PINEDALE – Pinedale was recently named one of the five finalists to be named Ranger Country USA by Polaris.

Now, after a week of voting, Pinedale has found itself in battle with Darlington, Wis., for the title. The official numbers aren’t available, but videos for the two towns had been viewed over 39,000 times while the other towns’ videos were hovering around 27,000 views.

“We think we have a real shot at it, but we’re such a small community that we need everyone to vote,” town clerk Maureen Rudnick said.

People can vote once per day from every email address they have online, at https://ranger.polaris.com/en-us/ranger-country-usa/

Voting is open until 10 a.m. on Dec. 18.

Everyone that votes is automatically entered to win a Ranger XP 1000. n

PINEDALE – Before Sublette County’s Rural Health Care District gets a loan to build a critical access hospital, the United State Department of Agriculture Rural Development program will cross-check the entire process to make sure it’s sustainable.

That was one of the big takeaways from the meeting between USDA representatives, health district board members, mayors of Pinedale, Big Piney and Marbleton and other people interested in the hospital on Dec. 4.

Lorraine Werner, the program director of the RD Wyoming office, said she’s done several projects in Wyoming and 100 percent of them have proved to be sustainable. Nationwide, less than 1 percent of USDA projects fall into delinquency.

The USDA will look at all contracts entered into. It will review the selection process the district uses to pick a design-build team. It will examine the projected financial reports and it will review the engineering designs.

“The fact that the USDA will cross-check everything should give the community a big, warm feeling inside,” board member John Godfrey said at the meeting. “I want the community to know this is being done the right way.”

Werner said she doesn’t have enough information to make an informed decision at the moment, but the district was assured she will have everything when the formal application is submitted.

What’s next?

Selecting a design-build team is the next thing the district needs to do before applying for a loan. Once a design team is selected, the district will have its architect review the three sites still being considered for the new hospital. Once a site is selected, the design team can make a preliminary architectural report detailing the hospital’s floor plan and other pertinent information, like the soil.

The district is currently advertising the open bid and plans on selecting a design-build team at its Dec. 20 meeting in Big Piney.

The district has $2 million earmarked for the hospital, which is what it will use for the preliminary designs and engineering. Then USDA can reimburse those costs.

Once the preliminary report is complete, the district can begin the loan approval process. The first part, of three, in the approval

rocess is obligation. This requires a full review of contracts and a completed application including the architectural design, the site selection and an environmental report on the building site, among other things.

Once submitted, Werner and her staff will review the application. If it passes her review, it will then go to the federal office for final approval.

The second part of the process is the construction, which can’t begin until the obligation step has been completed. Construction funding is required to come from a local bank, based upon the RD guarantee of permanent funding once the construction is completed and approved. The USDA will conduct regular inspections throughout the process. Since the RD is a cradle-to-grave lender, it will remain involved with the project from the initial application until the end of the loan term.

Out of the $28.3 million the district plans to request, $17 million is dedicated for construction of the new critical access hospital.

The third, and final, part of the process is the loan closing. This is when RD funding is made available to pay off the construction funding.

What’s the timeline?

Werner said her department has streamlined its process to make it as quick as possible. She described the hospital as her “top priority” and said her department could complete its review in just a couple of weeks. Once the project gets her approval, it will need to be approved by the national office, which could take between two weeks and a month.

Other takeaways?

Big Piney Mayor Michelle Hymas questioned how the health district could fund a hospital and two clinics when it is currently struggling just to fund the two clinics. While the district is waiting for the final financial examination, which it expects by the end of the month, the financial group’s preliminary reports have shown that the proposed hospital project, including continuing to finance the two clinics, will be sustainable.

Part of this is based on the additional services the hospital could offer. Another part is how clinics and hospitals are paid. Critical access hospitals, and associated satellite clinics, get a cost-based reimbursement from Medicare while clinics receive an all-inclusive rate for their services.

Lorraine Gatzke, the health district’s financial director, used the following example to explain the differences: An ambulance is dispatched and the patient is brought to the ER of the clinic where he goes into cardiac arrest. First of all, Medicare will not pay for the ambulance ride to the clinic because he was not brought to a hospital. That ambulance bill will become the patient’s responsibility. Second of all, the clinic can only bill Medicare for a high-level clinic visit, not a full blown cardiac arrest billing that you would see at a hospital. So both the patient and the clinic are getting the bad end of the deal, so to speak. Now if the same scenario were to take place with the ER in the CAH rather than in the clinic, Medicare would pay for the ambulance ride. The CAH would be reimbursed based on what it cost the CAH to provide the service to the patient. So instead of a clinic visit payment, reimbursement would include the cost of the staff, equipment, building and overhead: everything required to make the patient visit possible.

Conversely, without a hospital to supplement the clinics, the county might be reduced to providing EMT services, and nothing else, in five years.

Who’s going to repay the loan?

Based on BKD’s preliminary report, the hospital should be able to pay for itself. To determine if the project is sustainable, the USDA will look at its debt-to-service ratio.

Debt-to-service ratio is defined as the net operating income divided by total debt service.

A ratio above 1.0 means there is sufficient cash flow to cover debt service. The USDA requires a 1.1 ratio while First Bank representative Gretchen Mastin said her bank requires a ratio of 1.3. The report by BKD predicted a critical access hospital in Sublette County would have a ratio between 1.8 and 1.9.

The underwriting for the loan, which hasn’t been written yet, will decide how much of the loan comes from the USDA and how much comes from a local bank. BKD recommended an 80-20 split, with the USDA providing 80 percent of the total as a direct loan, with lower interest and a longer time to pay back, and the other 20 percent coming from a guaranteed loan provided by a local bank and backed by the USDA.

The USDA also encouraged the district to look for grants and donations to help pay for the hospital.

“We absolutely love to see skin in the game,” Werner said. “We like people to take ownership of their program.”