As seen in the February 18th issue of The State Journal.

We generally view things from 50 feet and focus on the small things that are happening from day to day. Every now and then, we need to step back, view things from 10,000 feet, and focus on the big picture. Here is a view from 10,000 feet of some of the big picture issues for hospitals in West Virginia.

National Health Reform

After Congress devoted two years to enacting comprehensive national health reform legislation and after the federal and state governments devoted a year to the initial implementation of this legislation, the future of this legislation is in doubt. The Republicans, after taking control of the House of Representatives, have vowed to repeal this legislation. If they cannot repeal it, they have vowed not to fund it. Six federal district courts have also invalidated some or all of this legislation, leaving it to the U.S. Supreme Court to ultimately decide this legislation’s fate. In the meantime, the hospitals in West Virginia have no choice but to navigate their future without knowing what the lay of the land is or what the lay of the land is going to be.

Change in State Leadership

At the same time, the three top officials who oversee hospitals in West Virginia have changed. Earl Ray Tomlin is now Governor. Michael Lewis is now Secretary of the Department of Health and Human Resources. And Jim Pitrolo is now Chair of the West Virginia Health Care Authority. There is always a change in priorities when one of these positions changes. Now, all three have changed at once.

Consolidation

A frequent comment is that the health care industry has become so complicated that it is becoming impossible for a community hospital to go it alone. We have seen our share of consolidation in West Virginia. In the north, West Virginia United Health System soon will be affiliated with a total of six hospitals: WVU Hospitals, United Hospital Center in Bridgeport, City Hospital in Martinsburg, Jefferson Memorial Hospital in Ranson, and Camden-Clark Memorial and St. Joseph’s Hospitals in Parkersburg. In the south, two hospital chains from Brentwood, Tennessee, Community Health Systems and LifePoint, now own five hospitals: Bluefield Regional Medical Center, Greenbrier Valley Medical Center, Raleigh General Hospital in Beckley, Plateau Medical Center in Oak Hill, and Logan Regional Medical Center. In the center, CAMC Health System now owns four hospitals: General, Memorial, Women & Children's, and CAMC Teays Valley Hospitals.

Medicaid

The West Virginia Medicaid Program has always paid extremely low rates. These rates are now so low that we may have reached a tipping point. University of Virginia Medical Center recently stopped accepting West Virginia Medicaid patients because the reimbursement rates are simply too low. Appalachian Regional Healthcare and the community health centers in West Virginia also recently filed separate lawsuits to require West Virginia Medicaid rates to increase its rates. The West Virginia Legislature, in particular, is concerned about these lawsuits. The Legislature's concern is that, if the courts order West Virginia Medicaid to pay substantially higher rates, West Virginia may no longer be one of the few states with a balanced budget. The hospital industry has proposed a solution: a new provider tax to generate additional funding for West Virginia Medicaid.

Sharpe and Bateman Hospitals

There are two state mental health hospitals in West Virginia: Sharpe Hospital in Weston and Bateman Hospital in Huntington. Both are chronically overcrowded. There may be a solution in sight. United Hospital Center recently donated its former hospital to affiliates of Highland Hospital, the freestanding psychiatric hospital in Charleston. These affiliates have filed an application for a certificate of need with the West Virginia Health Care Authority to convert United's former hospital to a freestanding psychiatric hospital to accept transfers from and decompress Sharpe and Bateman Hospitals.

Huntington and Wheeling

St. Mary's Medical Center, Cabell Huntington Hospital, and King's Daughters Hospital in Ashland are all vying to be the dominant hospital in Huntington/Ashland area. Cabell, in particular, has become a much stronger competitor with its affiliation with Marshall University, donations from Joan Edwards, and new ultra-modern wing. In the Northern Panhandle, Wheeling Hospital has made similar moves to be the dominant hospital in the Ohio Valley, recruiting University of Pittsburgh physicians to its campus, recruiting top admitters away from other area hospitals, and undertaking a major renovation.

These are some of the big picture issues for hospitals in West Virginia.