Wednesday, July 28, 2010
Sunday, July 25, 2010
Memorandum of Understanding between KMHD and Centura Health
A Memorandum of Understanding was signed on July 22, 2010 at the Kremmling Memorial Hospital Board of Director's meeting. Gary Campbell, CEO of Centura Health and Bill Widener, CEO of Kremmling Memorial Hospital signed the MOU.
President of the Board of Directors, Kent Whitmer explained: "An MOU is a recitation of what each party's understanding are as we go forward and try to ultimately reach and affiliation, a partnership or some sort of arrangment where we are working together [on delivering healthcare in Granby, in particular regarding the proposed Middle Park Medical Center Project by Kremmling Memorial Hospital District] ... "
"Kremmling Memorial Hospital is staying"
Although a recent poll from Sky Hi Daily News shows that the vast majority of responders believe the proposed Middle Park Medical Center Project by Kremmling Memorial Hospital is needed and a good idea,
( http://apps.skyhidailynews.com/utils/polling/poll_results.php?poll_ident=1978a )certain minority (and appreciated) perception exists that the hospital in Kremmling might one day disappear because of the measured decision to also provide services on the east side of Grand County with the proposed Middle Park Medical Center.
There are several reason why the hospital in Kremmling must remain in Kremmling and even more reasons why the propossed Middle Park Medical Center will actually provide the resources necessary to not only provide services to the Kremmling neighbors to the east side of the county, but to also provide the means to continue and grow the hospital services on the west side of Grand County. The full intention of everyone involved in the planning process is to have both the hospital in Kremmling AND the Middle Park Medical Center in Granby.
First of all, it is important to note that the hospital is needed in Kremmling. Sure, there are not a lot of people on the west side, (approximately 80% of the entire county population resides on the eastern portion), but the residents and guests of the Kremmling area still need Emergency care and always will. (We also figure that a significant population within the Kremmling area can be re-captured, as we develop and enhance services).
In order to provide emergency care, a hospital must have radiology services, laboratory services and a clinic. From there it's just a simple step up to provide patient beds. (Further more, it is believed that improved billing systems, electronic medical records, the continuation of retaining extraordinary medical providers and other medical professionals, will actually prove to recapture locals who had stopped patronizing KMHD years ago for one reason or another. Yes, we are working hard to give those people legitimate reason to come back and utilize their hospital. In fact, we have testimonials galore of people who believe they or their family have received very high levels of care, with unusually compassionate and caring providers and high-technology).
Additionally, the hospital simply CAN NOT move and discontinue current services in Kremmling and maintain it's business model. That drastic and unimaginable move would require CMS (Centers for Medicare and Medicaid) approval--a vital part of KMHD's revenue matrix. (see: http://www.cms.gov/) Doing so would also alter another revenue stream, so vital to the financial operations of the hospital--Critical Access designation. (see: http://www.coruralhealth.org/programs/cah/coloradocahs.htm )
So, by vitue of maintaining two revenue channels, the mere thought of building the propossed Middle Park Medical Center Project in Granby and discontinuing services in Kremmling automatically becomes counter-intuitive.
KMHD CEO reminds all citizens and guests of Grand County, that "the hospital is not leaving Kremmling now, while we are developing the proposed Middle Park Medical Center in Granby, nor after." Every effort and intention of the administration and the community elected board of directions is directed towards a county-wide, community oriented view of managing and providing sustainable and viable healthcare systems.
The hospital board believes we are approaching this project very thoroughly. (Keep in mind this has been in the works for well over 12 years!) No stone has gone unturned. Diligence has been applied in every single aspect, from feasibility studies to community feedback forums and more. It is this well-thought-out approach, with a community wide perspective that seeks to retain healthcare services locally and keep them managed and controlled locally, that fuels the drive and energy of so many professionals and volunteers, government officials and citizens engaging in thoughtful discussion and forward-moving actions to provide healthcare.
( http://apps.skyhidailynews.com/utils/polling/poll_results.php?poll_ident=1978a )certain minority (and appreciated) perception exists that the hospital in Kremmling might one day disappear because of the measured decision to also provide services on the east side of Grand County with the proposed Middle Park Medical Center.
