After celebrating the opening of Sublette County’s first hospital Thursday — a $73.8 million health care complex — local leaders are already turning their attention toward keeping the facility open and operable for residents in the long haul.
Sublette County Hospital officials say they’re basically “burning” through cash without a special federal designation that will allow the facility to receive reimbursements, federal aid and subsidies.
Interim Hospital CEO Bill Patten told Cowboy State Daily on Thursday he and other hospital leaders are now seeking a designation as a “critical access hospital,” which would open up federal assistance the hospital is in dire need of to remain open.
Further stretching the hospital’s finances is a 25% state property tax cut passed in the last legislative session which has forced the hospital to look for other sources of revenue.
U.S. Sen. John Barrasso and U.S. Rep. Harriet Hageman joined Gov. Mark Gordon in Pinedale to mark the hospital’s grand opening as a major victory for the county that was nearly 100 years in the making.
Prior to the hospital’s opening, locals were forced to travel elsewhere for medical care, sometimes as far as 90 minutes away by car. Sublette County had been Wyoming’s only county without a hospital.
For local residents, the hospital’s mammogram offerings will help with early detection of breast cancer while an included long-term care facility will give aging residents a place to feel secure.
Opening the hospital required tremendous effort by board members and advocates, but it is just one of several hurdles now facing the organization.
‘Hemorrhaging Money’
Congress created the critical access hospital designation through a 1997 bill in response to the closures of several rural hospitals across the U.S. Facilities that receive the designation benefit from additional government aid, reimbursements and subsidies, which keep operating costs down.
To qualify for this designation, hospitals must be more than 35 miles away from another health facility and have fewer than 25 acute care inpatient beds. Patten said the designation will become a critical determining factor in the long-term outlook of the hospital.
“The governor and senator talked about how rural hospitals are so challenging financially,” Patten said. “That’s part of my job to make sure that it’s here for generations to come.”
Hospital Board Chair Tonia Hoffman told Cowboy State Daily that until it receives the designation, however, the hospital is burning through its cash.
“We're kind of, I don't want to say 'hemorrhaging money,' but we kind of are because we're operating at a higher level than we will have to at critical access,” she said. “But we can't scale things back as far as staffing models and things like that until we get to that point.”
Former hospital board trustee and Pinedale resident Dave Bell echoed those concerns, adding that achieving the designation was taken into consideration when planning the hospital’s operation finances.
“The reimbursement levels that we need to successfully financially operate the hospital won’t be achieved until critical access status is realized,” he said.
While Hoffman acknowledged Sublette County benefits from a robust oil and gas industry, she also said cuts to state property taxes have caused the hospital to take a financial hit from the revenue expected because of its reliance on that money.
Gordon in March signed Senate File 69, creating a permanent 25% property tax exemption for the first $1 million of the value of a single-family home. While he acknowledged doing so on behalf of tax-weary Wyomingites, the governor said these funds would be challenging for local and county leaders to replace.
“We've had to rely just on our mill levy for so long, and because it's so subject to the oil and gas activity that's been really difficult, we would have some really good years and some really lean years,” Hoffman said. “So we've always felt like, if we could get the hospital built and critical access designation, we would be able to, you know, use the mill levy money for [capital expenditures] and things like that that, and we wouldn't be so reliant on mill levies. So that's always been our goal.”
Hoffman added that should a potential 50% property tax cut that will be on the 2026 ballot pass, the hospital would quickly find itself in dire straits.
“I think across the state, that would be catastrophic to all sorts of essential services — hospitals, EMS, schools, all of these services that are carried by property taxes,” she said. “And I think we have to figure out a different way to go about that. I understand everybody wants property tax relief, but we have to retain our essential services.”
Staffing Struggles
Staffing is the second greatest concern facing the hospital, said Hoffman.
She explained the facility is using contract workers to get by as it navigates the critical access designation process. These interim workers, however, represent a higher cost than permanent full-time employees.
“So I think the goal is, once we get open and get through the immediate financial struggles and kind of navigate that, we'll hammer down on how to get more full-time employees in here that are not through contract services,” she said.
Bringing on employees can only be done if there is enough affordable housing to support them. Hoffman said she is aware of several families facing “hardship” in their searches for places to live in Pinedale, which is near the affluent Teton County.
The hospital board, Hoffman said, is engaged in conversations with nearby towns such as Big Piney and Marbleton to hopefully find solutions to support a growing workforce.
“You know, it's difficult to get people to come here because there's not a lot of housing and affordable housing at that,” she said. “So we're kind of looking outside just the hospital district to come up with local solutions.”
“Those are obviously heavy on our minds right now,” she added.
Even with the staff present at the hospital, these individuals require training and hands-on time with patients to truly learn the scope of their jobs. This extends all the way to the members of the hospital board, none of whom have prior experience operating a hospital.
“I'm a nurse, so I have healthcare experience, but I am the only one on the board with healthcare experience,” she said. “We have a lot of experience between us in different areas, but yeah, none of us have ever [run a hospital before].”
Hoffman said the board’s inexperience has complicated everything from approving vendors to searching for consultants.
Bell added that board members must strike a balance between their role as elected officials and businesspeople. Their role, he said, is to make critical decisions based on recommendations, not to manage day-to-day operations.
“This is a very complicated business,” he said. “You don’t see a board member telling [Cisco CEO] Larry Ellison how to run Cisco. A better example would be a board member telling Elon Musk how to run Tesla.”
This, he said, requires a great deal of trust between staff and board members and will require both sides to overcome political differences.
“The hospital is kind of a whole new start to building a health relationship between elected board members and hired staff,” he added. “That will be a big challenge.”
Jackson Walker can be reached at walker@cowboystatedaily.com.
