To form or not to form a hospital district

In addition to hearing from the candidates of the various races this election during Thursday evening’s meet the candidates forum, those attending heard from representatives of three Political Action Committees, and received information about Amendment A.

Karen Sinclair spoke for the Yes to Our Hospital PAC.

“Hot Springs County Memorial Hospital is a vital part of our community,” Sinclair said. “It is the foundation of healthcare in Hot Springs County.” She noted the hospital offers a wide variety of services, and supports other entities in the medical community, such as pharmacies, dentists, family practice doctors and surgeons.

The hospital also draws people to the town, Sinclair said, which positively affects other businesses.

“The existence of quality healthcare is important to all residents, and our hospital makes Hot Springs County attractive to people and businesses considering moving here.”

With regard to the building itself, Sinclair pointed out it is old and in constant need of repair, and also struggles to accommodate new technology. Further, restrooms are not handicap-accessible and there is a definite lack of shower facilities. The layout of the building also impedes efficient staffing, and these factors make it difficult to recruit and retain healthcare professionals and physicians.

There’s been plenty of input from the community on how to solve the issue, which has led to the creation of two initiatives on the ballot. The first, Sinclair said, is the creation of a hospital district. A district, she explained, ensures the hospital continues to be locally run, and allows the community to take advantage of new technologies and advances in healthcare. The three mill tax levy the district can raise annually will provide steady funding and access to other funding opportunities. When applying for state grants, Sinclair said, the question is always asked as to whether we have a district.

As for cost of the levy to property owners, Sinclair said it is $30 per year, per $100,000 of property value. “I equate this, personally, to the cost of a tube of toothpaste each month.”

The second initiative is a one percent sales tax. Sinclair said the money brought in by this will provide for remodeling and expansion of the existing hospital. Sinclair pointed out people requested the hospital not be moved, and the board has listened. The sales tax will be paid by residents and visitors alike, and will go away once the required amount for the remodel/expansion is raised.

Funds raised by the initiatives stay in the community, Sinclair said, to help the community. Both are essential to the viability of the hospital. “If both initiatives do not pass, healthcare in Hot Springs County will be greatly reduced, jobs will be lost, people will move away, others will choose not to move here, properties will sit empty and property values will decrease.” This will impact other revenue sources for the town and county, she noted, and the number of people they can employ and the services they can provide. Families moving away would have an impact on the school district, including employment, class offerings and extracurricular activities. Fewer people in town would take away support of businesses, churches and local organizations.

Sinclair also pointed out loss of medical services could mean babies are not born in the county and elderly residents have to move to where ready access to healthcare is more available. It could also mean an increased likelihood for tragedy due to services not being immediately available.

“Your votes can ensure these severe economic impacts do not occur,” Sinclair said, “and can ensure medical services are available to meet day-to-day needs, as well as to meet emergency needs.”

As to those wondering if there are other ways to keep quality healthcare in Hot Springs County, Sinclair explained other options were considered – including partnerships with larger corporations. The interests of such corporations were found to not align with our best interests, she said. “We would lose local control of our hospital, and no funding would be available to remodel or replace our aging building. It is likely a partnership with a large corporation would result in our hospital just becoming an emergency care facility, with most services being referred to a partner’s existing hospital in another town.”

As to why people should agree to pay more taxes to maintain quality healthcare, Sinclair said the increased taxes are an investment in the community, which will return far more than the taxes themselves. It will provide steady funding for the hospital, and access to additional funding.

Regarding claims of mismanagement at the hospital, Sinclair said its easy to make such claims from the outside. The fiscal management of a hospital is extremely complicated, she said, with rules and regulations by which the hospital board has worked hard to abide. The board has pursued outside assistance when necessary, she further added, which has actually led to some cost saving. “Cost control has always been a priority for our hospital board. Creation of a hospital district will enable continuing local control of the funding of our hospital.”

These are some of the reasons the board chose to recommend a hospital district be created and a one percent sales tax be raised. Sinclair asked people to vote for both initiatives, and noted people would also be voting for people to serve on the newly formed hospital district board. She recommended people determine and vote for who is in favor of both initiatives, who have supported the current board’s decisions and who are able to take on the responsibilities.

“Your votes decide the future of healthcare in Hot Springs County. Please vote in favor of both initiatives and choose carefully who is to serve on the hospital district board. Do this to ensure there is a Hot Springs County Memorial Hospital and a robust community for ourselves and for future generations.”

Citizens for

Common Sense Healthcare PAC

Members of the Citizens for Common Sense Healthcare PAC spoke in opposition to the formation of the hospital district and the one-cent sales tax.

Mike Baker wanted to clarify “We want a vibrant, successful continuum of appropriate medical care for our community.” He was previously for the creation of a hospital district, and explained why he changed his position.

