Future of Hot Springs County Memorial Hospital discussed

Chairman of the Hot Springs County Memorial Hospital Board, Bill Williams, along with other board members, doctors and members of the community had a lengthy discussion with the Hot Springs County Commissioners on Tuesday regarding the future of the hospital.

Williams told the commissioners his board has been working diligently over the past year to find a solution to the failure of the proposed hospital district in hopes of saving the hospital and the quality care given to the county's residents.

To that end, the board formed a committee that has spent time talking openly with people in town regarding all sides of the issue, from why they did or didn't vote for the hospital district to what suggestions they would have for the board going forward.

The board has talked with other small hospitals to garner their ideas and even checked into creating an affiliation with other hospitals to create more of a regional hospital association of sorts.

An Accountable Care Organization, a group of hospitals banded together, sounds good for patients, and Williams said in some ways, it would be, but the bottom line is that an association like that eventually moves the hospital one step closer to a "one payer plan", one where a single company owns a number of smaller facilities.

"We've spent a great deal of time talking about this option," Williams said. "We have to kind of compare the regulations of a hospital to the regulations of a bank. We would all be members of another organization, not stand-alone entities.

"Banks have consultants and other member banks to lean on for advice and information."

While that may sound like a good idea, in the long run, it means one company is in charge of everyone, like little cookie-cutter hospitals, and the independence of quality care for the community is lost in the shuffle.

The Wyoming State Legislature defeated a bill to expand Medicare in the state, leaving the hospitals in the lurch when it comes to reimbursement costs.

"Costs have grown exponentially," Williams said, "yet Medicare reimbursements are just one-percent over costs. How can any business remain in business with just one-percent over cost? The legislature's idea is to 'kick the can down the road until it's someone else's problem.' They're certainly not going to bail the small hospitals out for unpaid medical care."

Williams admitted the hospital has taken a lot of criticism over the past year, from not being big enough or diverse enough, to the board being jaded.

However, Williams pointed out, the board is more diverse than ever, filled with younger members from all corners of the community who are fully engaged in what goes on at the hospital.

Without the hospital, Williams said we're poised to lose a lot as a community including jobs, families and other businesses.

"Our physical plant (the hospital) is nearly 60 years old," he said. "It's deteriorating to the point where we wonder every day what is going to break next that may compromise patient safety or patient care.

"We can't expect any help from anywhere else to fix this thing. We, as a community, need to decide if we want health care in this community or lose the whole thing."

Proposal

The board’s proposal is four-fold.

First, they would like a grant from the county to update their master facility plan. Next, they would like to see a one-cent special purpose tax put into place to cover the cost of remodeling, repurposing or replacing the current facility.

Their third proposal is the passage of a hospital district to help offset the costs of actually running the hospital, and finally, building on their current property, whether that is just adding on to the facility or something more.

The one-cent special purpose tax would be something the county would have to vote on. It would be for a specific amount, and once that amount was raised, would cease to exist.

The hospital district would add approximately $45 per year to the taxes of each home owner, slightly more to those who own land within the county. This, too, would have to be voted on by residents of the county, but would be in perpetuity.

The doctor’s perspective

Dr. Jason Weyer and Dr. Travis Bomengen spoke at length regarding the hospital and the experiences they’ve had before coming to Hot Springs County Memorial Hospital.

“My work with Banner Health (an association) was not a good experience,” Weyer said. “I was heavily recruited by Worland, who you know is owned by Banner.

“I came to Thermopolis instead because I’m getting to do the kind of medicine I like. The rural medicine. Frontier medicine. I was impressed that you had an MRI and ultra-sound.

“Medicine is rapidly changing and with it, the rules are changing, too. Tiny hospitals are being shut down. That’s a fearful thing for this county. We have to make a move of some sort because we just can’t go on the way we are now.

“One wing of the hospital, the patient care side, has no suction. That’s a safety thing. That’s not a simple fix, its a huge issue. My concern is providing care and I want to provide that top notch care, but if we don’t have what we need, I can’t do that.

“I’m not willing to provide lesser care because we don’t have the proper tools. This hospital has made great strides to get good, quality doctors in here and we’re bringing in patients from all over.”

Commission chairman Brad Basse said the commissioners had recently talked to Banner Health and they had indicated they’d be happy to build a $15 million hospital here.

