Why does Cascade need a new hospital?

We’re out of room. Given our current patient base and volumes – we have half the space we need to provide the medical care according to current care standards.

The existing facility is nearly 50 years old and lacks certain expected hospital features, such as in-wall medical gasses, ADA bathrooms, and a safe room. The building has electrical, plumbing, and mechanical systems that cannot be readily repaired or replaced. In some cases, parts can no longer be found to fix certain issues. This creates a less-than-comfortable environment for patients and staff and makes adding new or updated medical equipment and technology much more difficult and expensive. Several areas do not have adequate ventilation, heating and cooling, making climate control a frustration for patients and staff alike.

If you build a bigger facility and add services, aren't you worried that you won't be able to find people to hire?

We're actually more worried about finding good employees if we DON'T build a new hospital. Over the past 3 years, our growth has required us to hire many additional staff. So far, we've been fortunate to find excellent people, but it is getting harder and harder to recruit people to a small and outdated hospital. A new medical center is attractive to patients and to prospective health care professionals. Nurses, techs, doctors and Physician Associates all want to work in an environment that allows them to practice at the top of their license, and a modern facility supports their professional skill.

But even if you find staff, where will they live?

We have added at least a dozen new employees in the past 3 years and they have all found suitable housing. While housing is still challenging for many employees, the recent approval of new developments, including a mix of affordable high-density options, means the supply and demand of housing will normalize somewhat in the years ahead. Due to the nature of employment in healthcare, the Median wage at CMC is over $30 per hour, enabling most of our staff to find housing even in the current environment. CMC will continue to partner with the County, School and City to develop new affordable housing options for LOCAL workers.

Why not do a renovation and small expansion at the current hospital now?

Renovation and expansion in a hospital setting is expensive and disruptive to patient care. A hospital must be able to maintain 24x7 operations to serve its community, honor its license granted by CMS and the State of Idaho, and meet its mission. Closing during construction is not an option. Any money spent prolonging the life of the current hospital hampers our ability to prepare a new campus that will serve our community for future generations.

Can the current hospital be renovated?

Much of the current facility was constructed in such a way that replacing critical infrastructure simply cannot be done, short of demolition. Known asbestos content makes demolition more difficult. The cost and disruption of renovating the existing buildings make a new facility, in a new location, a much better option for our community.

Adding a new building on the same site is not feasible due to our limited space (2.2 acres split down the middle by a public road). With required set-backs, there is simply not enough space to expand or build a hospital large enough to meet the community’s needs beyond 10 years. Even parking is a problem, with only 40 spaces which are further reduced when snow piles up.

What are the biggest challenges with the current facility?

CMC simply does not have enough space to meet the needs and demand for medical services at current health care standards. CMC operates in a space that is approximately HALF of what is needed to meet patient needs – and that doesn’t even consider future growth which our community is already experiencing. Climate control in each season is a big frustration. Even concrete is beginning to break down. Basic accessibility requirements are not met, including public stair and ramp slope and ADA bathroom requirements. There are other issues with plumbing and electrical systems that are simply not sustainable. The use of multiple outbuildings is inefficient.

Why do we have to move the location of the hospital?

In 2020, CMC hired Wipfli to assess the ability of our existing hospital to meet the community’s needs. (Wipfli is an independent company with expertise in strategic planning and financial auditing of rural hospitals.) Over several months they conducted detailed audits and interviews to reach an opinion in a 76 page report. In summary, Wipfli concluded that “The existing site is extremely constrained and expansion zones are limited by topography and the public street; any growth will displace parking which is already tight on campus. The existing site cannot accommodate needed expansion to serve the hospital over the next 10+ years.”

The existing hospital seems just fine, why change it?

Our incredible hospital and clinic staff has done a great job providing high quality medical care in this building for several decades. They continue to do so today but it is becoming more and more difficult as health care changes and our community grows. In its facility assessment, Wipfli stated that there are “major facility and operational issues.” Departmental space issues and challenges were documented in every single department. Even with renovation, we are simply bursting at the seams.

How much space is needed to build a new hospital?

The existing hospital sits on 1.6 acres, with an adjacent helipad and empty lot of 0.6 acres separated by a public street (Lefever Drive). Wipfli recommends at least 10-15 acres for new Critical Access Hospitals to allow for growth and expansion. Currently at 12,000 square feet, the new hospital needs to be roughly double that size to meet TODAY’s needs, with the ability to expand further to meet the future needs of our community and support the growing retirement and tourism activity.

Where will the new hospital be located?

The Cascade Medical Center Hospital District Board of Trustees voted to acquire eight acres adjacent to Highway 55 as the site of the new hospital. The property is located about half a mile north of the Catholic church in Cascade on the west side of Highway 55. This site was chosen for its accessibility to the Highway, its relatively flat topography, and its size. The sale includes a potential option to acquire additional adjoining acreage in the future if needed for further expansion.

Why do we have to do this now?

The process for planning, funding, and building a new hospital takes years. By starting now, we can open the new hospital in 2025. The current facility will be over 50 years old by then and its mechanical systems will be at their limit. Waiting will require further renovation and replacement of equipment and systems which will nickel and dime the health district and its tax payers while only postponing the inevitable replacement of the medical center. We are already seeing accelerating growth in the area and new residential developments are coming on line from Clear Creek to Donnelly and from Cascade to Tamarack. Improved access to the area once the canyon’s road construction is complete will create even more interest in our area by the time the new hospital opens in 3 years.

