New Hospital FAQs
Cascade Medical Center – New Hospital FAQs
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.
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.
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 (2.6 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.
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.
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.”
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.
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.
The Cascade Medical Center Hospital District Board of Trustees voted in February 2022 to acquire eight acres adjacent to Highway 55 as the site of the new hospital. The property, owned by Davis Cattle Company, is located just north of the Catholic church in Cascade on the west side of Highway 55.
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 4 years.
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.
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. The hospital’s Foundation is readying a capital campaign to raise funds. Finally, a temporary property tax increase will be requested of voters to help service the debt necessary to build a new hospital. A critical piece of funding will be a General Obligation bond, funded by property taxes over 30 years. Visit here for more details.
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.
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. Besides, becoming part of a larger system does not guarantee that the new owners will invest in our needed expansion and modernization.
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 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 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.
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.
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. Please visit our Annual Report page for more details.
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.
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.
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.
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.
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.
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.
Thorough market and financial assessments were conducted, as well as a space analysis based on current use and future projections of patient volume. 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.
If voters approve the project in May 2022, the new medical center could open in 2025.
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.
The proposed bond is a 0.000692069 (0.0692%) property tax increase for 30 years. This rate would equate to $68 per $100,000 of taxable assessed property value and is in addition to the current tax assessed within the hospital district.
“Taxable Assessed” value is important. This is not the price Zillow says your home is worth. The tax would be assessed to all property owners within the Cascade Medical Center Hospital Tax District and be based on assessed value less a homeowner exemption (if applicable).
A bond is the only way to build a new facility in a realistic timeframe. CMC looked at every option and considered many funding sources. While fundraising will be a part of the overall funding mix. The total project cost is estimated to be $27 million today and we have added $7 million in contingency and inflation factors to that amount making the budget $34 million, given the uncertainty of the economic and construction trades environment.
CMC is able to fund half of this cost with loans and grants and the remaining $19 million would be funded by the bond. It is the only realistic path forward in order to preserve our independence and assure current and planned services.
Forecasting the future is always a challenge. That said, as more homes are built within the hospital district, the tax burden would be spread out and potentially be less per household in the future. However, that is the future and this is now, so we are asking voters to consider what would likely be the highest possible tax increase at $68 per $100k in assessed value.
CMC has hired an engineering company to assess the cost of running water and sewer service to the new hospital site on the other side of the river. They estimate it will cost around $2.3 million for the utility infrastructure construction and that cost has been factored into the overall project price. We have no expectation that the City of Cascade will pay for that construction. We will seek grants to help pay for the project and reduce the amount of bonds necessary.
That decision is up to the board of trustees. It is at the end of its life as a hospital, but still has good bones and could serve many other purposes. We don’t know what that will be yet, but there are so many possibilities.
Voters who live within the Cascade Medical Center hospital district as their primary residence are able to vote, however ALL property owners would be assessed the property tax. Approximately 65% of homes within our taxing district are second homes. While second home property owners cannot vote, they will be impacted by the outcome of the election. So full-time residents are in a unique position to impact the majority of the district with a minority voice. In this light, it also gives primary property owners some “bang for their buck” as the tax burden would be distributed across all property owners.
It depends on when the bond is issues and CMC has access to several unique options as a rural hospital. However, it is most likely that if passed, the bond would be issued in late 2022 or early 2023 and the tax increase would start on the next tax payment (in 2023).
If the bond passes, CMC would look to start construction as soon as spring 2023 with a target open date of early 2025.
Cascade Medical Center has received both state and federal pandemic relief funds, however the use and stipulations for that funding is fairly restrictive. We have been able to utilize some of those funds to make minor improvements to the facility (such as creating two negative air pressure rooms to isolate COVID patients), but that funding cannot be used for the construction of a new building.
And while that money cannot be used to help fund a new facility, we ARE being strategic by using those funds within directed parameters to purchase equipment with longevity that could be moved and utilized now AND in the new facility. As new funding becomes available, either through ARPA or other programs, we will look for ways to use those opportunities to reduce local taxes.
We take any ask for a tax increase very seriously and while paying more out of pocket is never a first choice, for a project like this, there is great benefit. During our forum in Cascade, a resident framed this tax increase as taking money out of your left pocket and putting it in your right pocket. It is money that never leaves your control. As a member of the hospital tax district who pays property tax to help fund the hospital, you also have full access to what that money buys…you can attend all board and foundation meetings and help direct how that money is spent. The hospital’s board is required to be made of appointed and elected LOCAL citizens.
This is one big benefit of keeping Cascade Medical Center independent…it keeps the control local. And that means input from the people who help fund it – YOU.
I’m 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 out-dated hospital. A new medical center is attractive to patients, and also 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.
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.