There are several reason why the hospital in Kremmling must remain in Kremmling and even more reasons why the propossed Middle Park Medical Center will actually provide the resources necessary to not only provide services to the Kremmling neighbors to the east side of the county, but to also provide the means to continue and grow the hospital services on the west side of Grand County. The full intention of everyone involved in the planning process is to have both the hospital in Kremmling AND the Middle Park Medical Center in Granby.
First of all, it is important to note that the hospital is needed in Kremmling. Sure, there are not a lot of people on the west side, (approximately 80% of the entire county population resides on the eastern portion), but the residents and guests of the Kremmling area still need Emergency care and always will. (We also figure that a significant population within the Kremmling area can be re-captured, as we develop and enhance services).
In order to provide emergency care, a hospital must have radiology services, laboratory services and a clinic. From there it's just a simple step up to provide patient beds. (Further more, it is believed that improved billing systems, electronic medical records, the continuation of retaining extraordinary medical providers and other medical professionals, will actually prove to recapture locals who had stopped patronizing KMHD years ago for one reason or another. Yes, we are working hard to give those people legitimate reason to come back and utilize their hospital. In fact, we have testimonials galore of people who believe they or their family have received very high levels of care, with unusually compassionate and caring providers and high-technology).
Additionally, the hospital simply CAN NOT move and discontinue current services in Kremmling and maintain it's business model. That drastic and unimaginable move would require CMS (Centers for Medicare and Medicaid) approval--a vital part of KMHD's revenue matrix. (see: http://www.cms.gov/) Doing so would also alter another revenue stream, so vital to the financial operations of the hospital--Critical Access designation. (see: http://www.coruralhealth.org/programs/cah/coloradocahs.htm )
So, by vitue of maintaining two revenue channels, the mere thought of building the propossed Middle Park Medical Center Project in Granby and discontinuing services in Kremmling automatically becomes counter-intuitive.
KMHD CEO reminds all citizens and guests of Grand County, that "the hospital is not leaving Kremmling now, while we are developing the proposed Middle Park Medical Center in Granby, nor after." Every effort and intention of the administration and the community elected board of directions is directed towards a county-wide, community oriented view of managing and providing sustainable and viable healthcare systems.
The hospital board believes we are approaching this project very thoroughly. (Keep in mind this has been in the works for well over 12 years!) No stone has gone unturned. Diligence has been applied in every single aspect, from feasibility studies to community feedback forums and more. It is this well-thought-out approach, with a community wide perspective that seeks to retain healthcare services locally and keep them managed and controlled locally, that fuels the drive and energy of so many professionals and volunteers, government officials and citizens engaging in thoughtful discussion and forward-moving actions to provide healthcare.
"Why Neenan?"
KMHD is working with The Neenan Company, selected as the design/build team by Request For Proposal, (RFP) through the Grand County Rural Health Network, (which included Kremmling Memorial Hospital representation and board approval). As required, the RFP was published in late 2005. Dozens of firms competed. After much investigation, Neenan was chosen. Out of 27 Critical Access Hospitals, [KMHD is a Critical Access Hospital], Neenan has been involved with several including: Lamar, Trinidad, Burlington, Brush, Holyoke, Del Norte and Ledville—about 20% of Colorado’s Critical Access Hospitals. (For a definition of Critical Access Hospitals and a map of Colorado Critical Access Hospitals, visit: http://www.coruralhealth.org/programs/cah/coloradocahs.htm ) Further confidence in Neenan came from their experience in the county with the school projects they had been involved with.
MARKET ANALYSIS
June 2010
The last market study/financial feasibility report was done in 2007, based on census data from 2000. The economy had also changed significantly since the 2007 report, requiring an update. 2010 census projections were estimated and considered in the report.
Stroudwater Associates, (www.stroudwaterassociates.com), was chosen by the hospital board of directors as the independent research firm to re-assess the project and provide the new results. This report has been completed and is now in the process of being audited by an independent accounting firm.
Murray says the results of the report are favorable to a smaller facility than planned in 2007 and that it is economically viable to go forward with the project.
The last market study/financial feasibility report was done in 2007, based on census data from 2000. The economy had also changed significantly since the 2007 report, requiring an update. 2010 census projections were estimated and considered in the report.
