Transitional Care Unit

Cheyenne Regional Medical Center. Wyoming Tribune Eagle/file

CHEYENNE – After some delay, Laramie County commissioners are set to consider the fate of Cheyenne Regional Medical Center’s Transitional Care Unit this week.

On Tuesday, the commission will vote on a resolution to dissolve the rehabilitation unit for financial reasons at the request of hospital leadership. The TCU is a 16-bed hospital division that provides nursing care and physical therapy to patients not ready to return home.

In 2015, commissioners voted against a similar proposal amid public concern. But CRMC CEO Tim Thornell said the unit continues to be a financial drain – the hospital doesn’t receive enough federal Medicare reimbursement to keep it viable. At one time, it was operating at a loss of $1.3 million a year, but that number had declined to $859,000 in losses by 2015, according to previous reporting.

“The Fiscal Year 2019 loss is projected to be about $1.5 million,” Thornell said. “Financial trends for this service have not turned around since 2015.”

The medical center’s operating income was $15.4 million at the end of fiscal year 2018, according to an Eide Bailly audit, up from $11.9 million at the end of 2017.

If the hospital moves forward with the closure, management would use existing space to expand CRMC’s Mother-Baby Unit and Intensive Care Unit.

“These are critical services that are not otherwise available in our community, and both are experiencing high demand,” Thornell said. “Without discontinuing TCU services, the needed renovations and support for the Mother-Baby Unit and the ICU will be delayed by up to two years.”

He said expanding those units without closing the TCU would also increase construction costs by more than $4.7 million.

The closure is also part of the hospital’s ongoing effort to emphasize in-home rehabilitation and care, which the Wyoming Department of Health believes is one of the best ways to reduce Medicare costs to the state and local hospitals.

A recent study published in JAMA Internal Medicine shows patients sent home with health-care services following a hospital stay were just as likely to improve as those who transitioned to a skilled nursing facility. Hip and knee replacements were the most common reason for the 17 million Medicare hospitalizations reviewed over several years.

“Cheyenne Regional has an excellent home-care service that has the capacity to meet this need,” Thornell said. “We already place patients, at their request, at the three local organizations that can provide the same kind of service offered by our TCU.”

Still, Cheyenne is Wyoming’s fastest-growing city in terms of population, and the documented shortage of local health-care professionals could prove problematic. Employees who work in the unit worry the closure may further burden local nursing homes and rehabilitation centers struggling to keep up with a high volume of elderly patients.

“It’s possible readmission rates at the hospital could spike if they don’t closely consider how much goes into skilled, at-home rehab,” said Kailey Barnes, a personal caregiver in Laramie County. “The nurses I know in town all say there’s high employee turnover at work and not always enough people to keep up.”

Thornell said CRMC has the capacity to absorb any of the unit’s 30 full-time employees who want remain at the hospital, including registered nurses, certified nursing assistants and physical therapists. But those who want to remain in transitional care would have to transfer facilities or find another job. Current employees say they have been asked to reapply for new positions within the hospital system.

“It will be a very emotional issue for people,” Commissioner Amber Ash said at a Cheyenne Downtown Development Authority meeting last week. “If we tell them to stay open, there will have to be decisions about the losses incurred in that unit and what we’re going to do about that.”

Laramie County commissioners will meet at 3:30 p.m. Tuesday in the third-floor board room of the Laramie County Historic Courthouse, 310 W. 19th St.

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