The Telluride Hospital District now has a roadmap for its expansion over the next five years, in the form of the 49-page Strategic Assessment embarked upon six months ago by Stroudwater Associates.

The Maine-based firm is a national health care consultancy "with deep experience in rural health care delivery," says Stroudwater Chariman and CEO Marc E. Voyvodich, and has worked with facilities "in more than 30 states" in just the last year.

"There were no surprises" Telluride Medical Center Director Gary Hughes says of the Stroudwater report that boardmembers of both the Telluride Hospital District and the Telluride Capital Fund received in late March.

But Telluride Hospital District boardmembers were surprised to hear about the report's public debut at last week's Intergovernmental Meeting with its open invitation to anyone with a stake in the future of the Telluride region – and specifically to government representatives of the towns of Mountain Village and Telluride and San Miguel County as well as organizers now planning for three much-needed community-oriented facilities (a new school, a new rec center and an expanded medical/health services center).

Former Telluride Hospital District boardmember Rick Houck, M.D., now representing the Telluride Medical Capital Fund, cited the Stroudwater report by way of suggesting that the level of health care in the Telluride region is inadequate.

Alphabet Soup

Acronyms for medical/health service organizations in Telluride are a confusing alphabet soup – there's THD (Telluride Hospital District, TMC (Telluride Medical Center) and TMCF (Telluride Medical Capital Fund).

THD oversees operation of TMC, whereas TMCF is a nonprofit board, under the aegis of TF, or the Telluride Foundation, with roughly half-a-million dollars in its coffers thanks to its annual $500-a-plate Operation F.E.A.S.T. dinner parties held from 2003-2005.

Opinion is divided regarding precisely what TMCF's capital expenditures should be, as evidenced by last year's discord between THD and TMCF, when TMC, desperate to replace its aging X-ray machine, had to wage a campaign to get $10,000 from TMCF to help do so.

TMCF – which has in its coffers roughly the same amount of cash ($500,000) TMC would need to get back into the black – did ultimately pick up the tab for the X-ray machine, but only after lengthy discussion about major versus major capital expenditures, with TMCF seeming to lean toward a physical plant in the form of a 50,000 square foot hospital (with an anticipated $15 million price tag) and perhaps an adjoining medical campus that, Operation F.E.A.S.T. organizers, hope will be the Telluride region's next step in medical facilities.

The Stroudwater report, which gives top marks to the Telluride Medical Center at the outset "in terms of location, quality of emergency and primary care and quality of providers," is the result of a thorough investigation into the historic, sociological and economic history of the Telluride region and its 28-year-old medical center.

But it is a "baby step," Hughes emphasizes, on the long road to addressing the appropriate "centralized location for the hospital district," while at the same time taking into account "access to the airport for evacuation" and prioritizing what services should be offered, and in which order.

In the course of conducting the study, Stroudwater representatives first conducted a "drive-time analysis" to distinguish between the region's "primary service area" (the combined areas of Lawson Hill, Aldasoro, the Ski Ranches and the towns of Telluride and the Mountain Village) and its "second service area" (the West End of San Miguel County).

Stroudwater representatives then met, "maybe half-a-dozen times," says Voyvodich, with a carefully selected Telluride Medical Economic Assessment Advisory Committee, comprised of three TMC staff members (Peter Hackett, M.D., Becky Padilla, L.N. and Gary Hughes, executive director), as well as Bill Grun, acting board president of the Telluride Hospital District, mayors Davis Fansler (Mountain Village) and John Pryor (Telluride), County Commissioner Elaine Fischer, TMCF member Rick Houck, M.D. and David Homer, M.D., a local private practitioner) in the course of analyzing everything, Hughes says, from "our hospital utilization rates" to "tax receipts and flight arrivals."

Appropriately enough, the Stroudwater report kicks off with a description of the Telluride Medical Center's abrupt separation from Montrose Memorial Hospital on Jan. 1, 2003, at the stroke of midnight – an event still referred to, by staff and boardmembers, as "the divorce" between TMC and MMH, which had managed TMC as an ancillary rural health center for a decade.

The Stroudwater report defines as its goal "to develop a long-term strategic direction for the Telluride Medical Center (TMC), coupled with a concrete business and financial plan detailing specific directions and next steps for effectively pursuing the vision" of top-flight health care in Telluride that is presently served by a level five "rural" health facility divided in two, into family and emergency medical practices.

