Management candidates make extended bids

SUBLETTE COUNTY – Three prospective companies that submitted proposals to join the Sublette County Hospital District made their final bids in six public question-and-answer sessions last week.

Each company emphasized its role as a guiding partner to help the hospital district take the first steps toward building a proposed critical access hospital and expanding health-care services. The discussions are available on the hospital district’s YouTube page.

Eastern Idaho Regional Medical Center

The EIRMC and HCA team emphasized its vast resources and diverse experience they can provide as a large national corporation.

Jeff Sollis, CEO at EIRMC, stressed the medical center’s 11-year relationship with the clinics in Sublette County. Across the state and nation, critical access hospitals are closing, yet EIRMC and HCA believe in the potential for a CAH in Sublette County. Sollis stressed the importance in finding a management partner to “navigate the challenges.”

HCA has access to resources and experience that the other bidders lack. HCA manages 185 hospitals in the U.S. and United Kingdom, including eight critical access hospitals, some serving similar demographics to Sublette County.

The other bidders do not have a comparable track record in managing CAHs, Sollis said.

HCA’s vast network provides buying power to purchase items in bulk at low rates for its facilities, including high-cost items like CT scans and pharmaceuticals.

HCA established an enormous library of knowledge with unmatched intellectual capital, including providers in every medical specialty that Sublette County can connect to. The company provides continuing education for staff and providers and a range of telemedicine opportunities.

HCA maintains an in-house auditing department with higher standards than the Centers for Medicare and Medicaid Services.

Financial teams at HCA are experts in maximizing revenue from Medicare and Medicaid.

“You could leave millions on the table if you don’t know what you’re doing financially,” said Sollis.

EIRMC’s role is to provide tertiary care – trauma care that requires sophisticated equipment and specialists. The Sublette County Hospital District would focus on secondary care, including specialists and surgery and primary care.

EIRMC does not intend to take those patients away from Sublette County.

EIRMC can provide an “outside and objective check and balance system” on Sublette County’s relationships with facilities across the region, Sollis said.

Rep. Albert Sommers raised concern about large medical corporations buying hospitals and asked if HCA is a good fit for a small community.

Sollis replied that HCA “promotes and allows independence” at each facility, including the ability for hospital districts to choose their own management teams with varying degrees of consultation with HCA.

Kyle Brostrom, HCA vice president for strategy and business development, said HCA “stays in the background” to provide help when needed, but ultimately, “it’s your hospital.”

Pinedale Mayor Matt Murdock expressed concern about bringing jobs to Sublette County and using local contractors. Sollis replied that hospital districts make those decisions, with HCA in a hands-on hands-off position. EIRMC uses local contractors and tradesmen 95 percent of the time, he added.

Janice Simons, the CEO of Medina Healthcare System near San Antonio, Texas, entered into a management partnership agreement with Methodist Healthcare, a subsidiary of HCA. Medina is governed by an elected hospital board and operates a CAH and six assisted living facilities.

Simons said HCA respects Medina’s autonomy and acts as a “big brother” or “big sister” – “When you need them, they’re there,” Simons said.

HCA rescued Medina from near-bankruptcy, Simons explained. Medina’s CAH created 130 well-paying jobs in the community, Simons said. Medina’s long-term care facilities retain community members that would otherwise go to San Antonio.

Star Valley Health

Executives from Star Valley Health (SVH) discussed similarities between the critical access hospital in Afton and the proposed facility in Sublette County, emphasizing their company’s autonomy and connections to the local community.

Daniel Ordyna, SVH’s CEO, described Star Valley and Sublette County as rural, like-minded communities with similar values.

“We are the only CAH that is trying to partner with you,” said Daniel Ordyna, SVH’s CEO. “We have an intimate understanding of your experience. We have insights (the other bidders) don’t have and a unique way of delivering medicine in rural areas.”

