State bill stands to ‘crater’ rural health care

Nurses, doctors and administrators rest during a quiet moment in the emergency room last March.

(Editor's note: This is the second of a two-part update on Gunnison Valley Health. The first appeared in the April 6 edition of the Times.)

The state-wide landscape for healthcare going in 2023 is more challenging for rural providers than it was just a year ago, as Gunnison Valley Health executives are looking at slimmer profit margins and trying to solve the years-long issue of employee retention. But as administrators look down the pike at what may be a tough year in cost-recovery, a larger shadow looms at the state level. 

A ‘devastating’ bill in

legislative session

The Colorado legislature is considering House Bill 1215, which would prohibit hospitals from charging facility fees for most outpatient visits. Hospitals charge facility fees to both insurers and patients to cover costs of providing care that are outside of what doctors get paid. The argument for the bill is consumer protection, as facility fees can appear as an unexplained or extraneous add-on to a patient’s final bill. 

But for GVH, this fee is anything but extraneous, said GVH Chief Executive Officer Jason Amrich. It pays for nurses, techs, supplies, facilities and utilities, essentially allowing the service the hospital provides to be "financially viable.”

“It's an absolutely devastating, terrible bill that will crater many health care organizations … It would get rid of our thinking about having a medical office building, and will potentially force us to close services. It would really impact whether or not GVH could be in business,” Amrich said in a Gunnison County Commissioners meeting on March 28.

The Colorado Hospital Association (CHA), a statewide advocacy group representing over 100 hospitals, is working with lobbyists and legislators to try and amend or even kill the bill, as CHA is estimating a $9.8 billion dollar loss in revenue to health care organizations. Most health care margins hovering close to zero, Amrich told the Times, so the removal of facility fees would hit hard.

“We're in that same boat, I mean, we're going to be fighting and scrapping this year to try to get a 2% margin, and this would wipe that off the books,” he said. 

Rural hospitals as close as neighboring Delta County Memorial Hospital (DCMH) are already feeling the strain. DCMH fell into dire straits recently when cash funds dropped dangerously low after repayment of pandemic-era Medicare loans drained the business of available money. After board members learned the hospital was saddled with debt, they brought on a new CEO, tasked with parsing a financial future in an industry caught in a funding bind.

A recent amendment to the bill would exclude certain hospitals, including GVH. But Amrich said the amendment is not enough, and the bill, if passed at all, would create “untenable” ripples across the state’s entire health care system. 

A new building for 

more services 

To improve the patient experience and create more office space, GVH is planning to build a medical offices building to house primary and urgent care providers and visiting specialists. The facility, still in preliminary planning stages, may offer ambulatory services like primary care, an eye doctor, a dentist, physical therapy or even basic radiology services. Staff envision the building as a “hub for all things medical,” so residents can come for anything health care-related in the Gunnison Valley.

Industry trends reflect a continued movement toward ambulatory services, Amrich said, especially with telehealth and in-home care service. The building is meant to help the hospital keep up.  

“We feel that is more important than building more beds for the hospital or more ORs, because that kind of demand is staying where it is and everything else is shifting outside the walls of the hospital,” he said. “If we're not investing in that type of delivery model, then we're potentially falling behind.”

A new building stands to accommodate growth by keeping potential patients in the valley, rather than losing them to adjacent hospitals in Montrose or Salida. Right now, the hospital is limited by office space: there’s simply not enough space for specialists to see patients, Amrich said.

The “if you build it, they will come” strategy has been proven in one department. The hospital hired Dr. Augustine Lee in general, colon and rectal surgery and is already seeing “through the roof” colonoscopy numbers for the first quarter, along with an overall increase in the number of general surgeries. The same story goes for radiology; a full-time employee brought on in 2022 has catalyzed appointment numbers. The hospital will figure out the details of the design, financing and location this year, before formally moving the project forward in 2024. 

“Obviously, our number one goal is to always keep care local and provide access to the community,” Amrich said. “We feel like a new building could do that.”

(Abby Harrison can be contacted at 970.641.1414 or abby@gunnisontimes.com.)