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Diagnosing Valley healthcare needs

Finding out what works in rural critical access hospitalsis part of due diligence, North Platte Valley board finds


January 8, 2020

The Critical Access Hospital (CAH) designation has become a vital link to providing quality healthcare services in rural America but building one from scratch, as they’re hoping to do in Saratoga, adds an extra layer of challenges. 

For more than a year, the Platte Valley Healthcare Project (PVHP) committee has been pursuing a Critical Access Hospital to provide services to the North Platte River Valley. According to Will Faust, PVHP chairman, one important aspect of the effort so far has been to seek knowledge and advice from similar rural communities on making the program a success.

“We have sought advice from many institutions in the region to get a handle on the benefits and downsides of a CAH,” Faust said. “Although rural healthcare remains a challenging issue, virtually everyone we talked to said having a CAH had greatly improved their healthcare services and benefited their communities overall.” Afton, Sundance and Lusk, Wyoming, as well as Sheridan, Columbus and Red Lodge, Montana were among six regional communities the PVHP Board visited and 13 they interviewed about the Critical Access Hospital experience.

In many of the communities Faust and his colleagues talked to, healthcare services had reached a critically low level of care before the CAH solution was tried. According to Keith Gnagey, CEO of Teton Valley Health Care in Driggs, Idaho, the hospital shut down when the economy and housing market collapsed in 2008. But with the help of the Critical Access Hospital program, today it offers some 20 different service lines, including specialty care, and operates as a 501(c)(3) non-profit, offering two rural clinics and a specialty clinic in addition to the hospital.

Critical Access Hospitals are often similar to the model planned in Saratoga because they are all based on the same criteria, Faust said. To obtain a CAH designation, hospitals must:

•Have 25 or fewer inpatient beds

•Be located more than 35 miles from another hospital

•Maintain an annual average length of stay of no more than 96 hours for acute care patients

•Provide 24/7 emergency care services.

Under the program, about 20 percent of the construction is funded by the community; a no-recourse loan from the USDA funds the remaining construction costs and operations are subsidized by Medicare. Most CAHs are governed by a non-profit board under a 501(c)(3). 

McCone County Health Center in Circle, Montana is a typical model because it utilizes mid-level providers—physician assistants (PAs) and nurse practitioners (NPs)—for all its services including outpatient, inpatient, emergency, acute care/skilled hospital nursing, as well as long-term care. In-house facilities include an in-patient pharmacy, imaging, laboratory, physical therapy and telehealth.

Although mid-level providers often perform the bulk of medical services in many rural hospitals, Faust said that won’t be the goal in Saratoga.

“We’re seeking a secure funding platform that will enable us to hire an M.D.,” Faust said. “While we may use some mid-level providers, our community feedback very clearly says, ‘We want a doctor.’”

Matt Wahler, CEO of Liberty Medical Center in Chester, Montana, notes their successful recruiting for medical staff in rural towns comes from “seeking providers who are looking for a rural lifestyle and compensating them competitively.” Teton Valley Health Care’s Gnagey additionally stressed community support as a key factor in the success of a CAH. 

“Keith Gnagey told me that continued improvement of care and a constant focus on community needs were vital to maintain buy-in from community stakeholders,” Faust said. “That’s how we plan to move forward.”

To build their Critical Access Hospital, PVHP is currently seeking 501(c)(3) status and mounting a fundraising campaign to meet the required 20 percent of funds coming from the community. To learn more about the project, visit their website at


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