SNOQUALMIE – After a year spent getting back on its feet, the Snoqualmie Valley Hospital is as big as it has ever been and has plans to get bigger.

New services have been added, an emergency room has been started and two new clinics have opened (with a third on the way) in the past 12 months. The hospital is working on a plan to develop its property in Snoqualmie to become more of a health care campus, and there are already plans for an elder care facility that will be built by the Mount Si Senior Center. With such changes behind and in front of it, the hospital is now looking to prove that with additional services and by reaching beyond its borders, it can overcome the financial troubles that have closed it twice before.

“We are on the right track [to solvency],” said Don Galer, chief financial officer for the hospital.

Last summer the Valley Hospital was, in a sense, starting over. Its administrator resigned at the end of 2003 after staff communication and facility issues surfaced. The hospital’s chief financial officer filled in as interim administrator before Rodger McCollum was brought on board to get the hospital district back on its feet.

Since then it has grown precipitously. It changed the management contract of its geriatric psychiatric unit to Overlake Hospital Medical Center and revamped its facilities. It bumped up its urgent care center to a 24-hour emergency room and has been steadily adding specialists who visit the hospital for services previously only available in Seattle and on the Eastside.

It has also opened clinics, the hospital’s first ventures ever outside its Snoqualmie campus. In February, the North Bend clinic opened followed by a Fall City clinic in April. The third clinic, set to open next week in Maple Valley, will be another first for the district. Unlike the previous two clinics, the Maple Valley one will be the first in an area not covered by the boundaries of the public hospital district that governs the hospital (King County Public Hospital District No. 4). The hospital district’s borders start north of Carnation and head south to include Fall City, Snoqualmie, North Bend and areas east to Snoqualmie Pass and some parts of south of Interstate 90. Its southern reach, however, stops just north of Maple Valley, which is not located in any public hospital district. The nearest is King County Public Hospital District No. 1 that covers areas south of Interstate 90, including Kent, Renton and Covington. That hospital district is serviced by Valley Medical Center (VMC) in Renton, which has several clinics, including one in Maple Valley.

Since the Snoqualmie Valley hospital district receives no tax money from anyone in the Maple Valley area, the move to open a clinic was purely a business decision, said McCollum, who added that the Maple Valley health care market is untapped and underserved. With five doctors in the city serving a population of 18,000, the number of physicians in Maple Valley is way below the national average, according to Maple Valley City Manager Anthony Hemstad. In data he presented to the hospital district earlier this year, Hemstad showed that the national average number of doctors per 10,000 residents is about 25.

“Maple Valley should have 40-60 doctors,” Hemstad said.

That shortage led McCollum to believe that Maple Valley citizens would be willing to come izens would be willing to come to the Snoqualmie Valley hospital district’s hospital and clinic. They may even prefer it over the VMC facilities. VMC’s clinic does not have an urgent care facility and is open only during regular business hours. The hospital district’s clinic will be open later in the day, have weekend hours and will have an urgent care facility.

McCollum said the hospital’s Maple Valley clinic should also increase traffic to the Snoqualmie Valley Hospital. He believes those in Maple Valley will drive the extra miles to come to the Snoqualmie hospital and pointed out that the drive to Snoqualmie from Maple Valley would be shorter than the drive from Carnation. Hemstad agreed and said traffic to VMC (located in Maple Valley’s Four Corners area) can get so backed up that people will be more willing to go up State Route 18 than battle traffic to get to Renton.

Getting more services to the hospital, and more people to use them, is the ultimate goal of the hospital district, McCollum said. Once people visit the clinics, they can be directed to the hospital for additional care. The hospital has worked to grow its list of visiting specialists and has brought in more equipment for procedures previously available only outside the Valley. By the end of the year the hospital hopes to grant privileges to an orthopedic (skeletal system specialist) surgeon; ear, nose and throat specialist; and a gastroenterology (digestive system specialist) group. It has a general surgeon group that will be work ing on thoracic (chest) and vascular (heart) procedures by this September. These doctors would not be full-time employees of the hospital, but would visit the campus for care and procedures.

The hospital district is still not yet profitable but both Galer and McCollum said the present budget can be deceiving. There have been a lot of start-up costs associated with improving the hospital’s facilities and opening its clinics. The ability of the clinics to sustain themselves is not clear yet since their budgets are still ingrained in the hospital’s general budget, but Galer said those costs will be separated and itemized for the second half of this year.

Galer said that it is possible the district could be in a positive cash-flow situation by the end of the year. There will still be debt from outstanding bonds and running in the red for so long, but the hospital could be bringing in more money than it is spending by 2006.

Ideally, Galer said, the hospital district would like to reach a point where it can be self-sufficient on income it receives from services and use tax dollars to grow. To help get to that point the district is counting on getting a Critical Access Hospital (CAH) designation by the end of the year. The federal designation, which is administered by the state, would allow the district to receive a higher level of payment from Medicare and Medicaid than the current system allows.

“It basically means more revenue for doing the same thing,” McCollum said.

While the hospital may not turn into a facility such as those available in Seattle or Bellevue, the hospital’s leaders contend they can survive in today’s health care market if they bring services to the Valley (and Maple Valley) that people are today having to drive outside of their hometown to get.

“We need to find what we can do and do it well,” Galer said.