right now we’re involved in federal efforts to streamline that care – for instance, diabetes and depression. But we care for all chronic diseases. We don’t have the specialists within our facility, but we do have access to refer out to specialists. In some cases it’s on a sliding scale.”Whether there’s room for improvement or not, Mountain Family Health Center is the only Colorado Indigent Care Program option in the valley.Caro, of Mountain Family, believes the CICP program, which was dropped in Grand Junction and the Rifle Grand River Hospital (which now has a sliding-scale program), should not be taken for granted. “The program is awesome, and our physicians are as good or better than other doctors in the valley.”Dave Ressler, administrator and CEO of AVH, agreed with Caro. “I think Mountain Family plays a very important role in the community.” AVH plans to stay the course with the Mountain Family Health Center, Ressler said. “We don’t intend to make any changes” regarding the contract with Mountain Family. “There’s no reason to revisit the funding issue. Mountain Family provides an excellent service and it is very much needed.”Tonozzi confirmed AVH’s ongoing contributions but said, “We can always use more funding so we can do more care, but financially we’re on good footing.”Caro doesn’t want to imagine the valley without CICP clinics like Mountain Family Health Center.”It would be really bad. There would be a huge impact. We’re not open on the weekends or at nights. The patients have to go somewhere and the hospitals can’t turn them away. I know the hospitals and doctors don’t get much money from [the CICP program], but they’ll still have to pay one way or another” without CICP. Dr. Bill Mitchell of Aspen Valley Pediatrics sympathizes with those on Medicaid and CICP but said it’s hard on his case load as well as financially. “It [the Medicaid program] costs me money; I’m hemorrhaging,” he said. Robbiano thinks the answer lies within the community. “When we started our clinic in 1992, AVH provided a very small percentage of help; we got most of our funding from private donors, thrift shops, nonprofits and other organizations. We’d go knocking door to door and churches, asking for money, and we’d get it,” she said. “It’s a different day and age, but the problems have magnified since then.”People stop me in the grocery store, pleading for help,” Robbiano said. “There’s nothing in the world I want to do more. But we need more than Doctor Kotz and myself.”The bottom line, Robbiano said, is patients are not being cared for, but there is still hope. “I believe people still want to help out,” Robbiano said. “But there needs to be a community effort.”
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