Doc­tors leave Den­ver Health

New lead­er­ship cuts sta≠ and in­vests in a com­puter sys­tem.

The Denver Post - - DENVER & THE WEST - By David Olinger

Den­ver Health Med­i­cal Cen­ter has shed top of­fi­cials and doc­tors, in­clud­ing its chiefs of medicine and surgery, un­der the lead­er­ship of a new chief ex­ec­u­tive.

The for­mer city hos­pi­tal, known for pro­vid­ing ex­cel­lent care to the in­di­gent and trauma care for all, also is un­der­tak­ing a big in­vest­ment in a new com­puter sys­tem while staff po­si­tions have been cut else­where.

Arthur Gon­za­lez, who took over the hos­pi­tal’s helm in 2012, said the new Epic com­puter sys­tem is un­der bud­get at $170 mil­lion and is ex­pected to start up in April. He also de­fended the hos­pi­tal’s staffing, which in­cluded a re­duc­tion of 122 full-time nurses in 2013.

The hos­pi­tal has ap­pointed in­terim di­rec­tors to re­place its chiefs of medicine and surgery and hopes to con­clude a na­tion­wide search this year to fill those va­can­cies, he said.

Den­ver Health has “6,500 full­time em­ploy­ees,” he said. “In an or­ga­ni­za­tion of that size, there is a nor­mal course of turnover.”

Bill Sonn, a Colorado health care com­mu­ni­ca­tion con­sul­tant not in­volved with Den­ver Health, said the de­par­ture of top-flight tal­ent from any hos­pi­tal could be a sign of trou­ble.

“For any or­ga­ni­za­tion, turnover like that is a red flag,” he said. “Given the physi­cian short­age, more­over, keep­ing physicians en­gaged is a pri­or­ity for most provider or­ga­ni­za­tions. Hav­ing tal­ent leave of­ten in­di­cates some sort of dys­func­tion in com­mu­ni­ca­tion, com­pen­sa­tion or shared de­ci­sion­mak­ing.”

In in­ter­views, The Den­ver Post learned that at least five hos­pi­tal lead­ers have de­parted since Gon­za­lez ar­rived. He suc­ceeded Dr. Pa­tri­cia Gabow, the long­time hos­pi­tal leader who helped trans­form Den­ver Health from a city hos­pi­tal into a semi-pub­lic en­tity with more fi­nan­cial flex­i­bil­ity.

Dr. Richard Al­bert, chief of medicine, re­tired from the hos­pi­tal but teaches and serves as vice chair for clin­i­cal affairs for the Depart­ment of Medicine on the Univer­sity of Colorado’s An­schutz cam­pus.

Dr. Gre­gory Jurkovich, chief of surgery, and Dr. David Brody, head of man­aged care, both re­signed.

Stephanie Thomas, chief op­er­at­ing of­fi­cer, also re­tired, and Gre­gory Vel­tri, chief in­for­ma­tion and tech­nol­ogy of­fi­cer, de­parted af­ter a dis­agree­ment con­cern­ing the hos­pi­tal’s change of com­puter sys­tems.

Thomas was “highly re­garded” and gave ad­vance no­tice of her re­tire­ment plans, Gon­za­lez said, but he could not dis­cuss the de­par­tures of Jurkovich and Brody. They de­clined to com­ment, and Al­bert did not re­turn mes­sages.

Vel­tri praised Den­ver Health and its doc­tors. “They saved my life two or three times,” he said.

But he ques­tioned the size of the hos­pi­tal’s in­vest­ment in a new com­puter sys­tem, say­ing the costs could to­tal $300 mil­lion, in­clud­ing a $70 mil­lion pay­off to the cur­rent con­trac­tor and a dou­bling of the in­for­ma­tion tech­nol­ogy staff.

He said he warned that the cost could bank­rupt a hos­pi­tal op­er­at­ing on thin fi­nan­cial mar­gins.

“My es­ti­mates weren’t flat­ter­ing,” he said.

