St. Anthony Summit breaks relationship with Vail-Summit Orthopedics for emergency trauma surgeons
August 20, 2018
Depending on whom you ask, it's either a sound business decision that will benefit the community, or a brusque brush-off of a trusted local medical practice with decades of experience. St. Anthony Summit Medical Center, Summit County's only major hospital, has contracted Denver-based Panorama Orthopedics & Spine Center to provide emergency trauma surgery in its emergency room beginning Oct. 1.
Panorama's contracted emergency on-call surgeons would replace surgeons from Vail-Summit Orthopedics, some of whom who have been performing emergency trauma surgery for Summit patients for more than 30 years. Dr. Peter Janes, one of VSO's original surgeons who has operated in Vail and Summit for decades, said that the move will have a "substantial" impact on their business given how many orthopedic surgeries are performed in St Anthony's ER during ski season.
"It's going to hurt, but we'll still be here," he said. Janes said that VSO was blindsided by the move, was not given a chance to mend the relationship and is bewildered by why St. Anthony did not take local input into the decision, given how it is the region's only major hospital that all locals will rely on for emergencies.
Dr. Terrell Joseph, another surgeon practicing at VSO, said he saw the move as retaliation for VSO not signing a contract committing surgeons exclusively to St. Anthony Summit. VSO is also the primary provider of its nine orthopedic surgeons to neighboring Vail Health.
VSO believes there was an underhanded insult on top of injury, as Panorama's new practice will be called "Summit Orthopedics at Panorama Orthopedics & Spine Center," which can be considered an aping of "Vail-Summit Orthopedics."
Dr. Marshall Denkinger, interim CEO of St. Anthony Summit, which is owned by Centennial-based Centura Health, strongly disputes the notion that the move was retaliatory. Denkinger said the move was made for a variety of reasons important to St. Anthony's mission to serve the community. The most important appears to be Panorama's willingness to accept Medicaid and other insurance options, where VSO has not shown willingness to accept those provider rates.
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While neither St. Anthony nor its surgeons will ever refuse to treat patients due to lack of insurance or ability to pay, there is a real possibility that the more vulnerable among us can face medical bankruptcy if the surgeon treating them isn't covered.
There is also the fact that Summit residents pay among the highest health insurance premiums in the country, and this deal with Centura-aligned Panorama, which is one of the largest orthopedic groups in the country, can be seen as the kind of shrewd consumer-focused decisions that will bring down costs while not diminishing quality of care for emergency trauma. In a previous Summit Daily article, it was noted that Summit residents pay far higher orthopedic surgery costs than Denver-based physicians.
Denkinger and Panorama CEO Eric Worthan also object to the "corporates from Denver muscling into the High Country" narrative that has been implied, pointing out that VSO's surgeons live mainly in Eagle, while Panorama's contracted surgeons would live exclusively in Summit County. In its press release, Panorama emphasizes that its surgeons will be available "in all weather conditions," with a clear implication that it may be a problem getting surgeons from Eagle when the Vail Pass inevitably shuts down many times during the winter.
Janes strongly disputes the accusation of being unable to care for trauma patients due to weather, saying they've never had problems handling calls.
Dr. Don Parsons, a respected, retired local surgeon who sits on St. Anthony Summit Medical's board of directors that voted for the move, said that he was troubled by how VSO was treated given their long relationship with the community.
"I'm sure the hospital has done what they think is best," Parsons said. "But let me just say, Vail-Summit Orthopedics have been in this county for 30 years and they've provided excellent trauma care. If you have that valuable resource available, why not continue to support it and take advantage of it?"
Parsons pointed out that it was in large part due to the work of VSO's surgeons that St. Anthony Summit is considered one of the best orthopedic trauma hospitals in the country. Parsons also expressed dismay that VSO's expertise won't be the default in St. Anthony's emergency room.
Panorama's first two contracted surgeons, Dr. Rick Bowles and Dr. Aaron Black, are both board-certified and have just completed their fellowships, which means they've completed their six years of training to be trauma surgeons.
Being board-certified means that Bowles and Black are fully qualified to stabilize and care for ER patients, but Parsons said there is no disputing the difference in experience between them and some of VSO's surgeons.
"These physicians are unknown to the community and we don't know about their capability as they haven't had much experience," Parsons said. "Orthopedic trauma work is very intensive business during the ski season, and it would be in my view hard to replace the quality and the experience of the people who have been doing this a long time."
Worthan wants to put those concerns to rest.
"To reassure the community, we've recruited docs who are well-trained at quality institutions, and I have no concern that they are not going to be able to provide quality orthopedic care to the people in Summit County," Worthan said. "If there are people who have had relationships with Vail-Summit, they have the choice of asking for those doctors."
Bowles served his fellowship at the Cleveland Clinic while Black served his fellowship at the Taos Orthopedic Institute.
For patients who, for whatever reason, feel strongly about the surgeon who will treat them if they have to go to the E.R., there is a compromise available. Centura Health's Patient Bill of Rights states that patients may "[c]hange physician(s) and/or any member of the healthcare team, if the facility is able to accommodate your request."
In other words, patients have the right to specifically ask for a VSO surgeon to take care of their emergency trauma, or have a pre-written declaration or surrogate available to express that, and the hospital will do its best to accommodate the request. Denkinger said that patients need to have a pre-existing relationship with the surgeon to request them.
Worthan said that while Panorama understands if people have preferences, Summit residents should not be concerned about the quality of care they receive.
Janes and VSO are encouraging patients to ask for one of their surgeons when they're in the emergency room and need surgery, if such a request is feasible.
Denkinger said that St. Anthony Summit always does its best to comply with requests for specific physicians or surgeons, but the former ER doctor wants patients to know that if the requested surgeon is not immediately available, or if time is of so much essence that such a request would endanger care, St. Anthony will do what it needs to do to save a person's life. When the blood pressure is dropping and an arm, leg or life needs to be saved, that means having the contracted on-call trauma surgeon do the work they are fully trained to do.