By Sarah Jane Tribble
KFF Health News
PINEDALE, Wyo. 鈥� There鈥檚 a new morning ritual in Pinedale, Wyoming, a town of about 2,000 nestled against the Wind River Mountains.
Friends and neighbors in the oil- and gas-rich community 鈥渢ake their morning coffee and pull up鈥� to watch workers building the county鈥檚 first hospital, said Kari DeWitt, the project鈥檚 public relations director.
鈥淚 think it鈥檚 just gratitude,鈥� DeWitt said.
Sublette County is the only one in Wyoming 鈥� where counties span thousands of square miles 鈥� without a hospital. The 10-bed, 40,000-square-foot hospital, with a similarly sized attached long-term care facility, is slated to open by the summer of 2025.
DeWitt, who also is executive director of the Sublette County Health Foundation, has an office at the town鈥檚 health clinic with a window view of the construction.
Pinedale鈥檚 residents have good reason to be excited. New full-service hospitals with inpatient beds are rare in rural America, where declining population has spurred decades of downsizing and closures. Yet, a few communities in Wyoming and others in Kansas and are defying the trend.
鈥淭o be honest with you, it even seems strange to me,鈥� said Wyoming Hospital Association President Eric Boley. Small rural 鈥渉ospitals are really struggling all across the country,鈥� he said.
There is no official tally of new hospitals being built in rural America, but industry experts such as Boley said they鈥檙e rare. Typically, health-related construction projects in rural areas are for smaller urgent care centers or stand-alone emergency facilities or are replacements for old hospitals.
About half of rural hospitals lost money in the prior year, according to Chartis, a health analytics and consulting firm. And nearly 150 rural hospitals have closed or converted to smaller operations since 2010, according to data collected by the University of North Carolina鈥檚 Cecil G. Sheps Center for Health Services Research.
To stem the tide of closures, Congress created a new rural emergency hospital designation that allowed struggling hospitals to close their inpatient units and provide only outpatient and emergency services. Since January 2023, when the program took effect, 32 of the more than 1,700 eligible rural hospitals 鈥� from Georgia to New Mexico 鈥� have joined the program, according to data from the Centers for Medicare & Medicaid Services.
Tony Breitlow is healthcare studio director for EUA, which has extensive experience working for rural healthcare systems. Breitlow said his national architecture and engineering firm鈥檚 work expands, replaces, or revamps older buildings, many of which were constructed during the middle of the last century.
The work, Breitlow said, is part of health care 鈥渟ystems figuring out how to remain robust and viable.鈥�
Freeman Health System, based in Joplin, Missouri, to build a new 50-bed hospital across the state line in Kansas. Paula Baker, Freeman鈥檚 president and chief executive, said the system is built for patients in the southeastern corner of the state who travel 45 minutes or more to its bigger Joplin facilities for care.
Freeman鈥檚 new hospital, with construction on the building expected to begin in the spring, will be less than 10 miles away from an older, 64-bed hospital that has existed for decades. Kansas is one of more than a dozen states with that would require health providers to obtain approval from the state before offering new services or building or expanding facilities.
Baker also said Freeman plans to operate emergency services and a small 10-bed outpost in Fort Scott, Kansas, opening early next year in a corner of a hospital that closed in late 2018. Residents there 鈥渃ried, they cheered, they hugged me,鈥� Baker said, adding that the 鈥渓evel of appreciation and gratitude that they felt and they displayed was overwhelming to me.鈥�
Michael Topchik, executive director of the Chartis Center for Rural Health, said regional healthcare systems in the Upper Midwest have been particularly active in competing for patients by, among other things, building new hospitals.
And while private corporate money can drive construction, many rural hospital projects tap government programs, especially those supported by the U.S. Department of Agriculture, Topchik said. That, he said, 鈥渟urprises a lot of people.鈥�
Since 2021, the USDA鈥檚 rural Community Facilities Programs have awarded $2.24 billion in loans and grants to 68 rural hospitals for work that was not related to an emergency or disaster, according to data analyzed by KFF Health News and confirmed by the agency. The federal program is funded through what is often known as the farm bill, which faces a September congressional renewal deadline.
Nearly all the projects are replacements or expansions and updates of older facilities.
The USDA confirmed that three new or planned Wyoming hospitals received federal funding. Hospital projects in Riverton and Saratoga received loans of $37.2 million and $18.3 million, respectively. Pinedale鈥檚 hospital received a $29.2 million loan from the agency.
Wyoming鈥檚 new construction is rare in a state where more than 80% of rural hospitals reported losses in the third quarter of 2023, according to Chartis. The state association鈥檚 Boley said he worries about several hospitals that have less than 10 days鈥� cash on hand 鈥渄ay and night.鈥�
Pinedale鈥檚 project loan was approved after the community submitted a feasibility study to the USDA that included local clinics and a long-term care facility. 鈥淚t鈥檚 pretty remote and right up in the mountains,鈥� Boley said.
Pinedale鈥檚 DeWitt said the community was missing key services, such as blood transfusions, which are often necessary when there is a trauma like a car crash or if a pregnant woman faces severe complications. Local ambulances drove 94,000 miles last year, she said.
DeWitt began working to raise support for the new hospital after her own pregnancy-related trauma in 2014. She was bleeding heavily and arrived at the local health clinic believing it operated like a hospital.
鈥淚t was shocking to hear, 鈥楴o, we鈥檙e not a hospital. We can鈥檛 do blood transfusions. We鈥檙e just going to have to pray you live for the next 45 minutes,鈥欌�� DeWitt said.
DeWitt had to be airlifted to Idaho, where she delivered a few minutes after landing. When the hospital financing went on the ballot in 2020, DeWitt 鈥� fully recovered, with healthy grade-schoolers at home 鈥� began making five calls a night to rally support for a county tax increase to help fund the hospital.
鈥淏y improving health care, I think we improve everybody鈥檚 chances of survival. You know, it鈥檚 pretty basic,鈥� DeWitt said.
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