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Coronavirus Straining Financial Resources For Ohio Valley Hospitals

As coronavirus cases continue to increase throughout the Ohio Valley, rural hospitals are preparing for a potential surge of COVID-19 patients. But as they do so, these hospitals face tough financial decisions, and some could close down altogether.

Hospitals throughout the region have had to make brutal financial decisions the past two weeks. St. Claire Hospital in Morehead, Kentucky, furloughed 300 employees as the regional hospital saw a decline in patients. Appalachian Regional Healthcare, which serves east Kentucky and southern West Virginia, is furloughing 500 out of 6,000 employees. Williamson Memorial Hospital in West Virginia had planned to close this month before being bought in bankruptcy proceedings.

One hospital CEO in West Virginia says these financial troubles are linked to the efforts to fortify hospitals against the coronavirus pandemic, as states have suspended elective surgeries to make way for an anticipated surge of COVID-19 patients.

“When you take away the higher margin procedures like outpatient elective surgeries, you know, it really cripples a smaller community hospital,” said David Hess, who has served for six years as CEO of WVU Medicine Reynolds Memorial Hospital in Glen Dale, a town of roughly 1500 people in West Virginia’s Northern Panhandle. “The higher margin procedures pay for the negative margin or the lower margin procedures like staffing in emergency room 24-7,” he explained. “Some of the patients that come here, they spend an inordinate amount of time here, and we don’t get paid to be able to keep patients for prolonged periods of time.”

Governors across the Ohio Valley have ordered hospitals to suspend elective procedures. For Reynolds Memorial, Hess said, that has meant about 20% fewer patients now than a month ago in his 90-bed facility because they’ve suspended joint replacements, gallbladder surgeries, and colonoscopies.

Yet he’s waiting for a looming financial crunch. He said most rural hospitals collect payment from lucrative elective procedures one to two months after it’s completed. That money pays for employee payroll and supplies. When that money doesn’t show as the coronavirus outbreak peaks in May, more tough financial decisions could await hospitals.

He said that’s why some hospitals are trying to get ahead of the crunch through furloughs.

“It may be the final straw for some of these distressed hospitals,” Hess said. “I don’t want to see anybody get laid off, and I don’t want to have to take away anybody’s hours because I know that’s how they live. And I know that’s what they depend on. So that does worry me at night.”

While he believes the WVU Medicine healthcare system is financially stable — the largest in the state representing 14 hospitals in West Virginia — his hospital is still considering taking out loans to survive the shortfall.

Closing Doors

Meanwhile, shuttered hospitals throughout the Ohio Valley are leaving a healthcare system hollowed out in preparing for the coronavirus.

An Ohio Valley Resource data analysis showed at least 21 hospitals have closed over the past 15 years in the Ohio Valley. Three of those closures came just within the past year in an area around Wheeling, West Virginia, about eight miles north of Reynolds Memorial. And more hospitals elsewhere are still closing this month, as governors commit to keep them operating during the coronavirus pandemic if necessary.

One of those is Our Lady of Bellefonte Hospital, a 220-bed facility in Greenup County, Kentucky, planning on closing by May due to a lack of available staffing.

“Listen. We’re going to use that building,” said Kentucky Gov. Andy Beshear at a press conference this week. “We’re going to use it. Whether or not the hospital system is operating at that time, we’ll operate it with somebody else. We are going to use that building and I’d like that hospital system to try to hold on.”

Yet the options that remain once these hospitals close are unclear. Penn State University Assistant Professor Simon Haeder has studied health care policy and hospital closures for years. He said while a state could take over a hospital through eminent domain, keeping it operational is another question.

“What do you do then to staff those hospitals…and to establish the supply chains to keep them running? Because most of these places, they have very limited supply from everything that’s needed for this crisis,” Haeder said. “The government, on top of not having the supply chains, also doesn’t really have expertise anymore in running these kinds of entities.”

