SUBLETTE COUNTY – Following the third and final 90-minute interview for a managing partner, Sublette County Rural Hospital Board members stood from their chairs inside Pinedale Public Library’s Lovatt Room and exhaled.

It’s going to be a tough decision, they told each other.

Throughout the week, starting on Jan. 12 and finishing Jan 15 in the afternoon, the board members and concerned citizens peppered guests from area hospitals with questions to determine which one would partner with the board to get the new critical access hospital and assisted living facility off the ground. The interviews were open to the public.

Five different hospitals were contacted for proposals. Only Star Valley Health, in a partnership with South Lincoln Hospital District, St. John’s Health in Jackson and Eastern Idaho Regional Medical Center, as part of the HCA Healthcare network, returned proposals. Evanston Regional Hospital and Memorial Hospital of Sweetwater County did not return proposals.

At the Jan. 13 board meeting, board member Jamison Ziegler specified the purpose for a managing partner. He explained how Star Valley Health has the funds to add a cardiologist on staff but lacks the client base. A partnership with Sublette County could provide Star Valley Health the amount of clients to rationalize adding a cardiologist. 

Star Valley Health/South Lincoln Hospital District

Familiarity and partnership were two central themes to the pitch SVH board members made. Mike Hunsaker, Star Valley Health COO, said a partnership would provide a great opportunity for supporting each other.

Part of the SVH proposal included a group purchasing organization to keep costs down, offering accreditation and assisting the staff in Sublette County on hiring a CEO and CFO for the Rural Hospital District.

Hunsaker said the top priority in their partnership would be building the hospital and staffing it. Hunsaker also said the hospital could maintain its existing relationship with St. John’s, if desired.

Under this proposal, SVH would collect 1 percent of profits once the Sublette County Rural Hospital District became cash-flow positive.

Hunsaker said SVH generated $75 million gross income last year, a stark contrast to the “payday-to-payday” operation when it still operated in partnership with Intermountain Health Care.

Among the list of references presented to the public was one of State Sen. Dan Dockstader, who SVH officials said has been a supporter of the hospital.

On its list of accomplishments, SVH has been recognized as a Top 100 critical access hospital five times since 2012 and a Top 20 critical access hospital twice in the same timeframe. 

St. John’s Health

Maintaining and building off the preexisting relationship between counties was something St. John’s Health CEO Paul Beaupre, MD, emphasized. He said the staff in Jackson values the working relationship and, should St. John’s be selected as managing partner, those in Jackson would “do everything to ensure” success in Sublette County.

Beaupre said there are three cornerstones he would hope the new facility in Sublette County would establish: solid schools, good health care and an appropriate way to care for the elderly.

Two significant questions were raised regarding St. John’s hits from Medicare – one regarding re-admission rates and the other on infections. Beaupre explained the hospital formed a committee when it became aware of gastrointestinal infections, which dealt with the issue. That was in 2017 when that cluster of infections occurred. Regarding re-admission rates, Beaupre defended the hospital’s decision because those are measured by wealth of zip code. So St. John’s Health is measured with hospitals in Beverly Hills, Calif., Manhattan, N.Y., and Chicago’s Miracle Mile. Unlike those other locations, St. John’s is isolated from other medical facilities. Beaupre explained the hospital errs on conservatism and re-admits patients because of that proximity to other healthcare facilities.

St. John’s officials said it would charge a flat fee of $5,000 for initial assessments and then cost over 18 months would be an estimated $300,000. Beaupre also said in effort to ensure Sublette County staff is supported, St. John’s officials would spend an estimated 20 percent of their time focused on helping the Sublette County facilities.

Beaupre also addressed his upcoming exit from the CEO role at St. John’s. He assured the public that his replacement, Will Wagner from Montana, shares his philosophy for patient care above all and enthusiasm for the possible partnership. 

Eastern Idaho Regional Medical Center

Possibly the most compelling case for EIRMC was made by a Texas duo. Janice Simons, president and CEO of Medina Regional Hospital, and Tim Hardt, chairman on the hospital’s board of directors, talked about how a partnership with HCA Healthcare has changed the fortunes of their hospital.

They were brought on because Medina Regional Hospital, located in Hondo, Texas, provides similar care and is in a similar-sized community as Sublette County.

Hardt said the hospital needed to borrow money to pay staff on payroll. Had they not received help, they’d have been at risk of losing local ownership.

HCA Healthcare reached out to form a managing partnership, which turned hospital operations around and, in turn, regained community support for the hospital, Hardt said. He also said the hospital has been able to pay off USDA loans ahead of schedule and now boasts more than $30 million in the bank.

“We wouldn’t be here today without this management agreement,” Hardt said.

Simons said maintained independence was a concern when entering the agreement but hasn’t become one since. She said the people of Hondo see the hospital as 100 percent a community hospital.

Partnership in the HCA Healthcare network has also given them access to equipment at a lower cost and to more health care workers.

EIRMC’s proposal would include a $125,000 start fee per year, which includes evaluation, planning and architects. The hospital’s CEO and CFO would be employees of HCA but the Sublette County Rural Hospital District Board has ultimate hiring power with those positions. The CEO salary would be a passed-through cost onto the district.

Jeff Sollis, CEO of EIRMC, said the project is personal to him because the hospital has given to Green River Foundation and Fishing For The Fight. In addition to charity work, he said the hospital maintains a philosophy of not charging more than $2,500 for an operation. EIRMC has financial counselors to arrange payment plans, and even to write-off operation costs when applicable.