When Natrona Collective Health Trust hired a consultant this spring to assess Banner Health’s management of Wyoming Medical Center, the aim was to clarify conflicting narratives swirling around Wyoming’s biggest hospital and judge if Banner is meeting certain obligations.
Critics had maintained that since Banner purchased Wyoming Medical Center, management had allowed unacceptable and dangerous slips in the quality of care for patients. Hospital administration and others, meanwhile, contended Banner had provided crucial resources to sustain care through the pandemic and beyond.
The Natrona Collective Health Trust, a private health foundation that was founded to support the needs of the Casper hospital, commissioned consultant PYA to assess the scenario. In the newly released assessment, PYA found that in 2024, Banner met the majority of its 17 contractual covenants — such as maintaining essential services and adding new technologies. The same report found Banner lacking in four areas, including commitment to safety and patient satisfaction.
Though generally pleased with the report, Banner Health and Natrona Collective Health Trust representatives have vowed to address the areas that have gone unmet. (Natrona Collective Health Trust is a financial supporter of WyoFile.)
“We’re going to be adherent to the agreement,” Banner Western Division President Margot Karsten said during a meeting this week. “Fourteen out of 17, that’s a good track record, and we’re going to be perfect next year.”
The assessment, and Banner’s response to it, could shape the future management of Wyoming’s biggest hospital, a regional trauma and referral center that serves a huge swath of the state.
“This is an important topic in our community, and it has been for a long time,” Natrona County Commissioner Dave North said. “We need to move forward and grow, make sure that we’re doing what we have to do to meet those obligations, and make sure our community is getting what it needs, especially from our health care providers.”
The run up
Banner Health purchased Wyoming Medical Center for roughly $200 million in August 2020. The nonprofit hospital previously operated under a lease agreement with Natrona County, which owned the facility. Banner Health, headquartered in Phoenix, folded the hospital into its network of 33 nonprofit hospitals in six states.
The Natrona County Commission approved the arrangement, touted by supporters as a way to leverage Banner’s resources to create a preeminent facility and reduce the amount of care that leaves the state. Today, Banner Wyoming Medical Center operates two campuses and 14 care clinics.
In the transaction, Banner agreed to comply with contractual stipulations, including providing 24/7 emergency department care and retaining certain levels of maternity and trauma care, along with other essential services.
But not long after Banner took over, stories began to percolate in the community about service declines, doctors quitting, long waits and poor care. Those experiences spurred a group of concerned citizens to launch a campaign aimed at bringing the level of care back to what they said the community deserves.
Stories of long wait times, prescriptions going unfilled, understaffed departments and an exodus of doctors disrupting continuity of care were unacceptable, the citizens group said. The group worried eroding services would send residents elsewhere, degrading hometown quality and compounding health care challenges.
Banner defended its management. Ownership changes always trigger turnover and turbulence, CEO Lance Porter said at the time, but Banner had worked to iron out issues and provide excellent care.
The citizens brought their concerns to Banner administration and Natrona Collective Health Trust — which oversees Banner’s contractual compliance. The group also asked the Natrona County Commission, which plays a role in enforcing Banner’s obligations, to weigh in.
The Health Trust hired PYA in February to provide a third-party determination of whether and how Banner is living up to its commitments.
The results
In the months since, PYA reviewed the 2020 sale documents, toured the hospital and interviewed some 25 stakeholders. Consultants dug into appointment-wait-time data and patient transfer logs, among other information.
One thing was clear, said Lee Ann Odom, a PYA principal.
“We will say collectively that the entire community, you could feel the passion and the care and everybody’s alignment around wanting to have high-quality, excellent patient experience here in Casper,” she told commissioners during a Monday presentation of the findings.
The assessment, which compared 2024 with 2020, identifies 17 covenants Banner Health is on the hook for. In 2024, Banner met 13 of those. It maintained the Wyoming Medical Center as a Wyoming service area hub and acute care center, kept up essential services and collaborated with other hospitals, the report found.
However, consultants also found four areas lacking. One involved the Wyoming Advisory Board. That panel was established to act as a liaison for the public to provide input to Banner Health and Wyoming Medical Center. Such boards are industry standard in instances of management transition.
“It is critically important as organizations transition that they listen and they listen carefully and they listen authentically to the communities that they serve,” Odom said. Though the board met in 2024, she said, consultants did not find satisfactory evidence of active listening, with the community having meaningful input into things like strategic planning, CEO performance, clinical programs and expansion.