Haeder said to maximize hospital capacity, relief funds need to be sent to struggling rural hospitals to keep them afloat while also relying on publicly-funded healthcare infrastructure already in place, such as using the numerous Veterans Affairs clinics.

Yet he said with many state budgets strapped for cash due to the pandemic, funding for these hospitals may be hard to find.

For one Kentucky elected official in Greenup County, he can see what his community is losing right outside his window.

“That’s the only hospital I got in my county. When it closes we will never be reopened,” said Kentucky State Rep. Republican Danny Bentley, who lives a mile away from Our Lady of Bellefonte hospital. “My heart’s in it.”

Bentley, a pharmacist and former president of the Ohio Pharmacist Association, also served on a volunteer board for the hospital. While he said it’s too late to save his local hospital, he hopes a bill he’s sponsoring in the Kentucky legislature will help other hospitals.

The legislation would create a state emergency loan program for rural hospitals in counties with 50,000 residents or less to fund staffing, upgrade facilities and provide services not previously available. The bill unaminously passed the House, and he hopes it could get a vote soon in the Senate.

Bentley said after seeing a bill advance providing a $35 million state-funded loan for the purchase of Jewish Hospital in Louisville, he wants more attention for rural healthcare providers.

“It’s a truly needed instrument, so they’ll have that chance,” he said. “I hope that I can do something for this county in this area.”

West Virginia Hospital Announces Closure Amid Pandemic

The only hospital in a southern West Virginia county is closing after the coronavirus crisis disrupted attempts to sell the business, news outlets report.

Williamson Memorial Hospital in Mingo County announced plans on Monday to close in three weeks.In a statement, hospital officials explained that they went into bankruptcy proceedings in February and obtained a loan to fund operations until the business could be sold. The idea was to stay open until a sale closed in early April. But all potential buyers were health care providers who are now focused on preparing their own facilities for waves of coronavirus patients, delaying any sale.

“There is no option to obtain sufficient additional financing given its existing level of debt and the large losses currently being sustained by the hospital,” officials said. “The only option available to the hospital is to shut down its operations.”

U.S. Sen. Joe Manchin called it “unconscionable” that any hospital would close while the virus spreads.”I will continue to work with hospital leadership and state and local officials on next steps to ensure that Mingo County will not go without treatment during this terrible pandemic,” the West Virginia Democrat’s statement said.

Ohio Valley Facing Pandemic With A Health System Hollowed Out By Hospital Closures

As new cases of coronavirus mount in the Ohio Valley, health officials are bracing for an onslaught of patients and what could be unprecedented demand for beds, medical staff and specialized equipment.

Kentucky, Ohio and West Virginia have disproportionately high rates of people vulnerable to serious illness from COVID-19. But the region’s capacity to treat them has been sharply reduced by the closure of some 21 hospitals over the past 15 years. An analysis by the Ohio Valley ReSource shows some of the communities where hospitals have closed have some of the nation’s poorest health outcomes, making them especially vulnerable.

Still more hospitals in the region are being closed now, even as the pandemic unfolds.

Tiffany Wilburn-Meeks has lived in eastern Kentucky’s Greenup County for most of her 38 years. And the hospital her family has always relied on is only a five-minute drive away.

Tiffany Wilburn-Meek and her child Darian.

Our Lady of Bellefonte Hospital is where she would go if she was sick growing up, and it’s where she was considering taking her 23-month-old daughter Darian for speech therapy. It’s also where her mom, Judy, would go if an asthma attack turned for the worst.

“But I think if she’d had to go to King’s Daughters [Hospital], I don’t know that she would have survived the drive because it’s 10 or 15 more minutes down the road.”

But by May, her family won’t be able to rely on Our Lady of Bellefonte anymore. The 220-bed hospital with more than 1,000 employees — started by a congregation of Catholic sisters in 1953 with the blessing of the pope via telegram — will close its doors.

