CHEYENNE – Laramie County commissioners voted unanimously Tuesday to close Cheyenne Regional Medical Center’s Transitional Care Unit.

Commissioners approved a resolution to dissolve the 16-bed rehabilitation unit for financial reasons at the request of hospital leadership after an hour-long public comment period.

CRMC CEO Tim Thornell said the hospital doesn’t receive enough Medicare reimbursement to keep the unit viable, adding post-acute care provided by TCU staff could be absorbed by private facilities or CRMC’s in-home program. The department is expected to close within the next two to three months.

The unit’s projected loss in 2019 is about $1.5 million. The medical center’s operating income was $15.4 million at the end of fiscal year 2018, according to a recent audit, up from $11.9 million at the end of 2017.

“The cost of doing business is inherently higher here than other freestanding facilities,” Thornell said. “Our regulatory requirements are more strict and robust; sometimes hospitals have the ability to bill and get reimbursed at a higher rate because of that, but we get paid similar to other (smaller) facilities.”

Hospital executives plan to offer the unit’s 30 full-time registered nurses, certified nursing assistants and physical therapists continued careers at CRMC. But those who want to remain in transitional care would have to transfer or find another job.

The space in the hospital’s West Building will be used to expand the existing Intensive Care Unit and Mother-Baby Unit, both of which are operating beyond capacity, according CRMC staff. Expanding those units without closing the TCU would have increased construction costs by more than $4.7 million.

The ICU has at least two double-occupancy rooms, and the Mother-Baby Unit, which hasn’t been remodeled in decades, is overcrowded. About 100 babies are born in the unit each month, Thornell said.

County Commissioner Linda Heath, who recently toured the units in question, said it’s clear both the ICU and Mother-Baby Unit need to be expanded. The ICU isn’t big enough to properly separate patients, and there’s little privacy for new mothers.

“I think the one that hit me the most was the old nursery is being used for storage, but it’s also used for babies that need more intensive care,” Heath said. “There is absolutely no privacy in there for the mothers and babies because nurses are walking in and out for supplies.”

Thornell said the network’s home-care service can fill most of the expected need. A number of recent studies, including one published in JAMA Internal Medicine, suggest 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.

Complications from heart attacks, heart failures, pneumonia, chronic obstructive pulmonary disease, hip and knee replacements and open-heart surgeries are some of the most common reasons for readmittance nationwide, according to the federal government.

“An average of 11 patients are in the TCU at one time,” Thornell said. “Our most recent two years, approximately 37% of our patients had pneumonia, sepsis, renal failure, and a quarter were major joint replacements, all of which are eligible services for home health.”

Those who do need additional care following a hospital stay could transfer to another skilled nursing home in Cheyenne.

One of those places is Life Care Center of Cheyenne, an in-house rehabilitation facility, which, like CRMC’s TCU, continues to receive a 5-star quality rating from the Centers for Medicare and Medicaid Services.

“Today at Life Care, there are 130 patients and a 75-bed Transitional Care Unit,” said Bryan Merrell, executive director of Life Care. “We are providing care to 52 people in that unit. So, there is capacity.”

Still, many wonder if the unit’s closure will ultimately result in more hospital readmissions or uninsured patients falling through the cracks.

Resident Paula Qualls told commissioners she’s stayed at the TCU three times over the course of her life for a shoulder injury, breathing problems and a broken wrist. More recently, physical therapists there helped her son keep his leg after a wrecker accident.

“My husband was not able to go to TCU when he needed to,” she said. “He ended up back at the hospital three times after being sent home with home care. I have a real concern about sending people home before they are ready. I’ve had a lot of elderly people contact me at Pointe Frontier about their concern.”

Although hospital executives didn’t sign a contact with the county, both informally agreed to closely monitor CRMC’s readmission rates moving forward.

Earlier this year, CRMC was penalized by the federal government for an “excessive” number of discharged patients returning to a hospital within 30 days, receiving a 1.26% reduction in Medicare reimbursement. In an effort to reduce billions in health-care costs, the Affordable Care Act allows Medicare officials to reduce a hospital’s funding based on its rate of readmission.

“We’ve seen a significant number of emails and correspondence from the public on this,” said Commissioner Troy Thompson, who voted to close the unit when a similar resolution came before commissioners in 2015. “The TCU does a phenomenal job, and my hat is off to those folks. If they weren’t so good, we wouldn’t have such a hard time making this decision.”

Commissioner Gunnar Malm said he’s heard from more constituents about this issue than any other in his brief time as an elected county official.

“To me, it was more than the money problems and gaps,” he said. “That’s a philosophical problem about health care in America and Medicaid expansion. What it boils down to, most importantly, is that there are critical services at the hospital that are not offered in the private sector, and those need to have expansions. The TCU can be handled with our private-sector partners.”

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