RHCD moves forward with new plan to assist with future of health care

PINEDALE – The Sublette County Rural Health Care District (RHCD) could be on the right path the bring sustainable health care to county residents after recently bringing a trio of entities on board who have a proven track record of success in saving health care for communities very similar to Sublette County.

In a fifth attempt to get the ball rolling on bringing a critical access hospital (CAH) to Sublette County, a community meeting was hosted by Michael Curtis of The Neenan Company and Charles Ervin of Dougherty Mortgage on Tuesday of last week at the Lovatt Room in the Pinedale Library. The pair went over what the next step looks like in achieving CAH designation and how it differs from previous work that has been conducted in previous years in Sublette County that proved unsuccessful.

The overall goal is to have a sustainable, “right size” critical access hospital through successful planning and development with community stakeholders in order to meet the health needs of county residents, according to RHCD Health Care Administrator Malenda Hoelscher.

The solution may not even include constructing a CAH, if data suggests otherwise, Curtis said. He made it clear at the gathering that he has made recommendations to communities in the past to go a different route to obtain sustainable health care.

The pair has experience in bringing 28 CAH’s to small communities and has 35 years of experience specializing in small hospitals.

“They will give a fresh look through a new set of eyes,” Dr. David Kappenman said as he introduced the speakers.

Irvin, who is involved with investment banking and is a partner with the Department of Agriculture, noted that the current health care system in the country is not problematic at all.

“If we talk to one another and care for one another, it will work,” Irvin said. “We don’t have the solution tonight, but together we’re going to create the solution.”

Curtis says the process of coming to a solution will take approximately four months.

“We’re not here to give you the answers,” Curtis said. “We’re here to facilitate the solution that you all are going to help orchestrate.”

The pair went through a few examples of hospitals they’ve worked with in the past to become more sustainable. One was the Rio Grande Hospital in Del Norte, Colo., where a town of 1,600 was unable to keep its local hospital doors open. Through a good deal of work, the hospital went from $3.7 million in gross revenue in 1999 to $25 million in 2016, revitalizing health care for that particular community.

According to Susan Barney of Taliesin Consulting, the hospitals presented at the meeting were more profitable than the average rural critical hospital in the West and Wyoming, in particular, stating she is “cautiously optimistic” with bringing in this particular group to assist the RHCD in getting to a place where health care is sustainable for the future. She says the average margin for critical access hospitals is 1.9 percent in the West and 3.7 percent in Wyoming, while examples presented by Curtis and Irvin showed margins of 5 percent and 7 percent, with a clinic example showing a margin of 3 percent in earnings. If margins in the 5 to 7 percent range could be brought to the RHCD, the district would be sitting in a good position to become sustainable in providing health care.

What it all boils down to is getting the “right size” facility for Sublette County. This notion wasn’t completely taken into consideration when the two clinics were constructed initially, putting the RHCD in the situation it currently is in.

Curtis stated the average United States citizen spends approximately $9,000 a year on health care, equating to approximately $90 million in Sublette County alone with a population estimate of just over 10,000.

“How much of that money is leaving this community,” he asked.

Barney estimated 95 percent of residents seek their care outside of the county at this time. If more residents sought health care in Sublette County, it would greatly increase the amount of revenue being captured within county lines, making the RHCD’s financial situation much more sustainable.

A common trend in small communities, Ervin said, is aging populations, which is a good thing for the reimbursement model that helps CAHs stay afloat financially.

“There might not be that much in-migration of young people, we hope there are,” Ervin said. “But what you do have is the people above 65 increasing in the communities. What does that mean for your hospital? That means your reimbursement is going to be higher.”

He says the CAH still has to make sense to construct, and that the result of their work may be a recommendation to not go the route of a CAH.

“You still have to pay for it and it still has to make sense,” he said. “It’s got to make financial sense, but the government has given you something to stand on… something to build upon. That’s what makes this possible.”

Curtis says one benefit of having good, local health care is that it is less expensive than traveling out of the area to visit a larger hospital. This is due to the familiarity between patients and staff regarding patient and family’s past history, resulting in fewer tests and lab work that needs to be done to diagnose someone’s symptoms.

“That was a strong support to the critical access hospital program,” he said. “If we can find a way to provide a good continuity of care in the community for which the residents live, the cost of care through the Medicare system, the Medicaid system and to the insurers is less.”

Work in Sublette County will begin with a market needs assessment, followed by strategic facility planning. Work will then move to alternative financial forecast modeling before jumping into financing and fundraising. The final piece of the puzzle will be the alignment on vision and outcome, according to the presentation.

Data gathering will take place throughout the month of July, with a stakeholder facilitate strategic facility planning event to take place in August. A recommendation to the RHCD and SJMC is expected to come in September.

“We provide the data about the care that’s being purchased in the community along with the data of the care being currently provided by the current rural health clinics,” Curtis said. “We ask that those of you as community members and users of that care and providers of that care get into small groups and come up with strategies about what you see necessarily be done to capture more care.”

Data will then be put into a financial model and results will be brought back to determine what the best solution for Sublette County will be. Information will be brought back to the community to ask for local guidance in terms of what is the best solution will be.

From that, they come to alignment, meaning for the betterment for the community, aside from personal opinions.

“If we all hold out for what’s best for ourselves, we won’t have what’s best for the community,” Curtis said. “What we strive for is to find that place where you can have alignment so that it’s a win-win for everyone involved in this community.”

The RHCD board went ahead and signed a service agreement with Dougherty Mortgage to move forward with the next step in the process after a similar meeting was held with board members from the RHCD and St. John’s on Wednesday.

The process to come to a final solution as to how to proceed is expected to span a period of four months. The work will be done by three entities, including The Neenan Company, BKD and Dougherty Mortgage. The project is anticipated to cost $105,000, with the RHCD paying up to $50,000 for the project, while SJMC will fund the remainder of the associated expenses.


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