Mike Hunsaker, SVH chief operating officer, explained that he was a member of the hospital board in Afton when construction began on its critical access hospital in 2002. Star Valley is a template to help guide Sublette County through the process of obtaining USDA funding, merging the Sublette County Rural Health Care District and Sublette Center and searching for a qualified, seasoned management team.

Star Valley’s CAH is a self-sustaining facility that earns 98.5 percent of revenue from operations and services, while the remaining 1.5 percent comes from taxpayers – a smaller amount than many CAHs, Ordyna stated.

Hunsaker claimed that as a critical access hospital, SVH had unique knowledge on maximizing Medicare/Medicaid reimbursement that EIRMC lacked because they were a tertiary hospital.

Initially, SVH partnered with Intermountain Healthcare out of Salt Lake City but ended the relationship when the community demanded more autonomy over health care, Hunsakder explained. Intermountain frequently transferred patients out of Star Valley to its own facilities.

“There was a point in time when the community needed more opportunities to care for patients here,” Hunsaker said. He emphasized becoming a real hospital rather than a “transfer facility.”

Ordyna said the ultimate goal for Sublette County was to become an independent entity in charge of its own destiny in an interdependent relationship with SVH rather than a dependent one.

SVH offers telemedicine options and has agreements with Western Wyoming Community College, Star Valley High School and Weber State University for further education and to recruit future providers.

In response to several questions, Ordyna clarified that Star Valley Health does not intend to manage a CAH in Sublette County as a 501(c)(3) organization at this time.

St. John’s Health

Michelle Kren, administrative director, discussed the long relationship that exists between the SCRHCD and St. John’s Health dating back several years. In 2015, the two agencies joined an affiliation agreement to share leadership, services and visiting specialists along with hospice care and access to group purchasing, she added.

The agreement also provides opportunities for staff and providers in Sublette County to shadow their counterparts at St. John’s and improve their skill sets, Michelle Kren said.

Dr. Paul Beaupre, former CEO at St. John’s, stressed the importance of keeping quality health care in Wyoming and leaving health-care decisions up to Wyomingites. St. John’s was the organization capable of providing a local partnership with the ability to strengthen health care in both Teton and Sublette counties.

Beaupre spoke to St. John’s independence and the organization’s close link to policymakers and bureaucrats in state agencies.

St. John’s is focused on keeping people well, a skill set that large hospitals can sometimes lack, Beaupre said. St. John’s strives to establish low-cost care, including services like Mental Health Jackson Hole that provides free behavioral health to more than 500 people, Beaupre explained. Few other organizations are willing to reach out to their community in similar ways, he added.

St. John’s receives cost-based reimbursement from Medicare and Medicaid for part of its revenue, but the company also has experience working in close relationships with large insurance providers and helping patients that are underinsured or uninsured, said John Kren, CFO. St. John’s is uniquely able to look at the whole financial picture, he added.

William Wagnon, current CEO, stated that St. John’s is completely committed to partnering with the hospital district whether or not the hospital district chooses St. John’s as its managing partner.

Beaupre envisioned a CAH in Sublette County hiring 200 to 300 employees that would add revenue to local businesses. The partnership would also allow both St. John’s and a CAH in Sublette County to form a stronger organization to attract providers and specialists.

John Kren emphasized that St. John’s tries not to outsource staff and specialists whenever possible. He believed that a partnership between Sublette County and St. John’s could benefit staff working in Jackson. Due to prohibitively high living costs in Teton County, John Kren envisioned a system where staff members lived in Sublette County and worked remotely. He added that 67 percent of St. John’s contractors and tradesmen on construction projects are local.

In response to questions about the Marbleton-Big Piney Clinic, he stated that the first goal is to focus on getting the CAH up and running in Sublette County. St. John’s is working on projects to build additional urgent care and primary care clinics in different communities around Teton County and recently spent more than $40 million on building a new long-term care facility.

St. John’s has received numerous accolades, including Newsweek’s Top Hospital Award for Wyoming and the Women’s Choice Award and recognition by the American College of Radiology. The assisted-living facility is rated 5-star by CMS.