“The problem is,” Basse said, “then it's their hospital. You talk about delivering babies and CAT scans, but if we let Banner in here do you see us becoming a ‘band aid’ station with a 32 mile trip elsewhere?”

“I think letting Banner build here, and keep in mind they are for profit, everything would be shoveled to Worland,” Weyer said. “I think we would be a ‘band aid’ station and it would change the way we practice.”

Bomengen agreed.

“Riverton’s hospital has been all but gutted because of Banner,” Bomengen said. “Everything is being sent to Lander. I could see the same thing happening here.

“We want to do the same level of care we do now, but I think it would be a greatly reduced level of care if they came in.

“Red Rock wouldn’t be here. We love the variety of things we get to handle here, but I’m not interested unless there is a guarantee the level of care would be the same.”

Burning questions

“How many taxes can we stand,” Carl Dockery asked. “Some people have a lot of money, that wouldn’t be me, but I don’t understand why we need more taxes. We’ve already voted on this once and it got defeated.

“If we don’t have the district, is the hospital just going to go away? If it's managed right, it should be fine. It looks more like poor management to me.”

Paul Ward, had a few more reservations.

“I’m not against taxes,” he said. “My big thing is they never had a plan that I saw. It was like they didn’t have a clear plan because they kept bouncing around. No one could decide what they were going to do.

“I think a lot of people want to know exactly what they’re voting for. They want to see a plan.

“Granted, they’re going to need money to upgrade the master plan, and maybe that’s where we start. Propose a budget, propose an idea. I think that would be a help to others in the community, too.”

Hospital board member Breez Daniels said she thought there was an awful lot of misunderstanding the last time around.

“I hope people would be more engaged this time,” she said. “I heard it would be too expensive for our community, but I think the board has really thought about what we need to have for a top quality facility without it being too grand for our community.

“It will be a somewhat different master plan than what we submitted previously. We’re not going out to purchase property, we’re going to build right where we already are. People like where it is and we took that into consideration.”

Some were afraid building a new facility like the last proposal would cause us to lose our critical access designation. Concerns were raised that the facility would have to be 35 miles from the Worland hospital in order to maintain that designation. However, Williams assured those at the meeting that as long as the building is done where they currently are, nothing changes, we remain a critical access facility.

Local resident Joe Casciato felt the hospital has proven to be non-sustainable.

“We really need to think this one through before jumping on a hospital district,” he said. “Maybe we need to accept a lesser quality of service. We have a non-sustainable model. They’re asking the taxpayers to throw money at it.

“I don’t want them to leave, but maybe we need to have a lower level of service. Maybe we have more healthcare than we need here.”

Harry Hughes had concerns that none of these ideas or plans had been done in a public setting.

“If I heard correctly, they’ve talked with other businesses and healthcare providers. This is a public hospital but I haven’t seen anything along the lines of a thorough analysis.

“The Worland expansion isn’t using public funds. Banner is doing it. There are all kinds of examples of healthcare delivery models available that aren’t using public funds.

“I’m opposed to anything until the business models are thoroughly vetted and relased to the public.”

Dee Hillberry agreed with Hughes, saying, “I’ve been opposed to establishing a permanent district all along. I think it's been a lack of management problem more than anything else.

“It’s obvious the model we have now is working as well as we’d like it to. I think a special purpose tax is probably appropriate for a rehab or something along those lines, maybe borrow some money to go along with it, but I think a district is premature until we’ve looked at every avenue possible.

“I suggest we sit down and talk with Banner. There may be a middle ground. What about St. Vincent’s or others? I think its irresponsible not to look at all the places we can first.”

Williams assured Hillberry the board has been aware of Accountable Care Organizations for years.

“This board is appointed by the commissioners to over see the hospital,” Williams said. “If those discussions hadn’t come up, we’d be remiss in our duty.

“If we were to ever reach an accord with an Accountable Care Organization, to affiliate with them, we can’t just say ‘we’re doing this’, it would have to come before the commissioners for a vote. That’s just the way its done.

“We haven’t gone under the table for negotiations with anyone. Before anything goes too far it has to come here, to the commissioners.”

When asked, Williams said it would take approximately a year to have a concrete plan that the community could actually look at, including conceptual drawings. During that year, the hospital board would like to have a series of public meetings to get the community’s input as to what they would like to see included in the plan.