St. Luke's takes over hospital Monday

When Elmore Medical Center becomes St. Luke's Elmore this Monday, the merger of the hospital district's assets with those of the non-profit St. Luke's collection of hospitals in Idaho should increase access to expanded medical resources.

It also will provide some efficiencies through economy of scale (such as supply purchases) and elimination of some redundancies, hospital administrator Greg Mauer believes.

But while services offered will stay the same or be improved, who's in charge changes quite a bit.

Last May the voters approved a merger of the two facilities, and earlier this year the final "definitive agreement," which outlines the technical details of the merger, was approved by all the relevant parties.

"It's sort of like a prenuptial agreement," Mauer said, explaining that the complicated and lengthy documents outline the rights and expectations of both sides, the transfers of assets and liabilities, and the conditions under which the relationship could be ended at some point in the future.

"The facility stays here, serving the community as it always has," Mauer said. "Nobody's going to haul it off or close it down."

What will happen is a bit of bookkeeping in which the local hospital district transfers its current assets in the hospital (such as building and equipment) to St. Luke's, and it goes on the St. Luke's books as an asset for the St. Luke's Elmore hospital branch of the St. Luke's hospital group. It's the equity the local hospital brings to the deal. Any improvements St. Luke's may make to the facility in the future -- and some are being studied already -- also will be listed on the books as separate assets for St. Luke's Elmore.

If, at some point, the hospital district board were to decide to reaquire the facility, by invoking provisions of the agreement that would let it do so, it would essentially be responsible for paying for the additional assets on the books for St. Luke's Elmore, Mauer explained. Any excess revenue generated by the hospital would be shared by the local facility and the group.

Meanwhile, the hospital board's duties change from oversight of the hospital to oversight of the contract. It will not be involved in operations or policy issues at the hospital anymore.

The Elmore Hospital District board does retain its responsibilities to levy property taxes and will continue to do so, with those funds used to pay for basic operations and maintenance of the facility as they do now. "Without the taxes," Mauer said, "this thing won't work."

An Elmore Community Council will be formed, with approximately 12 members (the details were still being worked out last month), which will oversee implementation of the merger agreement (actual operations), planning, local initiatives, community relations and philanthropy. Three of those 12 members will be from the seven-person Elmore Hospital District Board. The others will be from the community or represent various aspects of hospital operations.

The community council will have one voting member and one non-voting member serve on the St. Luke's Treasure Valley Board of Directors, which oversees all of the St. Luke's operations in the area. Those two positions are initially for two three-year terms, each. After that, there is no explicit guarantee that anyone locally will serve on the St. Luke's board, although the Elmore Community Council will continue to provide reports, advice and recommendations to it.

It's a complicated flow chart of responsibility, with the new community council carrying much of the weight for day-to-day operations, the St. Luke's Treasure Valley Board of Directors providing the strategic guidance, and the hospital district board of directors making sure the necessary taxes get levied and the contract is followed.

The benefit is the expanded services St. Luke's expects to begin providing. It must provide a minimum of the services already provided here, but will be able to draw on its larger resources to provide expanded health care services in the future at the Mountain Home facility. '

Some specialists from Boise, for example, may be able to make weekly or monthly calls here, thus making it easier for local residents to access those doctors or services.

Who is going to own and run the county ambulance service was still up in the air last month as negotiators worked out final details of that complicated agreement. Technically, the county owns the equipment, but it had a contract with the hospital to run the ambulance service. A similar arrangement was expected to continue with the new management.

Similarly, Trinity Mountain Clinic will continue to operate as a contracted adjunct to the hospital.

"There just isn't going to be much of a change," Mauer said, except to see a slow improvement in services.

"Now, we have a very strong partner," he said. "We'll continue to provide services and be able to take advantage of opportunities to better meet our community's needs" with expanded services.

As an example, he said, without tying himself down to a firm commitment or a timetable, "we're already talking about (expanding) orthopedic services, providing new services. The challenge has always been to engage a partner to come here. St. Luke's can help with that" by utilizing members in their own group of doctors. "We'll be looking at all our scope of services," Mauer said. "The philosophy is, if we can do it locally, it's better for the community and the patient.

"This is an organization that believes in local support services, and they understand Idaho and rural Idaho."

The legal stature of the hospital won't change. It will remain a Critical Access Hospital, which is a federal designation that involves largely reimbursements for allowable Medicare costs (it gets more than some larger hospitals per patient), but it also will keep the limit on 25 beds the hospital currently has to maintain that classification.

Led by several local doctors and a number of community leaders, the hospital was built and officially opened its doors on Feb. 6, 1955. It has seen a number of changes over the years. One of the most important will happen on Monday, April 1, 2013, when it transitions to the St. Luke's group of hospitals.

At that time, it will get a new sign and new uniforms for the staff.

"But our level of care won't change," Mauer said. "We expect it will only get better."