'The Divorce'

"Following TMC's termination of its management contract with Montrose Memorial Hospital in 2003," the report explains, "TMC was in a position of needing to re-establish an operating, financial and management infrastructure from the ground up. Part of the tactical response by the board was to bring in an interim contract management capacity, and to contract out for billing services."

Explaining itself as a step in the process "of developing a future for TMC" that began with "the completion of a needs assessment by the Telluride Foundation in the spring of 2004," the Stroudwater report describes just a few of that previous study's findings, including the good news that "TMC was rated highest in terms of location, quality of emergency and primary care and quality of providers." A quick summary of TMC's limitations then follows, finding room for improvement in everything from "hours of operation" to "range of services available" to time spent by patients "waiting to see a provider and transparency of billing of payment information," and the fact that 60 percent "of consumers reported leaving the area for specialty services and 38 percent …for primary care of outpatient surgery services."

For the informed reader, the foundation report held few surprises. Nor does the Stroudwater report, which Hughes sums up as "putting numbers to some of the ideas floating around" regarding what should be part of the Telluride region's medical/health care future.

Two particular points of interest: The report's contention that "the majority of consumers (72 percent) are supportive of using tax dollars to support TMC and 66 percent were supportive of additional tax assessments to offer more services at TMC," and that services TMC regulars would like to eventually see include "pediatric services, orthopedic services, behavioral health services, birthing, cardiology and ambulatory surgery." Another interesting observation is that a rise in tax dollars and regional enplanements leads to a commensurate rise in use of the Telluride Medical Center.

The fact that no Telluride Hospital District boardmembers were invited to last week's Intergovernmental Meeting clearly rankles, as comments made by at least two boardmembers at a board meeting on Tuesday would suggest.

"We are a rural medical center," said longtime boardmember Alexandra Dujardin, a bit tartly "and we are rated very highly."

THD Acting Board President Bill Grun indicated similar dismay by calling for discussion as to how the board could help to "explain" the Stroudwater report "to the community."

"I am so proud," Voyvodich said Thursday, of the Telluride Hospital District board, and how "they are getting out in front of" plans for the future, which is just what "leadership must try to do."

THD boardmembers were not pleased, Hughes confirms, nor was Stroudwater CEO Voyvodich, to read after the fact that the Stroudwater report made its public debut amidst verbal implications that the Telluridge region's medical/health care future is in jeopardy.

Hughes chalks up the fact that no THD boardmembers were present at the Stroudwater report's debut to THD's "unusual position" of being unaffiliated with the Telluride Foundation-managed TMCF board. But with TMCF funds earmarked for facilities over equipment, and definitely not operation and management, some observers charge that TMCF's one and only goal – to build a $15 million, 50,000 square-foot hospital and possible medical services campus – is inappropriate as the Telluride Medical Center travels along its hard-won return to financial stability in the wake of the 2003 Montrose Memorial Hospital departure.

All parties involved agree with the Stroudwater report's contention that the Telluride Medical Center "should acknowledge that its existing facility, which is leased for $1/year from the Idarado Mining Co., is inadequate to meet the peak volumes that it currently experiences," and that "making major investments in a facility that is not owned and is poorly designed and sited to support future growth would represent a poor business decision for TMC."

As to the report's variety of scenarios for future, ranging from suggesting that the medical center could "consider seeking federal Critical Access Hospital designation" to open up new avenues of revenues as an early step in the expansion process; a new "platform for negotiating with all commercial players" is roughly outlined, along with suggestions for new services and equipment purchases aimed at improving "economic viability" that range from adding MRI services to ambulatory surgery to rehabilitation services. The report refers to relatively new developments in the medical/health care field ranging from "medical tourism," described by Hughes as offering everything from cosmetic to ambulatory surgery and rehabilitation to "mental health services" (think Betty Ford Clinic) at a resort to telemedicine, presumably for educational purposes.

With an eye to addressing any confusion that may have arisen in the past weeks, the Telluride Hospital District is holding an open-to-the-public meeting today, 8 a.m.-12:30 p.m. in the Telluride Fire Station's third-floor conference room. Everything from challenges facing the board in the next five years to the changing role of the THD board to augmenting board skills will be discussed.

Also on the table: A discussion of the "strengths and weaknesses" of the Stroudwater report, and just what should be the two boards' and one Medical Center's "next steps."