How much will the new hospital cost?

The entire project is estimated to cost $27 million today. To be on the safe side, we have added over $7 million in contingency and inflation factors in that amount making the budget $34 million, given the uncertainty of the economic and construction trades environment. The Board is forming a project management committee that will examine project details and dig deeper into the budget in order to validate these preliminary estimates.

How will we pay for it?

Hospitals routinely face the challenge of renovating, expanding, and replacing their infrastructure. As an independent Critical Access Hospital and Rural Health Clinic, Cascade has several good options. Federal agencies such as USDA have programs specifically to support hospital building projects. A combination of public and private loans and grants will be sought in addition to the operating funds surplus that the hospital has been able to accumulate over time. A critical piece of funding will be a General Obligation bond, funded by property taxes over 30 years.

How much will this add to my taxes?

The Cascade Medical Center Hospital District Board of Trustees will seek public support in the May 2022 election to help fund a new medical center. Residents in the hospital taxing district will be asked to consider approving up to $19 million in General Obligation bonds over the next 30 years.

If the full $19 million in bonds is used, the impact on property owners will be $68 for each $100,000 in taxable property value. The total amount of this assessment per property will not increase over time even if the assessed value of property rises.

Why not be absorbed into one of the large health systems and have them pay for expansion?

In 2020, Cascade Medical Center polled its community and received over 400 responses. Two-thirds of those surveyed asked that we remain independent. While we enjoy excellent relationships with other health providers, including St. Luke’s, Saint Al’s, and the University of Utah, independence has its advantages. As an autonomous provider owned by the taxpayers, we can be laser-focused on the needs of the people who live in our area. We get to make decisions and invest in resources that make the most sense for people living in the west central mountains. Our local control allows us to move quickly and make decisions locally. Becoming part of a larger system does not guarantee that the new owners will invest in our needed expansion.

Why not simply rely on the medical facilities in McCall?

Having local access to health care is an important quality of a vibrant community. Without Cascade Medical Center, many of our patients would need to drive up to 30 miles farther to see a provider or receive physical therapy. For time sensitive emergencies, having a local hospital with 24x7 ER service and an on-site helipad is literally a life saver. Our patients enjoy receiving care close to home and continuing their care relationship with our providers to maintain wellness and improve their quality of life.

Will the new hospital offer additional services?

The primary goal is to assure continuity of existing services: primary care, family medicine, 24x7 emergency care, inpatient and rehabilitative services, mental health, and physical therapy. A larger footprint will allow us to add new services, including specialties like cardiology, eye care, foot care, dermatology, urology, ENT, and digestive health. We will continue to look for ways to serve our local communities so they can receive as much health care locally as possible.

What is the current financial status of the hospital?

The hospital has achieved a positive bottom line each year for the past 5 years. This is the result of prudent financial management, public support of the medical center through property taxes, productive and cost-conscious providers and staff, and partnership with the hospital’s Foundation and Auxiliary. This solid financial standing will help CMC secure bond or loan funding at attractive interest rates to support construction of the new hospital and clinic.

How many people are seen in the Clinic annually, and where do they come from?

Our volumes have been growing steadily. From 2018 through 2020, the family medicine clinic saw an average of 5,275 patients each year and this year we saw over 5,500 patients. Approximately 70% of our family medicine patients live in Cascade, 10% in Donnelly, 10% in McCall, and 10% from other communities. In addition, almost all of Cascade’s 4,000 plus physical therapy sessions this year were with patients who live locally.

How many residents are treated annually in the current hospital’s emergency room, and where do they come from?

The CMC ER treats 1,400 patients per year, of whom 56% live in Cascade, 25% in the Boise area, and 8% from other Valley County communities. The remaining 11% live elsewhere in Idaho or out of state.

How is the emergency department staffed?

The ER is staffed 24x7 by board-certified Physicians and Physician Assistants. A new hospital facility will provide the environment and appeal needed to retain providers and support staff as well as recruit additional health professionals as we grow.

Will the project generate new jobs?

In addition to short-term construction jobs, the new medical center is projected to increase the hospital’s workforce as we add new capacity and services.

What accommodations have been made for future pandemics or large-scale community disruptions?

The new hospital is being planned and designed with the capability to quickly convert beds to handle a higher number of inpatients, with rooms that provide negative pressure systems when the need exists. Emergency power systems will also be available in both the hospital and clinic, allowing for ongoing needs without interruption.

What will happen to the old hospital facility?

There are a range of possibilities for the future use of that property, but nothing has been decided. While it is out of date as a hospital, the building and grounds can be repurposed in many ways once the medical center moves into its new home.

Was a needs assessment conducted in considering a new hospital and clinic?

The site selected was chosen based on factors such as public access, EMS access, topography, helipad location, zoning, building orientation, parking, site amenities, traffic, neighborhood, potential for future growth, and environmental issues. The location’s suitability has since been confirmed through on-site assessment from the selected architecture firm and engineers.

How long will construction take?

If voters approve the project in May 2022, the new medical center could open in 2025.

Why should I support this if I don’t use the hospital?

The medical care provided for our growing communities should be considered in the same light as police, fire, schools, parks, public infrastructure and other essential services that are supported by tax dollars. Even if you don’t personally use such services, they are necessary and valuable for the well-being of the entire community. Maintaining a state-of-the-art medical facility is key to improving public health, retaining local talent, attracting new businesses and employers, and growing our economic base. Our medical facilities are available 24x7, to everyone.