Stroudwater Associates, (www.stroudwaterassociates.com), was chosen by the hospital board of directors as the independent research firm to re-assess the project and provide the new results. This report has been completed and is now in the process of being audited by an independent accounting firm.
Murray says the results of the report are favorable to a smaller facility than planned in 2007 and that it is economically viable to go forward with the project.
PROJECT UPDATE: JUNE 9, 2010
Kremmling, Colorado – Kremmling Memorial Hospital District is continuing to make progress on the proposed Middle Park Medical Center project, with the goal of providing a variety of needed healthcare services in East Grand County sometime in 2012.
Recent developments of the project include the process of acquiring capital financing, auditing recently completed third-party market-analysis, to determine viable service lines, (those services that have enough market demand to warrant investment and expect reasonable return), and analyzing financial feasibility studies; ultimately for the approval of the financing company, which will be the true launching point for this significant community-oriented and initiated, long–term healthcare endeavor.
On July 22nd, a MOU (Memorandom of Understanding) was signed by the President of Centura Health and the KMHD CEO. The agreement, although not legally binding, is thought to be a significant development and a positive sign of colaboration between Centura and KMHD.
“We are hopeful to join forces with Centura in order to bring the highest quality of care possible and the most requested and financially reasonable services to Grand County,” noted Jeff Miller, VP of the KMHD Board of Directors.
While important components of developing such an important capital project are moving along favorably, hospital leaders are responsibly quick to clarify that anything can happen between now and financing approval and that any number of variables might affect the development and the time-line of the project.
“We have a team of exceptional professionals working on this project and a dedicated board of directors who want to see both the survival of the hospital in Kremmling and the development of services in East Grand. We are confident and very motivated to make this project work,” Bill Widener, CEO of KMHD, said. “We are seeing a growing number of supporters who are realizing that what we are pursuing is most likely the best possible option for the development and sustainment of community –managed and operated healthcare.”
Widener kindly asked that Grand County residents, second-home owners and guest, “Be patient with us and know we are working hard every day to sustain current operations and to bring more and better healthcare to all of Grand County.”
“We’re getting closer to bringing these community healthcare needs to fruition and the future looks bright,” and he adds, “but remember that there are no guarantees on anything; in life, in business, in healthcare, (especially in this day and age),” he confessed.
“We need the support and encouragement of both communities [East and West Grand] to make this happen – to make healthcare accessible for everybody; their guests and their neighbors, whether that neighbor be to the east or to the west of them.”
Progress has also been made with land planning and building design. Recent preliminary adjustments have brought the square footage to approximately 37,000. In the plans developing around in as early as the late 90’s, propelled by such admirable and valuable efforts of numerous Grand County Commissioners, various municipality planners, town counselors, the Grand County Rural Health Network founders and successors, chambers of commerce, business owners and so many more, it was closer to 42,000 square feet.
Regardless of the immediate proposed square feet, there is room for growth and development as community medical need dictates. After all, the desire for Kremmling Memorial Hospital is to not only provide for as many needs as reasonable and possible now, but to plan for the care of future generations, who will live, work and/or play here.
Recent developments of the project include the process of acquiring capital financing, auditing recently completed third-party market-analysis, to determine viable service lines, (those services that have enough market demand to warrant investment and expect reasonable return), and analyzing financial feasibility studies; ultimately for the approval of the financing company, which will be the true launching point for this significant community-oriented and initiated, long–term healthcare endeavor.
On July 22nd, a MOU (Memorandom of Understanding) was signed by the President of Centura Health and the KMHD CEO. The agreement, although not legally binding, is thought to be a significant development and a positive sign of colaboration between Centura and KMHD.
“We are hopeful to join forces with Centura in order to bring the highest quality of care possible and the most requested and financially reasonable services to Grand County,” noted Jeff Miller, VP of the KMHD Board of Directors.
While important components of developing such an important capital project are moving along favorably, hospital leaders are responsibly quick to clarify that anything can happen between now and financing approval and that any number of variables might affect the development and the time-line of the project.
“We have a team of exceptional professionals working on this project and a dedicated board of directors who want to see both the survival of the hospital in Kremmling and the development of services in East Grand. We are confident and very motivated to make this project work,” Bill Widener, CEO of KMHD, said. “We are seeing a growing number of supporters who are realizing that what we are pursuing is most likely the best possible option for the development and sustainment of community –managed and operated healthcare.”
