Access to quality healthcare increases in importance when we have children, as our parents get older, and for those of us who are, in fact, getting older.
In Estes Park, knowing that the hospital was only a few minutes away has been a source of comfort for us all.
When the hospital opened in April 1975 Marcus Welby MD was in its sixth season and General Hospital was in its twelfth season on ABC.
People expected their doctors to be personable, available, and pillars of the community. Scientific expertise was less important.
Hospital operating rooms were for a swollen appendix or a fractured leg; hospital emergency rooms were great for cuts and coughs. Beyond that, hospitals were where old people went to die.
The delivery of healthcare has changed so much over the past five decades as to be unrecognizable as the same service.
- Medical technology improves at a rapid pace. For example: As the chief resident in 1977, I read all the EKGs done during the day. Today, the EKG machine itself does that, and does a better job than I did.
- Patients have much more information about their health today, though the internet and hundreds of books on just about every illness.
- Healthcare and insurance costs take a larger part of our budgets than ever before, and businesses and government pay those increased costs as well.
- The doctor was once the most important person in the office. Ask a doctor about that today, and she will tell you it is the insurance coder.
Estes Park Health (EPH) met the community’s needs quite well 50 years ago, and for many years afterward. However, healthcare has changed, and Estes Park Health has not changed with it.
In response to a chronic deficit in revenue, EPH has closed units and reduced services, while retaining services that lose even more money.
In response to the nursing shortage prevalent throughout the country, EPH has filled the void with nurses who work through agencies, making their services far more expensive than staff nurses.
In a desperate attempt to mimic large full-service hospitals, EPH brought in specialists and surgeons—ophthalmology, orthopedic surgery, general surgery—even though the number of procedures they did was inadequate to maintain a well-functioning team with low post-operative complications.
Retaining professional staff is an increasingly complex problem for EPH.Young doctors, nurses and technicians can easily find positions elsewhere where they will have a social life, leisure activities, and places to spend their money.
Those with young families cannot find childcare. A number of experienced clinicians have been dissatisfied for a number of reasons and have left town.
What we have, therefore, is a very good Emergency Department for acute emergencies, a transport service that takes seriously ill patients to excellent full-service facilities less than an hour away, an underutilized outpatient clinic, and an inpatient service that is only appropriate for patients who don’t need inpatient care.
Why is the hospital board and the hospital administration holding so tightly to an anachronistic and costly system of care?
Although the makeup of the Board changes, their attitude has remained the same—we want to be independent, we want to maintain control, we want our community to be able to boast that “We Have a Hospital!”
Logic, financial maturity, and altruism all combine to argue for a different direction for EPH:
- Discontinue the inpatient service. While the hospital boasts 23 beds, according to information provided by EPH to the Estes Valley Voice in July on the inpatient census, on average EPH has fewer than 5 patients in its inpatient service a day. That is simply not a sustainable economic model for maintaining an inpatient service.
- Become a part of a modern, well-run medical care system, such as UC Health, or Banner. In May 2023—17 months ago—the voters of the Park Hospital District authorized the hospital board to “enter into one or more agreements, constituting a multiple fiscal year financial obligation within the meaning of Article X, Section 20(4)(b) of the Colorado Constitution, with one or more nonprofit healthcare providers concerning the ownership, operation, and maintenance of all or any portion of the District’s hospital and other healthcare and related facilities and assets, including the lease or other conveyance from the District of real and personal property, and to pledge all or any portion of the District’s revenues pursuant to such agreement.”
- Utilize their support services, administrative expertise, financial acumen, electronic health record, economies of scale in purchasing, infrastructure, and resources.
- Arrange for specialists (orthopedic surgeons, ophthalmologists, urologists, neurologists, electrophysiologists, oncologists) to come up to Estes twice a month from the larger system to see outpatients at EPH. When tests or procedures are indicated, the patients would go to the larger hospital. Both patients and the larger hospital benefit.
- Engage the services of a telemedicine psychiatry service for the Emergency Department. The Emergency Department doctors have relatively little experience with psychiatric or drug related emergencies.
- Upgrade the equipment and physical facilities in the Emergency Department.
- Reconfigure the inpatient unit as a “23-hour unit”. That is, patients are admitted to the 23-hour unit from the Emergency Department for observation, acute treatment, and sequential testing. For example, a 60-year-old man from Texas arrived yesterday in Estes Park. He decided to climb Long’s Peak with his son. Halfway up, he developed chest pain. Initial tests in the Emergency Department were inconclusive. He was admitted to the 23-hour observation unit.
- Scenario #1: Repeat blood tests and EKGs over the next few hours showed a worsening of myocardial ischemia. He was medicated and transferred to a hospital in Loveland.