That would leave 35,000 people in Greenup County without a hospital, forcing those who need intensive medical care to drive to King’s Daughters Hospital in Ashland. This comes as many Ohio Valley public health officials are bracing for the coronavirus to reach their communities.

While the number of confirmed cases in her region have not reached levels in larger cities, she knows the number will grow.

“If it does, there’s no way that King’s Daughters is going to be able to handle that,” she said. “It is terrifying, and I’m afraid that people will die as a consequence of the hospital closing.”

In a statement, a spokesperson for King’s Daughters Hospital said they were working daily with Our Lady of Bellefonte to potentially expand the capacity of King’s Daughters if patient needs surge due to coronavirus.

The entrance of Our Lady of Bellefonte Hospital in 2009.

Wilburn-Meek started an online petition to try to call attention to the situation and save the hospital, but she isn’t optimistic she’ll be successful. And more than a dozen communities across the Ohio Valley are facing a similar situation.

Our Lady of Bellefonte will join at least 21 other hospital closures in the Ohio Valley within the past 15 years. The Ohio Valley Resource estimates those 21 closures represented more than 1,000 hospital beds in total.

Some shuttered hospital sites are now vacant parking lots. Some have been turned into addiction rehab facilities or urgent care facilities, but those often have limited or no in-patient services.

These closures have left a hollowed out healthcare infrastructure in the Ohio Valley, and leading healthcare professionals worry that the loss of hospital beds, skilled staff and equipment — combined with a population that is especially vulnerable to COVID-19 disease — could hinder how well the region can respond to the coronavirus.

Running Out

For 15 years, Marlene Moore was lead nurse of the intensive care unit at Ohio Valley Medical Center in downtown Wheeling, West Virginia. She would make determinations about who would be admitted and who would be discharged, who would be transferred to other departments and hospitals, and helping younger nurses with questions and assistance.

That time came to an end when the company that owned OVMC and another hospital in nearby Martin’s Ferry, Ohio, announced last year both hospitals would close. Along with Belmont Community Hospital also closing, three hospitals in total last year shuttered in the Wheeling metropolitan area.

Ohio Valley Medical Center, one of three hospitals that closed in the area last year.

“It was just devastating, because especially at our smaller hospitals, the employees know everybody. I mean, from housekeeping, to dietary to the lab, to all the departments,” Moore said. “It affected the whole valley.“

Moore started working last month at what is now the only hospital in town, Wheeling Hospital, where a coronavirus patient is currently being treated.

She said because Wheeling Hospital often has many beds filled with patients having other needs, those needing a bed for coronavirus treatment may have to travel a half-hour or more to hospitals in Steubenville, Ohio, Columbus or Pittsburgh.

And it’s the kind of people her hospital tends to serve that has her particularly worried.

“We have such an older population here. And if you get several that come in at the same time with severe respiratory distress, you’re going to run out of ICU beds, you’re going to run out of ventilators, you’re actually going to run out of places to treat these people,” she said.

A recent Kaiser Family Foundation study found West Virginia led the nation in how vulnerable its population is to coronavirus because of old age and preexisting conditions. More than half of all adults in West Virginia and more than 45% of all adults in Kentucky were at high risk of serious illness from coronavirus because of advanced age, pre-existing conditions, or both.

A report from Kaiser Health News also found there are only 325 ICU beds for more than 12,000 people over the age of 60 in Ohio County, where Wheeling is located. People over the age of 60 make up 28% of the county’s population.

According to an Ohio Valley Resource data analysis, 4 of the 18 counties that lost hospitals over the past 15 years also have some of the worst health outcomes in the nation. Those counties have some of the country’s highest rates of chronic respiratory disease deaths, cardiovascular disease deaths and diabetes prevalence.

Amid closures, remaining Ohio Valley hospitals are reinforcing their capacity for beds, equipment and personal protective equipment for worst case scenarios.