“It is inappropriate to frighten the volatile, the ill, the elderly, Pioneer Home residents and families, just to win a vote,” he said, noting there have been statements the hospital would likely close without the district, and the Pioneer Home would be lost. He further added that raising taxes at a time of economic downturn is not advisable, and there are no provisions in the one-cent sales tax for major maintenance of any facility. “We’re in this situation today because of a lack of major maintenance.”

With regard to the hospital possibly closing, Baker said capital purchases continue, including a new MRI, salaries have increased and hiring continues to happen at a facility that is “likely to close.” Another point Baker raised is that, by state statute as it stands now, only the county commissioners can close the hospital. “Will they really? Can you see them closing it? Ask them.” That changes only if the district is created, Baker said.

Baker also said there is not enough money or bonding capabilities to completely build any proposed additions to the hospital, as planned by the consultants, and there would not be a significant increase in operative revenue for the hospital with the creation of a district.

Jim Collins said he has only one objective for the hospital. “For my wife and I,” he said, “it is imperative that Thermopolis has and keeps a critical access hospital now, and into the future.” The point he wanted to bring up is the community cannot shoulder the entire management cost alone. After the initiative for a district failed in 2013, Collins was asked to serve on a hospital board created sub-committee to explore how the hospital should go into the future.

“We met for nine months,” Collins said of the sub-committee, “gaining an understanding of regulations, community needs, past income, past expenses and where the hospital management fit and adjusted to these issues.” The sub-committee was disbanded before any recommendations could be made, he said.

Hospital board chair Bill Williams later stated the board did receive a sub-committee report and expressed appreciation for their services.

As Hot Springs Memorial Hospital is a county hospital, Collins said, the county commissioners are responsible for the managerial and financial duties of the hospital. If a district passes, such responsibilities will be place on the new board and, ultimately the citizens, of Hot Springs County. The ten-year average county commission support has been just short of $300,000 per year, and this year Hot Springs County valuation is down 39 percent, Collins said, and a three-mill district would raise just under $420,000 – a per year average gain of only $120,000 for the hospital. With a loss from the hospital, in 2015, of $355,000, the gain from a district would only cover a third of that loss.

“Recapping,” Collins said, “the commissioners would gain $300,000 to spend on something. The taxpayers would lose $420,000, and have their property encumbered from now on, and the hospital would only gain $120,000, covering a third of their 2015 losses.” The current business model will not sustain the hospital’s future, Collins noted. The hospital is currently managed by HealthTech, and while that may be the management company to take us into the future Collins strongly suggested coming together to explore all management options.

Collins believes Thermopolis must have a critical access hospital, but he fears the passage of a district and the funds it supplies will be nothing but a bandage to continue current failing business models. “The road we are on is not the one for a successful hospital that we strive for. This is a taxing issue that benefits the county commissioners. Remember, the district and its board are forever. We cannot change our mind.” Collins also noted the one-cent sales tax would stand on its own without the district.

Harry Hughes, chair of the PAC, stated the group does support affordable, quality healthcare but does not support imposing taxes prior to an analysis of all potential healthcare delivery models.

The specific purpose sales tax proposition reads, in part, that the tax would be used to collect $16.4 million for the construction, expansion, remodeling, renovation, furnishing and equipment of the hospital. Hughes asked people note operation and maintenance costs are not included on the proposition.

Based on current sales in Hot Springs County, it would take about 14 years to collect the necessary funding. “You should know,” Hughes said, “that 89 percent of sales tax collected in Hot Springs County is paid for by Hot Springs County residents and businesses.” The tax would be added to every necessity and service purchased. Even more problematic, he said, is the hospital board has not put forth a plan of how they will use the additional one-penny tax. “If the tax is approved by the voters, presumably they will borrow against the total of $16.4 million. However, they can only borrow 80 percent of the total amount, or about $13 million.”

Collins said the final architect estimate does not include items such as asbestos removal, medical equipment, permits and fees, soils engineering, furniture, fixtures and equipment and demolition. He urged voters not to vote yes for the hospital measures until all alternatives have been explored. If the measures fail at the election, he said, the PAC would take a lead role, representing the majority of voters, in evaluating all available business models and encouraging a collaborative process.

Baker said there is no imminent threat to the hospital, and he does not foresee the commissioners making a move to close the facility. Raising taxes would not significantly increase cash flow for the operation of the hospital, he said, and passing a one-cent sales tax would not create enough to finance or maintain any new facility. He pointed out Wyoming has 16 critical access hospitals with and without hospital districts, and financial success varies with each. “Success is not based on whether they’re in districts or not, but on how well they are managed and if they’ve entered into good collaborative agreements that utilize medical specialists from the area.”