HRRMC CEO defends closure of clinic

by Ken Leisher

Heart of the Rockies Regional Medical Center recently notified patients of HRRMC Internal Medicine that the hospital’s Internal Medicine clinic would be closing at the end of March 2013.

The decision to close the clinic portion of HRRMC Internal Medicine has not been an easy or a quick one. We have been very fortunate to have the expertise of excellent internal medicine physicians in our community over the past several years both for our patients and as a resource for our local physicians, who can consult with our internists on complex care issues. Maintaining this resource in our community has been, and will continue to be, a priority of HRRMC.

With the retirement of Dr. John Ellis at the end of this year, and Dr. Laura Donigan’s plans to relocate to Denver at the end of August 2013, the hospital was faced with the prospect of recruiting new physicians to the practice. Internists have traditionally practiced in both the hospital and outpatient settings, but over the past decade, there has been a growing trend for hospitals to hire internists to work solely in the hospital. As a result, fewer and fewer internists want to work in a traditional practice like HRRMC Internal Medicine. Instead, they choose the hospitalist role, the clinic setting or to further their training in a sub-specialty, such as cardiology.

In addition to the recruitment challenges, the hospital’s administrative team also considered the financial viability of a traditional internal medicine practice. When Intermountain Internal Medicine decided to close its doors in 2005, HRRMC hired Dr. Paul Ammatelli and Dr. Susan Blakely to continue the practice as an HRRMC clinic. Over the years, there have been a number of providers at the clinic, but the one constant has been that the clinic has continued to lose a great deal of money.

We do realize that we are a Hospital District and, as such, have a fiduciary duty to the taxpayers of the district. Certainly, the decision to provide services is not based solely on the ability to realize a positive bottom line. HRRMC has provided certain services to our community, such as childbirth services, at a loss for years. We continue to provide this vital service, keeping in mind that every decision is a balance of community needs, our ability to maintain the service and its impact on the long-term viability of the hospital.

Looking to the future and the need to create a sustainable model for internal medicine in our valley, the administrative team and hospital board determined it was most important to have an internist based in the hospital, focused on treating complex hospital patients while retaining the position as a resource for our local physician community. Dr. Donigan will be working as a hospitalist at HRRMC from April through August. The hospital is currently recruiting for a hospitalist to begin after her departure.

The hospitalist will be available to follow hospitalized patients who do not have a local primary care provider and to follow inpatients admitted after surgery. The hospitalist would also continue to serve as a valuable resource for local family medicine physicians to consult.

We know that change can be difficult and to ease the transition to a new primary care provider, the hospital supplied all Internal Medicine patients with information about the four family medicine practices in our valley and how to request the release of their medical records to their new physician. We have complete confidence that our local family physicians will continue to provide the Internal Medicine patients with high quality care.

With the addition of a hospitalist, HRRMC will be able to continue offering internal medicine locally but in a new form. We hope the community will understand that this was a difficult decision but one made to ensure the long-term viability of internal medicine in the Salida Hospital District.

Ken Leisher is the president and CEO of Heart of the Rockies Regional Medical Center.

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3 Responses to “HRRMC CEO defends closure of clinic”

  1. Fred Rollo

    In reading the current statement from the hospitals CEO, it is apparent that their reasons for closing the clinic have EVOLVED!
    Leisher's first statement on this site on Nov.27th, indicated that the clinic was closing because the current Dr's were leaving.
    Now the reason given is because the clinic is hemorrhaging money! I think it is important to remember that Leisher told me in a phone conversation on Nov.26th, that the hospital would have "stuck with the clinic" if the Dr's were not leaving.
    Leisher also says that the hospital's "fiduciary duty to the tax payers" demands they take this action. He further stated
    "the one constant "(over the past 10 years)" .....has been the clinic has continued to lose money" However, the hospital reported
    over a THREE MILLION DOLLAR PROFIT last year!
    So, no attempt has been made to replace the Dr's that are leaving, the CEO suddenly feels the overwhelming need to exert his fiduciary duty ( after TEN YEARS of losing money) and a very profitable Orthopedic Surgeon will take over the space once occupied
    by Internal Medicine, and the "decision was not easy"
    The only group for which this decision "was not easy" are the 1300 patients who will now crowd the schedules of the two remaining primary care providers! If you think that because you are not a patient of Internal Medicine,you will not be affected, think again! Waiting rooms of the other two providers will be more crowded,and they may have less time to spend with each patient.
    This does not have to happen. There are possible compromises. Perhaps there could be co-occupancy of the Orthopedic practice and Internal Medicine. If the Hospital DID a search, they might find an Internal Medicine Specialist that would want to come to this beautiful valley. Many things are possible when people TRY.
    First though, the people of this community must let their voices be heard. Call the hospital at 530-2231 and let Ken Leisher know you OPPOSE THIS DECISION. Write a short letter to the editor of the Mountain Mail. Speak up, or let your silence validate the hospitals decision!
    Fred Rollo Poncha Springs

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  2. Jay Moore

    Fred,

    Neither you nor I have a clue as to the internals poilitics of the hospital medical staff, nursing staff, or the board. So, we, as outsiders, have no idea why this paritcular decision was made. One of the recently elected board members made it quite clear that a profitable hospital was his most important agenda item. This is done by procedural specialities, surgery, dermatology, not by any form of primary care, which do the daily care of people. So, perhaps profit is/was the driver, but I don't know.

    Since there is an incipient shortage of primariy care people, how do you want the hospital to solve the problem?? Complaining does not solve the problem, as the shortage of primary care people is real.

    Jay, speaking as a retired, burned out, Geritrician, Internest whose persional Physician (moderately older than I am) is now retiring.

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  3. Fred Rollo

    My propose is not to complain, but to get the hospital to explore alternatives, which by Ken Leisher's comments to me on the phone on Nov. 26th , it was clear they had not done. No effort was even made to replace the doctors at Internal Medicine. So despite Leisher's claims about the unavailability of Doctors willing to do both Clinic and Hospital practices, he does not know if there are any willing to do that.
    Secondly, No other options were explored, such as to have co-occupancy of the Orthopedic practice with the Internal Medicine practice.
    I think there might be room for both in that clinic space. That would fulfill the need for more revenue and provide the primary care capability the community needs.
    Your earlier post on the shrinking pool of primary care providers and the age of the current doctors serving the community ,is all the more reason for the hospital to try to search for, and bring in new blood.
    I agree that complaining for the sake of complaint is pointless. But for the hospital to meet the news of the current doctors leaving Internal Medicine with the response of just shut it down with no exploration of replacement, shows a lack of desire to be bothered by it, at the least.
    This is not the first time that there has been turnover in the doctors at the clinic. It is the first time the hospital has made no active effort to do something about it.
    Fred Rollo 12-4-2012

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