A statement from the West Virginia Hospital Association said hospitals are canceling or rescheduling elective surgeries to free up more beds, in compliance with a state emergency order. Hospitals are converting different departments into infectious disease units, and developing “alternative treatment sites.” One hospital in Athens, Ohio, has now set up a triage tent to treat potential patients outside.

Rising Costs

Even if Ohio Valley hospitals are able to accommodate a surge of coronavirus patients, the financial toll it could take could devastate rural healthcare providers.

A report last year from Navigant Consulting showed that 16 rural hospitals in Kentucky — about a quarter of all rural hospitals in the state — were at high risk of closing due to unstable financial situations. Some of the reasons cited for financial struggles include population loss with fewer people to serve, and more patients insured through Medicare and Medicaid, which often undercompensates hospitals for treatment.

Those ongoing challenges will only be made worse by the pandemic.

“The payment mechanism for treating these patients is not clear at this point. The unusually long length of stay I think is a concern with the very sick of these patients who typically end up, or have ended up, on ventilator care, which is very expensive and resource intensive to deliver,” said Bud Warman, Kentucky Hospital Association Vice President and former CEO of Highlands Regional Medical Center in east Kentucky. “They haven’t always had potentially this much volume of wants to deal with.”

The American Hospital Association is asking for $100 billion from Congress to offset anticipated coronavirus costs, while some rural hospitals struggle to ration protective medical supplies. A bill being considered by the Kentucky Senate would also provide a loan program for struggling rural hospitals.

Warman also said when hospitals have closed in Appalachia, there are often few options remaining for the people the provider served.

“In some cases, they just don’t have adequate transportation to get them that longer distance,” Warman said. “If they’re deciding between food on the table or traveling 50 miles to see a doctor or to seek health care, oftentimes, they make the choice for food on the table. It sounds dire, but the fact is in many parts of our state, many parts of Appalachia, that is the case.”

What’s Left

In central West Virginia, Michael Brumage is leading one of the remaining options for those without easy access to a hospital.

As Chief Medical Officer of Cabin Creek Health Systems, he directs several Federally Qualified Health Centers that provide preventative care and substance abuse treatment, often for people who are low-income or uninsured. His experience also extends across multiple organizations: Brumage serves as director of the Preventative Medicine Residency Program in the WVU School of Public Health, was former executive director of the Kanawha-Charleston Health Department, and former health officer for Kanawha County and Putnam County, West Virginia.

His staff is preparing to treat patients who have respiratory symptoms outside of the centers in order to prevent the spread of the virus inside their buildings, and they’ll also have curbside service for those with respiratory symptoms.

“Our public health system has been underfunded for many, many years, at the federal, state and local levels,” Brumage said. “So we’re fortunate, I think that there are federally qualified health centers, that there are free and charitable clinics that are able to pick up the slack.”

But even with his centers, there are still intensive, in-patient services that he can’t provide, that a hollowed out healthcare infrastructure has left lacking.

Brumage was born in Fairmont Regional Medical Center in Fairmont, West Virginia. So was his sister. He’s had several relatives who’ve been hospitalized there over the years. The hospital is set to close this week.

“It’s befuddling to me how they can close this hospital during a pandemic, when there are going to be so many more beds that need to be filled. It staggers the imagination,” Brumage said.

While a hospital is being built to replace Fairmont Regional, Brumage is worried that it will be too late for the demand for hospital beds, ventilators and skilled staff needed to respond to the pandemic.

“There will be many competing economic priorities once this clears to restore the American economy,” Brumage said. “But shame on us if we don’t invest in our public health infrastructure, and if we don’t invest in our overall health infrastructure, and if we don’t look for ways to make health care equitable for all Americans.”

Fairmont Hospital Closing In 'Days,' Owner Says In Letter

The Fairmont Regional Medical Center is shutting down ahead of schedule and will cease operations over the next several days, the hospital’s owner said in a letter Monday.

Alecto Executive Vice President Michael J. Sarrao wrote that the hospital will complete its winding down of services and will stop admitting patients over “the next several days.” Hospital officials said on Feb. 18 that the facility would close within 60 days.

