Experts Say Ambulatory Surgery Center is Necessary and Ready To Go; Financing Options Last Hurdle

Experts Say Ambulatory Surgery Center is Necessary and Ready To Go; Financing Options Last Hurdle

ROCK SPRINGS – The ambulatory surgery center, which is ready to be built, was the subject at a special meeting of the Memorial Hospital Board of Sweetwater County Wednesday night.

Since 2011, Memorial Hospital of Sweetwater County has recruited over 30 new providers to Sweetwater County. They also formed the first partnership with the University of Utah. Through the hard work of MHSC and the partnership with U of U, they have added many new services which were previously not available to residents. They include Pulmonology, Critical Care, Hematology Oncology, Radiation-Oncology, Nephrology, Addiction Medicine, Psychiatry, Oral/Maxillofacial, Occupational, Medicine, Cardiology,Vascular Surgery, Emergency Group, Tele-Stroke, Tele-Burn, Tele-Icu, and a Hospitalist Program to name a few.

MHSC Board Member Joe Manatos said the hospital owes a big debt of gratitude to the voters of Sweetwater County who not once, but twice approved sixth-cent tax money for expansions including the Medical Office Building.

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Not only did the new MOB provide office space for local physicians, it also brought a valuable new Regional Cancer Center and expanded dialysis to the area. Manatos said the dialysis unit recently received a five star rating, one of only two  in the state.

Even with the new office building, Manatos said they continue to look for office space as the new building is at 125 percent capacity. The proposed surgery center would provide more of these office spaces for area physicians.

Board member Dr. Grant Christensen explained with the new growth comes growing pains which MHSC has worked through. He gave a few statistics to show the growth over the past four years.

In fiscal year 2011, total patient days at MHSC was 6,326. This has grown to 7,494 in fiscal year 2015. Outpatient visits jumped from 63,937 in 2011 to 73,532 in 2015.

Christensen said where you can really tell the growth is in the increase in clinic visits. In 2011, the clinic visits hit 13,443. This number hit 68,737  in 2015 marking a 411 percent increase.

Revenue has also gone up over the past years. Gross Patient Revenue jumped from $90,083,000 to 138,637,000 between 2011 and what is anticipated in the fiscal year 2016 budget.

However, it was said several times during the meeting that because it is a county hospital, MHSC does not turn people who have medicaid and medicare or no insurance away.

Total uncompensated care has also risen about $20 million dollars over the same time frame.


Surgery Center

The main purpose of the Wednesday meeting was to discuss the new surgery center and to investigate different financial options to build the $37 million facility.

Charlie Van Over of Plan One Architects has been working on the MHSC Master Plan and proposed surgery center for several years. Plan One was instrumental in the development and building of the Medical Office Building.

When the idea of the surgery center was raised in 2013, Van Over said the hospital board recognized a need to really look at the campus and come up with a plan to best utilize the property and the resources.

The Master Plan would also provide a map of how MHSC could expand into the future starting with the new surgery center.

The planned center will be approximately 90,000 square feet standing three stories tall. This would also include putting the helipad on the roof of the new center. VanOver stressed to everyone in attendance the plans for the surgery center have already been approved by the Rock Springs Planning and Zoning Commission and it is “good to go.”

Plan One said with the cost of construction, the fixtures and furniture and upgrades to Skyline Road which the city of Rock Springs asked MHSC to do to meet the public’s needs using the road due to the expansion, the total cost of the project will be approximately $43 million.


Financial Options

The cost has been the issue that has stalled construction of the center. It came to a head recently after the Sweetwater County Commissioners voiced concerns over using bonds to pay for the construction and felt going to the voters again for the extra penny tax was the best option.

During Wednesday’s presentation, several board members said that in the past they have asked the voters twice for the extra tax and the public was generous enough to approve it.

Several officials said they felt going to the public for a third time was a little excessive. Especially when there were other financial options and other opportunities they could look at.

Currently MHSC’s financial rating is a triple B+. Klein said the size of the hospital is why it is not an A rated. With such a high financial rating, Klein said he has been contacted by several companies who are ready and willing to facilitate this project.

Representatives of a couple of these companies were in attendance such as Mark Hogan of Impact Capital who said they have a high interest in doing the project and are set to get going.

Cheyenne Bond Attorney Barbara Bonds, who has worked with Sweetwater County for the past 20 years on the sixth-cent tax and bonding issues, also addressed those in attendance. She said MHSC is like many of the county hospitals throughout Wyoming. She said historically, county commissioners have always used bonds to pay for construction and expansion at all the county hospitals.

