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Strategic Development and Facility Master Planning

Board Approved in October 2010

Hot Springs County Memorial Hospital

Research the Market

Evaluate Demographic Trends

Assess Hospital Performance

Identify Opportunities

What is our context?

Phase 1: Awareness

What works well and what does not?

Phase 1: Awareness

Site Analysis

Departmental Assessment

Clinical Flow and Adjacencies

Code Compliance

Phase 1: Awareness What do the stakeholders

want?

Patient Perceptions

Unmet Needs

Community Support

Phase 1: Awareness How much can we afford?

Capital Capacity and Resources

Current and Historic Financial Performance

Plan Within Our Means

Realistically Achievable

Financing Options

Phase 2: Actionable OutcomesWhat would it look like?

Explore Multiple Options:

• Renovation

• Expansion

• Replacement

The Deliverable

Assessment of our market and how we are doing in it

Understanding of our current facility situation, areas of exposure and for improvement

Awareness of our community’s unmet needs

Evaluation of what we can realistically afford

A financially and market appropriate facility response

Hot Springs Washakie West Park Wyoming Med Ctr

Powell Billings St. Vincent Other Hospi-tals

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

68.9%

1.9%

9.4%

15.9%

0.0%

3.9%

64.1%

2.2%

8.5%11.1%

0.5%4.3% 4.3%

5.0%

60.0%

3.5%

8.0%

15.6%

0.2%

5.5%4.4%

2.7%

55.4%

2.7%

8.5%

16.7%

0.3%

4.6% 5.1%6.6%

Market Share of Inpatient Discharges Hot Springs Co Memorial Hospital - Primary Service Area

FY 2010 FY 2011 FY 2012 FY 2013

Current Facility Issues

Current building in place since 1959 (Utilized Hill Burton funds) No private showers or bath Imaging equipment spread throughout facility Significant lack of efficiency Very ‘inpatient’centered “Upstairs/Downstairs” services Maintenance tunnel infrastructure Heating and cooling challenges HIPAA Recruitment and retention

• 55,000-60,000 square feet in size. • More focus on outpatient services• Two operating rooms• One endoscopy room• Emergency room with six treatment spaces• An expanded/consolidated imaging area• 14 medical/surgical patient rooms

• Two obstetrical rooms• Pharmacy• Laboratory• Specialty clinic• Cardiopulmonary space• Cardiac rehab space• Dietary area

New Facility

ALL ON ONE FLOOR

Cost Estimate Remodeling costs were equivalent to roughly

80% of full replacement.

The projected budget for this project as of July 2012 was $27,786,689

This figure does NOT include financing costs or required construction period interest

Assumes 17-month construction duration, and this was presented with an anticipated construction start date of Spring 2013

Financial Affordability

County bonding capacity as of 2013 valuation is $2. 35 million

County bonding with a district would result in bonding capacity of up to $5 million

A 3-mill levy based on 2013 valuation), would generate $684,000

A 1% optional sales tax (based on sales from 2013) will result in gross proceeds of $333,153.76

Financial Affordability

Financial Affordability Hospital District

Consistent funding mechanism• Provides improved strategic and long-term planning capabilities• Large equipment purchases• Bonds• Cash flow• Anticipated decrease in Medicare and Medicaid reimbursement• Continued use, and potential increase in charity care and

bad debt service

(FY 2013 HSCMH provided more than $1, 423,447 in bad debt and charity care-$513,762 FY14 as of Feb)

Financial Affordability

Spreads support across all county taxpayers

Currently 16 hospitals in Wyoming are considered Critical Access Hospitals (CAH)

11 of these hospitals are district-funded facilities, including West Park Hospital, Powell Valley Healthcare, North Big Horn Hospital and South Big Horn Hospital

Improved support from State Land and Investment Board because we are taking steps to tax ourselves

Improved bonding capacity

Provides for ongoing operational needs

Questions?Additional Information Needs?