- Scenario #2: Repeat blood tests and EKGs over the next few hours showed no change; chest X-ray showed diffuse changes. He was treated for altitude sickness, observed for another four hours, and discharged with instructions.
- Scenario #:3 Repeat blood tests and EKGs over the next few hours were normal, as were chest X-rays. He was advised that adjustment to the altitude takes a while and discharged.
We can still benefit from excellent medical care in Estes Park, however bold changes will be needed.
Terry Rustin is a physician, board-certified in internal medicine and certified in addiction medicine. He graduated from medical school in 1974 and completed his residency in 1977. He is a recognized expert in behavioral medicine and addiction psychiatry.
Dr. Rustin has given the Estes Park Health Board both the rationale and roadmap for the future of the hospital. Many years ago I worked at a 32-bed hospital in Ohio as their community relations director. I remember the pride I saw when equipment was purchased with funds raised by the auxiliary, especially when they were able to open a critical care unit. The hospital was a point of pride for the community and it showed. But I also saw how much money was lost every time a patient was in that CCU. Decades ago that hospital affiliated with a larger system and eventually became what Dr. Rustin envisions for Estes Park. That choice was critical to ensure that much needed community services could continue to be provided. The current board and administration at EPH are prioritizing job security and pride above community need. Their stunning lack of understanding of the current healthcare landscape and how EPH should fit into it is putting lives at risk.
Thank you for this article! I have long thought that EPH should be a high-quality trauma center/emergency room ONLY. It is refreshing to hear from someone from the medical community espouse the same.
Another thing I also believe – if EPH should become ‘part of a modern, well-run medical care system, such as UC Health, or Banner’, I would be all for ending the property tax mill levy we now pay to keep EPH afloat, especially since those taxes were approved by the public when EPH offered a full suite of services, many they have now dropped. They have pulled a ‘bait and switch’ slowly and incrementally over time, and EPH is no longer the institution the voters agreed to support …. perhaps it’s time for another citizen initiated ballot issue to re-visit whether the community still wants to contribute to EPH via our property taxes …
EPH needs to provide the community with high quality time-critical services in its ER. One drawback to outsourcing our medically demanding outpatient and inpatient services to Loveland and/or Longmont is transportation. Ambulance transport costs are currently out of control. In addition, many of our working families only have one vehicle, so getting to and from regional hospitals is a significant challenge. Some of the savings from outsourcing medical care must go towards cost-efficient transport for both patients and their families.
Our community has chosen to provide a medical facility for several reasons- safety( life and limb saving care) which an ER and 23 hr service can usually cover. It does make it more difficult to provide specialty medical services on more than the occasional visit.
Among the services we have lost, OB and long term care provided care we really need here. That’s what really hurts our community…. Losing needed services. We wanted to make living here safer and more convenient; for young families who most often are our service workers – who use our schools, and who often need housing assistance. We seem to recognize those needs and help support them…. But the need for medical care has been largely considered a choice, not a need.
Too expensive. Then there are those whose elderly family need longer term care. That was a break even cost. Instead our family members languish in “facilities” far away…. Visiting them is no longer easy, or frequent, nor in a homey atmosphere where loved ones can be monitored for safer care.
These residents also helped support the hospital when ill, usually chronic illness.
I know I’m harping on issues we have all heard before, but this is why we chose to provide medical care here in Estes Park. For emergencies, to see medical specialists, to have convenient outpatient care. So we don’t have to drive down the hill for so many services, as we seem to be doing increasingly. Especially in bad weather , which is another problem.
Affiliation or selling may be the answer, but I think it’s taking so long because our Board member in charge of accomplishing this, Drew Webb, is trying to create an agreement that preserves as much as possible of our local services. That might mean including our mill levy funds , if we want to keep even the care we now have available. It won’t be a panacea.
The economics of providing care here in Estes Park are in some ways similar to the current electric increase…. A large area, few people equals higher cost. The medical issue is few people, equals high cost services.
We seem to litigate this problem every decade. We accept higher cost services to maintain police, schools, fire prevention.
Why is that? All are services we need to make our community safe and convenient for all .
Medical services are a complex matter. We seem to be in the middle of losing needed services , to balance a budget to make our hospital attractive to a larger entity, hoping they will restore some high quality care. I sure hope Drew can make it happen. If not, we will be back to making our own decisions on what kind of medical care we want to support ourselves….. what we need vs what we want.
Karen Sackett
EPH will never be able to deliver efficient medical care. The equipment, facilities and staff required to deliver medical care comparable to that available 30 miles away cannot be paid for by this small catchment area. Eliminating money-losing services has revealed the depth of the remaining money-losing services.
The only way to balance the EPH budget is for the voters to write a much larger check every year.
Terry A. Rustin, MD
Is it possible for EPH to also partner with SALUD to increase better utilization of resources for both centers !
