KELLOGG, Idaho-"If you can't beat 'em, join 'em" is an old cliche, but two northern Idaho hospital districts took almost four decades to grasp its meaning.
The West Shoshone and East Shoshone hospital districts are considering merging after a rivalry dating back to the 1960s. It took the bankruptcy and closure of East Shoshone's 23-bed Silver Valley Medical Center in Silverton last year to bring the sides closer.
"Everyone is tired of this fight, and it's gone on for too long," said Joe Huston, West Shoshone board chairman.
The two districts serve the Silver Valley region of Idaho, a sparsely populated 25-mile corridor of about 10 small towns that begins some 30 miles east of Coeur d'Alene. Combined, the districts serve a population of only 15,000.
West Shoshone was formed first and opened 44-bed Shoshone Medical Center in 1958 in Kellogg, about 15 miles west of Silverton.
Prompted by a longstanding rivalry between Kellogg and the towns of Silverton and nearby Wallace, East Shoshone was formed and built Silver Valley about a decade later.
Local observers say competition between the two hospitals greatly contributed to Silver Valley's closure. Although the East Shoshone district still exists, its hospital has been unused since it was closed.
Huston said that late last month the region's community leaders, physicians and elected officials held a planning session that determined merging the districts would be practical, because operating one district would require a lower tax base.
Merging the districts would also make it easier to form an integrated delivery system, said Gary Moore, administrator of Shoshone Medical Center.
"We're looking for opportunities to integrate a large group practice, clinics and long-term-care facilities," Moore said, noting that the Silver Valley hospital might be used for outpatient care.
Although it's unlikely that Shoshone Medical would own all those facilities, Moore said he believes a single district could help unite all the necessary providers. A lower tax base would likely enhance community support for such an effort as well, he added.
Shoshone Medical Center is expected to complete a strategic plan that includes the merger early next month, Huston said.
East Shoshone was the first taxing district ever in the state to face bankruptcy. A merger of two hospital districts has never been attempted in the state, said Terry Peoples, spokesman for the Idaho Hospital Association.
Huston said he believes the merger legally requires only the approval of each seven-member district board, but the consolidation would almost certainly be put to the districts' voters for approval.
"I don't think we would do this without voter approval," he said.
In the meantime, some hurdles remain. Huston said the biggest premerger issue to be resolved is East Shoshone's bonded indebtedness of $800,000, which West Shoshone is reluctant to assume. Another issue is determining how the districts would combine governance.
Charles Ewell, chairman of the La Jolla, Calif.-based Governance Institute, noted that mergers of hospital districts are extremely rare, although it made sense in this case because the parties are so close together.
"The biggest potential for conflict is what one of the hospitals would do post-merger, but it makes it a lot easier when one is already bankrupt," Ewell said.