Dr. Chuck Franklin is a physician at Weston County Health Services in Newcastle. He made his way between several patients in the ER on a weekday afternoon.
“We've got a couple ER patients right now, a little two-year-old with a broken leg and then a lady with newly diagnosed diabetes, and severely low potassium,” he said typing in his notes on the hospital's electronic medical records system.
Franklin knows some patients personally in this small community of just under 3,400 people. He checks in with the newly diagnosed diabetes patient.
“You have diabetes,” Franklin said.
“That’s what I figured,” the patient named Dana, who is in her mid-60s, responded.
“You were right,” Franklin replied. “She was suspicious already, so. Your blood sugar was 570.”
“Oh my gosh,” she replied.
Franklin is one of two doctors, a physician assistant, or PA, and a nurse practitioner that treats patients at the hospital. A clinic across the street has three doctors and three mid-levels, which refers to physician assistants or nurse practitioners. The hospital and clinic, which are both operated by Weston County Health Services, keep separate operations.
Rural hospitals like these in Wyoming are a lifeline for small communities throughout the state. But staying afloat can be challenging. Some say Medicaid expansion could help with financial woes but the Wyoming legislature failed to pass it this year. So rural hospitals, like Franklin’s, are finding ways to survive.
Even during Franklin’s 40-year medical career in Weston County, things have changed.
“For years there were four or five of us that covered everything. I mean, sometimes I worked over 100 hours a week, 110 hours a week, and typically probably 70 or 80 hours a week for years; [it] wasn't fair to my family,” he said. “I wouldn't do it over again. But there were three docs and two PAs a lot of times. Sometimes we only had one PA. It was brutal for a lot of years. So now we [have] 10 instead of five [total doctors, PAs, and nurse practitioners].”
Weston County Health Services has been lucky in this sense. While they still face challenges that a small healthcare facility does, recruiting and retaining healthcare providers is a continual challenge in rural areas.
“It has to be just the right person and their spouse has to be happy here,” Franklin said. “We had several [doctors] that were really good, and they were happy here, but their spouses weren't happy. So, I mean, I think it's a perfect place to live. If you're the mindset and you'd like small places. If you want the Symphony and Walmart down the street, it's not going to work.”
Besides retaining healthcare providers, the second challenge small rural hospitals deal with is finances. Franklin said so far Weston County Health Services has fared better than some places in that regard.
But Memorial Hospital of Carbon County in Rawlins is struggling financially.
“Running a rural hospital is dramatically more difficult than it was two years ago, or three years ago,” said Ken Harmon, the hospital’s CEO. “I've been a CEO and involved in healthcare for over 30 years, and I've been a CEO now for about 17, 18 years. And I will tell you, the last two or three years are more difficult than it's ever been.”
The hospital, along with South Lincoln Medical Center in Kemmerer, got rid of obstetrics and maternity care last year. A major cause was the lack of deliveries versus the costs of having these services locally.
“As a result, we were losing a tremendous amount of money on the service line,” Harmon said. “In addition, when you're only doing 50 deliveries a year, you're not accustomed to seeing certain things. And we thought that it was better for us to be able to partner [with] someone, so we didn't necessarily get rid of services, we chose to partner with Ivinson [Hospital].”
Harmon said many Carbon County residents were already seeking these services in Laramie. Partnerships with other hospitals in the region are a way that many of these hospitals try to stay afloat.
Over half of Wyoming’s hospitals are critical access ones. That means they get more money back from the government for the services that they provide. This helps them, but since the pandemic, it hasn’t been enough.
“They've emerged from the pandemic in pretty poor financial shape in a lot of circumstances,” said Eric Boley, president of the Wyoming Hospital Association. “And many of them are struggling a great deal.”
Short-term COVID-19 federal funds helped with the costs of the pandemic, but issues such as inflation and labor costs have contributed to the pinch many find themselves in.
“I would say we have a handful of our hospitals that are under 10 days cash on hand at this point,” he said. “That's one financial indicator that we use in the industry to judge the financial strength of hospitals. Prior to the pandemic, we probably had two, maybe three that were right around 10 days cash on hand, but we've doubled that number.”
Boley explained a more ideal situation would have hospitals with around 160 days of cash on hand.
Many see Medicaid expansion as a solution, including the Wyoming Hospital Association, which has and continues to advocate for expansion. Even as more Wyomingites have come to support expansion, the legislature failed to expand coverage this session. Boley currently said the state’s hospitals are dealing with about $130 million of unpaid bills.
“We estimate conservatively that if we were to expand Medicaid, we'd see a decrease of about 20 percent in uncompensated care,” he said. “So, it's a significant amount of money when you look at $130 million annually.”
Boley said Colorado, Montana and Idaho have expanded Medicaid and have seen their rural hospitals benefit. But for now, despite the challenges rural hospitals face, they will continue to be a lifeblood to small communities.