EPH has been working on the affiliation question for the better part of 2 years. Presently, board member Drew Webb works on it full time. People don’t realize that when it comes to affiliation it takes 2 to tango. EPH needs to be attractive enough financially for UCH or Banner to agree to an acquisition. This means having its house in order and not losing a lot of money each year. Reduction in services such as the nursing home and maternity center, painful as they were, were necessary parts of getting the EPH financial house in order.
Regarding the inpatient beds, I had pneumonia in June and needed to have fulltime care for 2 days as an inpatient at EPH after being admitted through the ER. They could have loaded me into an ambulance and sent me to a hospital in the valley. I much preferred to be cared for here. I received excellent care from the EPH nurses and doctors. Another gentleman was in a room near me after having a severe diabetic reaction. He needed to be observed for 24 hours as an inpatient. There is a real need for local inpatient services at our hospital.
From what I have observed, most of the specialist doctors in the Physicians Clinic are here part-time, maybe 1 day per week or 2 days per month. They have ongoing practices down in the valley. This allows EPH patients to benefit from expert specialists without having to visit their offices in the valley. EPH benefits by not having to maintain these doctors on the EPH full-time staff.
Mr Leavitt,
I am glad the treatment for your pneumonia went well, and that the medical staff was responsive to your needs. The problems with EPH have little to do with the care provided by clinicians. The problems result from systems which prevent them from delivering the most efficient and effective care.
Terry A Rustin, MD
It takes two interested parties to craft a merger or affiliation, but more importantly, the party being acquired or becoming the “lesser” of the two organizations has to be willing to negotiate and understand that the acquiring hospital/system is not going to allow the small hospital board to have the same level of control and oversight as they did when they were an independent hospital. Most larger health systems are more than ready bring smaller community hospitals into their system — even if their margins are razor thin or negative, which is not that uncommon in the current healthcare landscape. The longer-term benefits health systems gain from acquiring small hospitals are far more important to them. My take — the two-year delay is because EPH doesn’t understand what they have to give up in order for this community to have access to the high-quality services we need. And having a bunch of empty inpatient beds but no home health care, hospice, in-home PT etc., is not meeting the needs of this community. Healthcare is changing rapidly. EPH needs to accept that fact and do what’s right for the community.
Negotiations are compromises that occur between two parties when each one has something to offer. What does EPH have to offer UC Health? Relatively little. Therefore, EPH cannot ask for much. EPH would do better in the “negotiation” by emphasizing the UC Health mission statement: “We improve lives. In big ways through learning, healing and discovery. In small, personal ways through human connection. But in all ways, we improve lives.” I would tell UC Health: “Here is an opportunity for you to live by your mission statement.”
Terry A. Rustin, MD
If we were able to design the medical care we need in today’s world for Estes Park, we would probably choose the core services available through Emergency and outpatient services. The Physician staff are what we all think of first- and we have an excellent Emergency trained group. Nursing services are also a core requirement.
Supporting these services requires a laboratory, Radiology, including CT, MRI; Pharmacy, Respiratory therapy, probably 23 hr holding beds too. The ER services also are equipped with OB packs in case of emergent deliveries. Then there are the housekeeping, dietary services, maintenance service. Financial services are a vital supporting service, as is IT.
What have I left out? Something important, I’m sure.
So you see, provision of excellent ER services requires a whole host of supporting services too.
If those services are provided in Estes Park, we also must meet high standards of care as dictated by the State and Accreditation services to be reimbursed for care. This may add some level of inspection and standards .
Providing a high level of care, built around the core service of Emergency care is not a simple endeavor .
A small community “hospital” is no longer what the public has always envisioned…. Lots of beds, medical, surgical, pediatrics , OB . (Even the large hospitals are sending patients home in just a day or two after large surgeries – hip replacements, open heart surgeries, etc.)
So, what is our role in medical care? To provide the core ER services as described above, adding on only those services that can reduce costs of maintaining the core services, i. e. Outpatient lab, outpt radiology,
Outpt services … perhaps outpt surgery, physical therapy. We usually find that providing a Specialty Medical clinic with physicians rotating here from larger communities adds income from labs and Radiology which these specialists need for their patients.. This defrays some of the cost of maintaining services required by the core service… the ER.
That’s pretty much what we have here now. Associating with a large health care system may provide us with some level of added expertise, and small savings in bulk purchasing, may remove our financial services leaving a person to offer basic assistance, Quality review could go to a larger facility. We could also lose Outpt surgery. I’m sure there’s a few other things too.
That’s what I perceive to be our future.
My experience is that of an RN, Director of Nursing , CEO for hospitals small and large.
I hope this is helpful,
Karen Sackett, RN, BSN, MHA