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May 10 through 16 is National Hospital Week. It’s an opportunity to recognize the critical role doctors, nurses and professional support staff – more than 54,000 trained personnel across West Virginia – make to communities here small and large.
Jim Kaufman, president and CEO of the West Virginia Hospital Association, spoke with Maria Young about some of the challenges that lie ahead for hospitals and those who need them in the Mountain State.
Here is a transcript of that interview.
This transcript has been lightly edited for clarity.
Young: Hospitals here in West Virginia have certainly been in the news a lot lately. Tell me what the state of hospitals in West Virginia is right now. How do things look?
Kaufman: Well, as you noted, we’re celebrating National Hospital week, so it’s a great opportunity to celebrate the 54,000 caregivers that we have in hospitals in West Virginia.
Like many in the country, we are struggling in certain areas. We have workforce shortages, increasing costs, but one of the biggest challenges that we face in West Virginia is with declining populations, especially in small communities. It is a challenge being able to recruit providers, keep providers there, and have sufficient volume to ensure quality programs, and that has been a true struggle for the past several years.
Young: We always hear in rural populations it’s hard to attract physicians, and support staff as well, but I’ve always assumed that’s because those communities are hard to get to, don’t always have roads that are accessible. What you’re suggesting is that the challenge is a little different, that there’s not the population there to support the salaries that would compete with those positions elsewhere.
Kaufman: It’s combinations thereof. You’re right. One of the challenges that we have: on average three out of every four patients that the average hospital in West Virginia treats is covered by governmental programs. So that’s Medicare, Medicaid and the Public Employees Insurance Agency (PEIA).
All three of those programs pay providers less than the cost of care. Now the national average for governmental programs is around 40%. So basically, we’re looking at more than double the national average. So that gives hospitals fewer dollars.
But something that is also a challenge – when you look at something, you also need a patient population to attract a provider. And I know there’s been a lot of discussion about obstetrics, labor, delivery, and there’s a national shortage of OB docs, so getting them to small rural communities is a challenge. But the other part is, if you don’t have a population of women delivering babies, or declining numbers, it’s hard to get there because there’s not enough deliveries to support a quality program. So that is another challenge.
If a physician doesn’t feel they’re gonna have enough volume to keep their skills up, they do not want to come to that smaller rural community.
Young: What I would imagine you would have to do in a situation like that is not be quite so specialized, so that a general practitioner can also deliver babies as needed. Is that not done these days?
Kaufman: Actually, a normal, routine delivery is one thing. The challenge that you run into when you get into obstetrics, everything can be looking perfectly fine, and then all of a sudden it goes south, very, very quick. And it’s not only that obstetrician that you want that’s skilled, but it’s the nurses, it’s the anesthesiologist, it’s the rest of the care team, and if they’re not doing enough, their skills are rote or they don’t have the skills or the equipment. And there’s been national studies showing that the fewer deliveries you do, the more likely you’re going to have negative outcomes.
Young: Talk to me a little bit about reimbursement rates, PEIA, Medicare, Medicaid, and where West Virginia stands on those issues, because I believe wherever we are right now, there are some challenging days and weeks and months ahead, right?
Kaufman: The fortunate part was, before West Virginia expanded its Medicaid program, the average hospital was about 10 to 12% uncompensated care. Today we’re at around 2%, on average, uncompensated care, but our Medicaid volumes are significantly higher, because right now, one out of every three West Virginians is covered by Medicaid.
One of the issues we’re very, very concerned about is, as the state starts to implement the provisions from the Big, Beautiful Bill, you’re going to see some major changes to the Medicaid program. So, for example, we’re going to see Medicaid recertification. They’re changing some of the administrative processes for those on Medicaid. So we’re expecting a large number of Medicaid beneficiaries. I’ve heard anywhere from 30,000 to 50,000 could lose their Medicaid coverage. Now do we think all of them are going to lose coverage? I hope not, but that’s the potential population.