Effective Sept. 30, Powell Valley Healthcare will no longer provide home care and hospice services to the community.

Due to continued changes in federal regulations and poor reimbursement for home care and hospice services, the PVHC Board of Directors made the decision to discontinue this service following an executive session during its July 27 meeting, according to Terry Odom, interim chief executive officer for PVHC.

In recent years, Powell Valley Healthcare’s home care and hospice services have operated at an annual loss of nearly $400,000. Another $400,000 loss was forecast for the current budget year, which began July 1, according to Mike Long, chief finance officer for Powell Valley Healthcare.

“We’ve always operated under the premise that providing home care and hospice is a community service and not a lucrative business model,” said Larry Parker, PVHC board treasurer, in a news release on Friday. “However, we simply can’t continue operating with reimbursements from Medicare and Medicaid being what they are; it is just not sustainable for small rural organizations such as PVHC.”

The decision was a very difficult one for the board, Odom said Monday. Hospital administrators and leaders have been searching for other alternatives for a year, but none have worked out, she said.

Former Chief Executive Officer Bill Patten told the board in January that a report showed that home health and hospice services would not be viable unless Powell Valley Healthcare could partner with West Park Hospital and St. Vincent Healthcare, with St. Vincent picking up 50 percent of the service and PVHC and West Park each at 25 percent.

Odom said Patten discussed the matter earlier this year with West Park CEO Doug McMillan, and she talked with McMillan again in April.

“He said, ‘We’ve talked about it and we’ve decided to go it alone,’” Odom said.

Patten also discussed a possible partnership or buyout with Frontier Home Health Services, and Odom contacted that company again as well “to see if they were willing to partner with us, to buy us, or any kind of joint venture, and they said no,” she said.

“Really, to be successful, you need to have 50 patients” in home health or hospice care, Odom said. “We had around 30 patients” in both services combined.

McMillan said Monday he actually has been interested in partnering with PVHC on home health and hospice services, as that hospital has been losing money on those services as well.

He said he talked to Patten, and they jointly reached out to two or three different home health organizations, only one of which, Frontier, expressed interest in taking over both services.

Frontier did an assessment and sent a report to both hospitals.

“From our standpoint, we were not comfortable with the proposed assessment,” McMillan said. “Based on information presented and the lack of information presented ... we felt it was not in West Park Hospital’s best interest. ... We felt it could actually hurt our services.”

McMillan said home health and hospice is a “loss leader” that is not profitable, but it is important.

“Otherwise, our patients wouldn’t have access to those services,” he said. “It is the right thing to do.”

Powell Valley Home Care and Hospice has operated since 1989 and served 30-40 patients, most in home health and just a few for hospice.

The program’s director, Michelle Hoyt, is working with her staff to transition patients to other home care providers in the area, according to the PVHC.

Hoyt said West Park Hospital’s home care and hospice serves a 50-mile radius, so patients as far east as Byron can choose that as an option.

However, Powell Valley Healthcare’s service has a 60-mile radius, which includes most of Park and Big Horn counties. Unless West Park expands its radius, most people in Big Horn County would not receive services through that program.

McMillan said West Park’s home care director is responding to requests for service, and hospital administrators have asked her “to do our due diligence to assess what (expanding the radius) would do to our agency. Some of their patients are 60 miles past our radius,” he said.

Hands to Help, also based in Cody, provides home-based health services as well. That agency is licensed for Medicaid, but not for Medicare, so it could not provide services for Medicare patients, Hoyt said.

Hoyt said this is a tough time for everybody — hospital leaders, home health staff and patients alike.

“I almost feel like I need a three-day bereavement leave,” she said, her voice breaking as she teared up. “I’m just very upset for all my patients and my staff. We all work very closely together. We got so close to our patients, because we get in their world. That’s a special bond, and to not be able to complete that service — it just hurts.”

“This was a tremendously difficult decision for the board,” Parker said. “All of us are familiar with home care and hospice services, and we know the benefits they provide to the community. (But) we simply can’t continue to take the loss financially.”

Odom said more tough decisions remain. Even with cutting home health and hospice services, “we’re still losing money,” she said.

The board also voted to discontinue its contract with Studer Group, which has guided PVHC’s self-improvement project, for one year.