The letter comes after last week’s announcement that West Virginia University Medicine would take over portions of the facility while constructing a new hospital in the area. Gov. Jim Justice and Albert L. Wright Jr., CEO and president of the WVU Health System, said Fairmont Regional Medical Center would be closed for around a month to allow for administrative turnover at the facility.

Sarrao wrote that the decision to shutter in the coming days was “based on Governor Justice’s and WVU Medicine’s announcement.”

“In other words, the plan announced by Governor Justice and WVU Medicine on Friday specifically calls for FRMC and its emergency room to be closed for a period of time before WVU Medicine commences operations at the FRMC location,” he wrote.

Wright last week said he anticipated that the Fairmont Regional Medical Center would be closed from the end of March to around early-to-mid May while preparations are made for WVU Medicine to operate there. He said he planned to have resources to transport patients to different facilities while the Fairmont hospital is temporarily closed, acknowledging potential problems that could emerge as the country grapples with the coronavirus pandemic.

“We might have a bumpy couple months here but long term we’re going to get it right,” he said last week.

The new WVU Medicine hospital will be about 2 miles (3.2 kilometers) away from the shuttering Fairmont Regional Medical Center and is expected to have 100 beds and about 500 employees, Justice said. It is expected to be open within 18 to 24 months.

The California-based Alecto has drawn severe local criticism over its decision last month to close the hospital. Hospital officials said they could not find a buyer for the facility.

State Del. Michael Angelucci, who operates an ambulance service in Fairmont, shared Sarrao’s letter with The Associated Press.

The announcement followed several other hospital closures or health care cutbacks in the region.

Pleasant Valley Hospital in Point Pleasant recently announced it was cutting 53 full-time jobs and ending obstetrics services. Hospitals in Bluefield and Richwood have closed. Williamson Memorial Hospital filed for bankruptcy in October, and a nonprofit system that operates hospitals in Charleston and South Charleston announced last month that it planned to file for Chapter 11 bankruptcy but would remain open.

WVU To Build Hospital To Replace Closing Fairmont Facility

West Virginia University Medicine will build a new hospital to replace a closing medical center in Fairmont, Gov. Jim Justice and university officials said Friday.

The new WVU hospital will be about 2 miles (3.2 kilometers) away from the shuttering Fairmont Regional Medical Center and is expected to have 100 beds and about 500 employees, Justice said. It is expected to be open within 18 to 24 months.

“You can’t stand to not have a community full-service hospital right here in Marion County,” Justice said.

Fairmont Regional Medical Center, owned by California-based Alecto Healthcare, announced last month that it was unable to find a buyer and that it would close within 60 days.

Albert L. Wright Jr., CEO and president of the WVU Health System, said health care workers will keep portions of the Fairmont Regional Medical Center open while the new facility is being built.

He said there will be roughly a month-long gap in services starting around the end of March due to administrative turnover, though the hospital should be running again by early to mid-May. They plan to have resources to transport patients to different facilities while the Fairmont hospital is temporarily closed, Wright said.

“We might have a bumpy couple months here but long term we’re going to get it right,” he said.

The WVU Health System operates 11 hospitals and is the state’s largest health system.

The announcement of the hospital was a rare bright spot as many medical facilities in the state have announced closures or drastic cutbacks in services.

In January, Pleasant Valley Hospital in Point Pleasant announced it was cutting 53 full-time jobs and ending obstetrics services. Other hospitals have closed in Bluefield and Richwood. Williamson Memorial Hospital filed for bankruptcy in October, and a nonprofit system that operates hospitals in Charleston and South Charleston announced in January that it planned to file for Chapter 11 bankruptcy but would remain open.

Officials have also announced that a hospital in Ashland, Kentucky, near Huntington, West Virginia, would shut down later this year.

Eastern Kentucky Hospital To Close, Impacting 1,000 Area Jobs

An Ashland, