All posts in CEO Viewpoint

Decisions and consequences

Keith Gnagey

Keith Gnagey, TVHC CEO

Within hours of the 2-1 vote by our county commissioners to vacate the current ambulance service contract held by TVHC and give this service to the Teton County Fire Protection District, 20 of our EMS employees received calls from hospital leadership telling them their employment would be ending. Twenty employees and their families are now uncertain about their careers and livelihoods.

We’re sorry. We’re sad. We believe we gave our county leaders every supportable document, testimonial, report and statistic available to show that the service provided by our EMS crew, medical staff and nurses — our team — was clearly the best choice at the best cost for our residents and tourists. And then on Monday, May 16, we lost a service we’ve been providing contractually for 13 years; a service that began with a volunteer force in 1975.

From 1939 to 1975, people in dire emergencies had to find their own way to Teton Valley Hospital. One physician used his station wagon to pick up people and bring them in. Bob Bean, the local funeral director, brought patients to the hospital in his hearse! We have a long and proud history of emergency volunteers and later, paid professionals, who built this service to a high-level paramedic-certified department. These people immersed themselves into the clinical team that’s on hand 24/7 to care for you on what could be the worst day of your life.
Taxpayers voted the Ambulance Service District into existence over a decade ago. On Monday, two people voted to terminate the existing contract, give all operations to the fire district, and wind down the Ambulance Service District. Instead of working together to provide ambulance service in the county, we are now going to have one provider, the fire department. At TVHC, we have expressed, time after time, a desire to forge a true partnership with Fire only to be rebuffed time after time regardless of the greater good that such a partnership could have brought to our community.

To all of our EMS employees and to those in the past who served or supported Teton Valley Ambulance, we give our deepest regards and appreciation. We’re sorry we weren’t able to continue your legacy. We’re sorry that we have families now in turmoil as they try to move ahead with their lives. We’ll continue to place our focus exactly where it should be: on caring for our patients, their families and our community.

We’ll continue to make available all documentation, letters, etc. that we offered to our county commissioners and community throughout this process. Anyone may access these here.

This article appeared in the opinion section of the Teton Valley News.


Change at what cost?

Keith Gnagey

Keith Gnagey, TVHC CEO

It’s interesting when you read about a situation you think you know well and see it presented in a way that is quite different from your viewpoint. Such were my thoughts in reading County Commissioner Leake’s op-ed in the April 28 edition of the Teton Valley News. I’ve been focused on how the current hospital/fire team can deliver ambulance service and how we can make that better. We’re doing that today in the second year of our third consecutive five-year contract. We believe that our approach is delivering high quality ambulance service to the community.

Commissioner Leake is leading the charge to examine what changes should be made regarding how the county provides ambulance service. At TVHC, we are not opposed to change; we embrace reviewing existing programs and identifying areas in need of improvement. However, we are concerned about the direction of change and the potential abruptness of the ambulance change. Our doctors have stated that the current system is better for overall community health and safety than the systems proposed by the Teton County Fire Protection District. As an organization, we have stated that the proposed change would diminish the quality of care that we currently have and that it would hurt the hospital now and in the future. Nationally, EMS services are becoming more and more clinical; transferring services from the hospital to fire goes against that trend. And the varying cost projections in the numerous fire proposals lead us to question whether the cost to taxpayers would in fact be any less than it is now.

The fire proposals are not joint fire/hospital team proposals; they are proposals for fire to run most or all of the ambulance service. They were not developed by the fire district working with the hospital, as was our current contract. None of TCFPD’s proposals include the quality measures the hospital has put into place to track and improve on the service we provide. The proposals also omit hospital EMS training that we feel is critical.

Making the changes proposed by fire would be risky; the county commissioners would be betting on unproven costs, unproven staffing plans, unproven training and quality processes, and unknown governance issues.

At TVHC, we don’t believe these changes are necessary or financially responsible. There are no spending shortfalls; we operate within the agreed-upon budget. We should make the current fire/hospital team better, not eliminate it. In the end, however, it is the citizens of Teton Valley who need to make that call for themselves, and then to express their opinions to their elected County Commissioners. I would encourage you to consider: If someone proposed they could save you and your family money, and then quoted three different prices to do that work, would you then give them a blank check?

The BOCC (acting as the ASD) will meet Monday, May 9 to discuss the future of ambulance services in Teton Valley. Let your voice be heard. Contact your county commissioners and let them know where you stand on the delivery of critical emergency services in the valley. You can find phone and email information (as well as meeting information) at the county website, As always, you can find up-to-date information on EMS services in Teton Valley at


This article appeared as an editorial in the May 5, 2016 edition of the Teton Valley News.


CEO Viewpoint: From Better to Best

Keith Gnagey, CEO

Keith Gnagey, CEO

This is not your average healthcare CEO article. I won’t trot out numbers, stats and confusing lingo. I’ll only use the word “metrics” once, and instead of looking back, I’m going to tell you what Teton Valley Health Care plans to accomplish in 2015 as we work toward becoming the one of the best rural hospitals in the U.S.

In 2015, you can look forward to online access to your medical records, treatment plans and prescriptions through the implementation of our new patient portal. Through this portal, you’ll also be able to tell us how you’d prefer to receive messages, when you need prescription refills and reminders for follow-up care. Online payments and a review of your prior bills will also be available.

We’ll respond to your needs by adding services that make sense for our community. Currently, we can all benefit from 24/7 consultations with University of Utah Health Center stroke and burn specialists through our portable telemedicine robot. In the New Year, we’ll add tele-adolescent psychiatry and hopefully tele-oncology. We also want to add new clinic service lines, such as dermatology.

You’ll see interior changes in our clinics and hospital as we continue to press ahead with our design goal to reflect a healing environment for our patients, their families and friends. Changes will include a more natural design theme and room renovations that will make navigation easier for patients and providers.

We’re also determined to provide more services at a “one-price-covers-all” cost. This is difficult for hospitals because everybody is physically different and many times when a surgeon or physician has begun a procedure, other issues are discovered that need to be taken care of.  For now, you can check out our new bundled pricing for colonoscopies and upper GI screenings at We’ll add more of this type of pricing throughout 2015.

Similar to the saying that good things come in small packages, I believe that Teton Valley is fortunate to have a small hospital that offers impressive medical and nursing staff, round-the-clock emergency care, a menu of carefully selected services and technology that rivals or exceeds the capabilities available at some larger hospitals.  After giving numerous tours of our facility to outside hospital leaders, specialists and providers from large healthcare organizations, I’ve learned to anticipate their expressions of surprise and some envy when they see – for example – our X-ray and surgical suites, laboratory equipment and digital mammography room.

What services, changes and improvements do you want to see at your community hospital? Let us know by calling me at 354-6355, email or comment on our Facebook page. TVHC tweets, pins, FBs and blogs, too, in an effort to continually offer access and information for everyone.  We invite you to be a part of moving TVHC from better to the very best.