Gon­za­lez re­sponded that Vel­tri was “held in good re­gard,” but “he’s se­verely mis­taken.”

He said he could not di­vulge how much it cost the hos­pi­tal to get out of its cur­rent com­puter con­tract, cit­ing a con­fi­den­tial­ity clause.

Den­ver Health records show it chose Epic as an elec­tronic med­i­cal record sys­tem provider partly to share re­sources and re­search with other hospi­tals. Epic now serves about 65 per­cent of hos­pi­tal beds across the Front Range.

The in­vest­ment is vast al­ready. Ac­cord­ing to the hos­pi­tal’s Jan­uary 2015 board min­utes, it com­pleted a tem­po­rary build­ing to house the Epic team and hired “the re­quired 125 per­son staff.” And while Gon­za­lez re­ported record cash col­lec­tions in 2014, he told the board “that much of this cash-on-hand is al­ready spo­ken for with projects such as Epic.”

The hos­pi­tal’s fi­nances have been helped some­what by Med­i­caid ex­pan­sion un­der the Af­ford­able Care Act, which en­ables it to seek re­im­burse­ment for newly qual­i­fied pa­tients.

In Septem­ber, the hos­pi­tal board in­creased Gon­za­lez’ base salary from $760,000 to $800,000, which the hos­pi­tal calls the mid­point for com­pa­ra­ble in­sti­tu­tions. In ad­di­tion, he was paid $180,706 last year for achiev­ing or­ga­ni­za­tional goals in 2014 rang­ing from pa­tient safety to fi­nances.

Gon­za­lez was re­warded at a time when some hos­pi­tal em­ploy­ees were com­plain­ing of staff re­duc­tions, par­tic­u­larly among nurses.

In re­sponse to a records re­quest from The Post, the hos­pi­tal said in Oc­to­ber that four nurses had been laid off since Gon­za­lez was hired, and 71 staff nurses had been “dis­missed/termi- nated” for rea­sons that “are typ­i­cally per­for­mance re­lated.”

Min­utes of the hos­pi­tal’s April 2015 board meet­ing, how­ever, re­fer to “the re­cent staff re­duc­tion of 122 FTE (full-time equiv­a­lent) nurs­ing po­si­tions.”

Gon­za­lez noted that the April re­port found no link be­tween an in­crease in atrisk events, which can be any­thing from in­fec­tions to falls, and the re­duced nurs­ing staff.

A hos­pi­tal spokes­woman said the re­port “was ac­tu­ally a dis­cus­sion about the work­force re­duc­tion in 2013, which was a com­bi­na­tion of leav­ing po­si­tions un­filled, re­as­sign­ing staff and job elim­i­na­tion, and how, two years later, there was not an in­crease in ‘at risk’ events be­cause of this change.”

In 2013, Den­ver Health spent $2 mil­lion for an ef­fi­ciency con­sul­tant named En­vig­o­rate to help in­stall a com­puter-based pro­duc­tiv­ity sys­tem. “This or­ga­ni­za­tion-wide sys­tem drives our abil­ity to align our staffing with our pa­tient census,” the hos­pi­tal said.

Gon­za­lez said the hos­pi­tal achieved “about $32 mil­lion worth of im­prove­ments” in re­turn, in part by right-siz­ing de­part­ments.

“We are just as con­cerned about de­part­ments that are over­staffed as de­part­ments that are un­der­staffed,” he said.

Gon­za­lez also raised eye­brows at the hos­pi­tal by set­ting aside space on cam­pus for his staff band.

But he said it amounts to a 10-foot-square space in a pre­vi­ously va­cant room on cam­pus con­verted to of­fice space, so the band re­hearsal area didn’t cost the hos­pi­tal any­thing.

It’s “an all-vol­un­teer staff band” that re­hearses af­ter hours and per­forms at hos­pi­tal events such as the em­ployee pic­nic, he said.

He plays rhythm gui­tar.

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