Banner also failed to meet its capital investment commitment. It had committed to spending $30 million on capital investments by 2023, but only reported outlaying $17.8 million.
And finally, PYA docked Banner for falling short on its “commitment to quality, safety and patient satisfaction” and “growth of clinical capabilities, services and access.”
Hot seat
During the discussion that followed PYA’s presentation, commissioners put both Banner and Trust representatives in the hot seat with pointed questions.
Commissioner Dallas Laird asked Trust representatives why the advisory board failed to function properly.
“I cannot say why that is the case,” Trust Board Chair Eric Nelson answered, “but I can tell you, we’re committed to finding that out, to making sure that that advisory committee is empowered to do what it needs to do.”
Laird also asked about the missed capital investments deadline.
Banner Wyoming Medical Center CEO Porter said the hospital has embarked on 19 major renovation projects and that reporting time between allocated and disbursed funds can lag.
“If you remember, one of the major reasons Wyoming Medical Center was sold is because they didn’t have access to capital, and so we inherited a building that was very old,” Porter said. “And so we’ve engaged in some of these renovations that have been needed for a very long time.”
The hospital’s 2025 annual report, Porter believes, “will show that we are in full compliance and on track to be in compliance going forward.”
Banner is proud of the PYA assessment, Porter added.
“Without a doubt, health care has improved since 2019,” he said. “We have expanded our access. We’ve expanded our number of physicians and providers that are providing care. I think we’ve done a phenomenal job.”
Commissioner Peter Nicolaysen regretted that the PYA report only focused on 2024, he said, rather than including the first three years following the transaction.
“I think that the community’s expectation was that the level of health care and medical care in the community, as of the transaction date, was going to be maintained, if not improved,” he said. “Over my first two years on this board, I heard from countless citizens of our community, with some tragic stories” about Banner’s level of care.
In addition, Nicolaysen said, “we’ve lost dozens and dozens and dozens of health care professionals … So I’m concerned that we’ve lost a lot of ground just to begin with.”
What’s next?
Banner will address the four covenant areas it was found lacking, Western Division President Karsten told commissioners. It is already making improvements for the advisory committee and will also bring its capital investment tracking more in line with actual spending, she said.
Banner has made progress, Bob Price of the concerned citizens group said, but work remains to be done to ensure it meets obligations for operating the hospital. The citizens’ group offered several recommendations to the commission. Increasing financial transparency, demanding stronger community health care metrics and strengthening annual reporting standards all made the wish list.
“We do feel that it must fall to you, the county commissioners,” Price said. “The decisions made now will shape outcomes for years to come.”
The Trust will also do more, representatives said.
“We are responsible for ensuring that the covenants that were made at the time of the transaction are being lived up to,” said Trust CEO Beth Worthen, “and we take that responsibility extremely seriously.”
PYA was retained for three years.
In 2024 I had an outpatient surgical procedure done at the hospital and could not have been more pleased by the quality of professional care that I received. I did, however, notice the aging signs of the facility that the CEO mentioned. That did not happen overnight! He is correct in saying that it will take several years and a continued investment in capital construction and renovation to get the facility up to date. It is short-sighted and narrow thinking for the county commissioners to believe the updates could have happened by now. Transitions of this nature do take time and there is bound to be some dissatisfaction and and turmoil as the community and the hospital navigate the changes. But, I believe the CEO, hospital staff, the commissioners and the Health Trust are committed to success and will continue towards improving the quality of and satisfaction with the level of care.
The article states they are nonprofit. Is that why I need to pay what mu insurance didn’t pickup? As for care my mom has been admitted at Banner numerous times over the past few years. She has not seen the same doctor twice. In fact the most recent time she saw four different doctors who gave her four different prognosis. The local PCs cannot see their patients there. They would rather use hospitalists. Who knows my history better than my PC. Begrudgingly my PC sent me to the ER two years ago. He said I needed a CT scan, possibly an MRI. The ER doctor said neither one would show anything that I was just constipated. Turns out my gallbladder had gone bad. The ER doctor treated me as if I was disturbing him. I refuse to return to Banner. My wife knows I’m to go to the closet hospital in Douglas.
“Healthcare” will continue to get worse. $$$ now drives the entire industry. We have the Affordable Care Act to thank for the continued erosion.
Take care of yourself the best you can, eat healthy foods, exercise. Stay out of hospitals if at all possible.
Banner Health when compared to others like UCHealth pall in comparison. I drive 3 hours because I have been treated at a Banner facility and if conscious I would never go to another of their facilities.