Widener kindly asked that Grand County residents, second-home owners and guest, “Be patient with us and know we are working hard every day to sustain current operations and to bring more and better healthcare to all of Grand County.”
“We’re getting closer to bringing these community healthcare needs to fruition and the future looks bright,” and he adds, “but remember that there are no guarantees on anything; in life, in business, in healthcare, (especially in this day and age),” he confessed.
“We need the support and encouragement of both communities [East and West Grand] to make this happen – to make healthcare accessible for everybody; their guests and their neighbors, whether that neighbor be to the east or to the west of them.”
Progress has also been made with land planning and building design. Recent preliminary adjustments have brought the square footage to approximately 37,000. In the plans developing around in as early as the late 90’s, propelled by such admirable and valuable efforts of numerous Grand County Commissioners, various municipality planners, town counselors, the Grand County Rural Health Network founders and successors, chambers of commerce, business owners and so many more, it was closer to 42,000 square feet.
Regardless of the immediate proposed square feet, there is room for growth and development as community medical need dictates. After all, the desire for Kremmling Memorial Hospital is to not only provide for as many needs as reasonable and possible now, but to plan for the care of future generations, who will live, work and/or play here.
Sunday, July 18, 2010
A History & Explanation of Kremmling Memorial Tax Revenues
A history and explanation of Kremmling Memorial Hospital District tax revenues
By Cole White, Chief Financial Officer, KMHD
June 9, 2010
Kremmling Memorial Hospital District (KMHD) has been operating at its current location at 214 South Fourth Street for more than 60 years. During that time, KMHD has seen major changes in both its physical structure and in the scope of services provided at the hospital. Major additions to the hospital and clinic were added throughout the last half a century, the last of which occurred in 1974. Early changes to KMHD were financed in part through Hill-Burton funds, which were appropriated for hospital reconstruction after World War II, and in part through generous community donations.
To assist the hospital in financing the 1974 expansion and the level of care available to residents of Middle Park, a mill-levy was introduced in the early 70s and a taxing district was formed. These funds have helped the hospital pay for not only the addition which was completed in 1974, but also with funding day-to-day operations, equipment purchases, physician recruitment, and countless other organizational improvements.
Throughout the last 45 years, the healthcare landscape has changed dramatically. Costs associated with providing healthcare have grown at double-digit inflation levels, while reimbursement from federal and state programs, commercial insurance companies, and private payers have grown at a much slower pace.
For many small hospitals this has spelled out their demise. Hundreds of rural hospitals failed during the 80’s and 90’s as a result of these changes. Most of the rural hospitals that were able to survive did so with both the support of the State and Federal government through enhanced reimbursement methodology and the unwavering support and patronage of their community. One such survivor is KMHD.
Kremmling Memorial Hospital District qualified as a Critical Access hospital in 2003. Essentially, this means that because of the hospital’s remote location and the need for 24/7 emergency care, the Federal Government allows the hospital to receive cost-based reimbursement from Medicare. This reimbursement is intended to improve financial performance and thereby reduce hospital closures. Among many requirements, the hospital must be 15 miles from another hospital in mountainous terrain. Critical access hospital must maintain a maximum of 25 acute care inpatient beds. They must also provide 24-hour emergency services, with medical staff on-site or on-call and available in 30 minutes or less.
Throughout the years, Kremmling and Grand County has seen numerous changes. Many traditional industries have come and gone, family ranches have all but disappeared, and much of what supports the area is now heavily reliant on tourism and the service industry. What hasn’t changed though is the community’s continued commitment to KMHD and the support of high quality, affordable healthcare for the people of our region.
A major change that occurred at the State level that directly impacted healthcare in our region was the passing of the Tax Payers Bill of Rights (TABOR) in 1992. TABOR, while effective at limiting the growth of government and reducing taxes, inhibited many parts of government from effectively planning for future changes and addressing the needs of the people they serve.