With using bonds in question due to the county commissioner’s concerns, Bonds and MHSC Attorney George Lemich spoke about other options the hospital could look at to fund the center.

Included in this was leasing agreements where the company building the structure would lease the building with agreements in the contract which would turn ownership back over once they were met.

Lemich and Bonds said this has been done locally in the case of Black Butte High School where Sweetwater County School District No. 1 and Western Wyoming Community College did something comparable.

Lemich said partnerships between public and private groups have also been successful in the past. Using the University of Utah’s research park and the hotel next to the Jonah Field at the University of Wyoming as examples of this.

Investigating the different financing options, MHSC also looked at whether or not the Sweetwater County Commission would have to be involved. Lemich said because Sweetwater County is the property owner, the commissioners would have to be involved with any decision made.


Public Comment

Several local physicians, residents and other officials asked questions and spoke on the project. Surgeon Dr. Jeff Johnson was recently one of those recruited to the area. He said surgery centers are the future of medicine and the way many hospitals are moving. He said they provide stability to surgery schedules, lower costs and offer more personal care. He also said it helps with recruitment of physicians to the area and was part of the reason he decided to join MHSC.

Newest MHSC Board Member Dr. Tom Spicer knows MHSC well. He said he has been overwhelmed by the new services, the quality of care and the enthusiasm he has recently seen at the hospital.

University of Utah Doctor and Director of the Outpatient Surgery Center Richard Orlandi addressed the group. He said the University of Utah built the first one in 2012 and have several more in the plans including one in 2016 and 2017. He said they found these centers are valuable financially, improve quality of care and customer service.

Recently Tooele County in Utah opened up a similar surgery center and Orlandi said it put a strain on the hospital there. He explained to the board, there are always going to be threats and MHSC should always be looking at possible associated impacts to their business.

Orlandi also touched on the price tag. He said $37 million is not “walking around money” and he understands the concerns on cost. Orlandi said when you break down the price tag of the proposed MHSC Surgery Center it averages to be about $450 a square foot. Orlandi said when the University of Utah Surgery Center was built it cost around $500 a square foot and that is when construction costs were cheap.

With this, Orlandi said the price tag for the one in Sweetwater County is a great deal.

Long time local surgeon Dr. Joseph Oliver agreed with what had been said. He added it is also important to remember by having a surgery center, patients are not exposed to other illnesses they would be at a hospital.

One area physician asked if the bylaws at the surgery center would be the same as at the main hospital. Klein said the bylaws at the surgery center would be separate from the main operation.

Local resident Craig Thompson spoke in favor of the center. He explained approximately 20 years ago he was appointed to the local Board of Health and due to the lack of physicians they had to declare a public emergency. He said he was grateful to hear about the MHSC successes in recruiting.

On the center, Thompson said experts are saying it’s important, physicians are saying it is needed and the county can pay for it.

“For the life of me I can’t understand why we are not moving forward with this,” Craig Thompson said.

Several residents who spoke, including Cathy Sizemore, thanked the board for really looking at options instead of going to the voters asking to raise their taxes for a third time.

Despite the topic of the meeting, there were once again people who brought up concerns about care and old issues which have happened in the past. One residents questioned if any of these doctors who were recruited have actually stayed in the community. A local physician who was recruited by the hospital responded that when he signed his contract it was for two years. He said he recently asked MHSC for a five year extension because of the community.

Klein also spoke to this. He said when he took over as CEO at the hospital the number one thing which concerned residents was physicians leaving the area. Klein said he listened to these concerns and instead of focusing all their attention on awards and accomplishments MHSC looked at how they would fit in the community at MHSC and the community as a whole. Since the big focus on recruiting, Klein said only four of those recruited in the past few years have left the community.

Klein also pointed to a recent study that showed a few years down the road there will be a shortage of 90,000 physicians across the United States. He said it is important to get these physicians now and keep them because in a few years they will be competing against every hospital in the nation looking for doctors.

Board Chairman Artis Kalivas wrapped up the special meeting. He said they started looking at this in 2013 and the board would not have moved forward unless they believed it was an important project. He added they will continue to discuss and look at the different financial options for the new center.

The proposed Ambulatory Surgery Center would sit near the current helipad. The helipad would be moved to the roof of the center. This would actually solve several issues such as securing the helicopter and offering easier access to the emergency department.