A difficult decision

Earlier this month, Memorial Hospital of Carbon County (MHCC) announced they would be terminating labor and delivery services. The decision, according to MHCC CEO Ken Harman, was not one arrived at easily.

On May 3, Harman informed the Board of Carbon County Commissioners (BOCCC) what led the MHCC Board of Directors to come to the decision. According to Harman, the hospital had lost approximately $1.5 million in a three month period with $800,000 lost in January, $400,000 lost in February and $150,000 lost in March. Though the organization was beginning to bring in revenue, it was not matching the level of expenditures.

“There’s misinformation out there. One is (that) people assumed, with Covid, that hospitals were rolling in cash,” said Harman. “You all know that’s not the case. From operations in 2020, we lost millions and millions of dollars. Operations in 2021, we lost $2 million and, right now, year-to-date we’re now $1 million behind.”

Harma told the commissioners MHCC had been able to maintain its cash position throughout the pandemic due to CARES Act funding and expansions of some of their programs. Ultimately, a number of issues arose which caused a 40 percent erosion in the hospitals’ cash position.

The first issue Harman cited was a two-month period in which the State of Wyoming would not not pay Medicaid. The second was a malware attack which hit MHCC earlier in the year and delayed collections by a month. The third, and most significant, issue was the use of traveling nurses.

“We pay a fair, good wage for our employees. A nurse, depending on how many years experience, is somewhere between 28 and 50 dollars an hour. But travel nurses, the fee that we’re now paying is over $220 an hour and that’s not sustainable for us,” Harman said. “Given the number of travelers we have right now, that expense works out to be four and five millions dollars a year and, unfortunately, we don’t have that four or five million dollars.”

According to Harman, the reason MHCC had come to rely more and more on traveling nurses was due to their own nurses leaving to become traveling nurses themselves.

“In order to continue to provide the great service that the community needs we have to bring on a lot of travelers,” said Harman. “That number of travelers has continued to go up as we’ve had staff leave to become travelers themselves.”

Harman told the BOCCC in order to prevent MHCC from dropping another 30 or 40 percent in their cash position “something dramatic” would have to be done. The CEO and the MHCC Board of Directors ultimately made the decision to close the labor and delivery services.

“There’s a couple of reasons for that. The primary reason is clearly that the finances of the organization are in trouble. The secondary reason is, as an organization, we’ve been putting a lot of effort into trying to grow the OB (obstetrician) program. We’ve spent a lot of money on bringing in good people, we’ve spent a lot of money on promotion and marketing and unfortunately the volumes are not dramatically increasing,” Harman said. “In fact, our market share continues to drop.”

Harman said the decision to end these services was not a reflection on the staff and both he and the MHCC Board of Directors were looking at other options. The CEO would later state the hospital had two programs which lost money and those were obstetrics and the emergency room. According to Harman, 61 percent of Carbon County women went to Laramie for obstetrics.

While those two programs have not generated revenue for the hospital, Harman said the clinics established by MHCC in Rawlins, Hanna and Saratoga were generating profit due to clinic visits and referrals.

“We take the mission of this hospital very seriously, the mission to improve the health of individuals who reside in Carbon County. Not being able to do that for a segment of the population, if that’s in fact what happens, is disappointing,” said Harman. “I consider it a personal failure.”

Commissioner Sue Jones noted healthcare was likely one of the largest economic drains in Carbon County, pointing out residents often went elsewhere for their healthcare needs.

“We have 14,000 people in this county. Most of Rawlins goes north to Casper, the rest of the county goes east and south to Laramie and Colorado and Cheyenne,” said Jones. “It’s about numbers. It’s about customer base. It’s a customer base business. If you don’t have customers, you don’t have much of a business. Somewhere along the line, I think that issue needs to be addressed if it can be because it’s a perception that the public has had longer than most of us in this room has even been alive.”

At the May 3 meeting, Harman told the commissioners he had been in negotiations with Ivinson Memorial Hospital of Laramie for a potential partnership. Two weeks later, on May 16, a partnership between MHCC and Ivinson was announced via a press release. According to the press release, labor and delivery services for MHCC patients would be provided by Invinson’s inpatient Women and Children Center and outpatient services through Ivinson Medical Group’s women’s health team.

The scope of services, according to the press release, will include prenatal visits—both in person and via telehealth—with delivery and gynecological surgeries taking place at Ivinson Memorial Hospital. Emergency deliveries, however, will be managed by trained emergency room personnel at MHCC.

The MHCC Obstetrics Department will officially close June 15.

The Board of Carbon County Commissioners will have met May 17.

The next meeting of the Board of Carbon County Commissioners will be at 9 a.m. on June 7 at the Carbon Building - Courthouse Annex in Rawlins.