In compliance with the TABOR regulations, KMHD has lowered their approved mill-levy over the years, (originally approved at 11%), effectively providing residents of the district with lower taxes. While the hospital is currently approved to collect approximately 7 mills, KMHD provides a credit back to the district of 2.5 mills, reducing the hospital’s levy to 4.5 mills, in order to cap our growth at the TABOR approved inflation rate. In comparison, the district supplied the hospital with $928,021 in 1991 and $852,180 in 2010.
Each year the taxing district contributes a portion of funding necessary to support healthcare services in Grand and Summit Counties. Throughout the years these funds have contributed a smaller and smaller portion of the resources necessary to support operations.
In 1991, tax revenue accounted for approximately 65% of the revenue necessary to keep the hospital operating. By 2009, the district supplied KMHD with less than 10% of the hospital’s total budget. Moreover, if the time value of money is factored, and expenses are adjusted for inflation, the tax revenue collected today means significantly less to the bottom line now than it did when the levy was approved in 1973. While TABOR has had a large impact in this area, this shift can also be attributed to the rising cost of healthcare, a factor not considered in TABOR legislation.
Changes taking place at both the State and Federal level have the potential to impact healthcare in both positive and negative ways. But after the dust settles in Denver and Washington D.C., it is ultimately left up to the people of our region to define what services and level of care are available here in our own back yard. Without the continued support of the District and the patronage of residents and guests of Middle Park, KMHD would struggle to acquire the resources necessary to provide a full range of services to the people of our region.
Simple zip code analysis of patient origin shows that the majority of hospital revenue is generated from services utilized by people from East Grand County; this includes those Timberline Family Practice patient patrons. (Timberline Family Practice located in Granby was purchased by KMHD in 2006). While approximately 10% of the hospital’s revenue is derived from the mill, nearly 60% of its revenue is derived from the utilization of services from people originating outside of the tax district, i.e.: east of Kremmling. That leaves approximately 30% of revenue derived from the utilization of services from people within the district. Simply put, if you minus the ever-decreasing revenue attained from taxes, and the patient base from East Grand, the hospital would not survive on the business from the population within its district alone.
A recently completed management feasibility market study indicates that the development of services in Granby to be provided by the proposed Middle Park Medical Center will be self-sustaining and contribute to the overall, bottom line of KMHD.
###
Location for Middle Park Medical Center
The proposed Middle Park Medical Center will be located on the Southwest corner of the Granby Park development area, off of US Hwy 40, in the same area where the land was donated to the Town of Granby for the proposed Rec Center. It is between the Fraser River and the Ten Mile Creek. East side of the road. In other words, if you go to the old Grand Mountain Bank and Little Tree Hotel, go across the Hwy and it is in the flat meadow.
“1000 Granby Park Drive South”
Welcome to the Middle Park Medical Center Project by Kremmling Memorial Hospital District
Dear Friends:
Thank you for your interest in the new, state-of-the-art, Middle Park Medical Center. This blog has been created to keep you informed on our progress.
We are honored to have this tremendous opportunity to build a healthcare center central to the Fraser Valley, Grand Lake and Granby.
The demanded for healthcare services on the east side of Grand County is something citizens, second home owners and guests have been asking for years. We are happy to spearhead this development and answer the call to provide many health care services. We believe that Grand County needs and deserves this availability and quality of care.
With nearly 60 years experience in providing healthcare in Grand County we have a rich history of quality care and a specific understanding of what this county needs. In good times or bad, we have always maintained a strong commitment to Grand County. Our current board of directors, as well as directors of the past, has worked hard to get this lofty project this far with full-intentions of making it a reality.
When we open our doors and welcome patients in 2012, (knock on wood!) Middle Park Medical Center in Granby will provide many of the medical services enjoyed by people on the west side of the county at Kremmling Memorial Hospital.
We have seen an outpouring of support from federal, county and local government, local businesses, organizations and individuals. We especially thank Granby Ranch for their belief in local healthcare, proven by their generous donation of land. With other supporters joining our mission to provide improved access to care every day, we are sure to make Middle Park Medical Center part of your life in Grand County.
We would especially like to remind those who rely on the services currently provided at Kremmling Memorial Hospital in Kremmling: We not only intend on staying right here in Kremmling, but also continue to improve and develop services.
Lastly, we'd like to invite you to attend the open board of directors meetings. These are held the final Thursday of every month at 5:30 p.m.
Sincerely,
Bill Widener, CEO
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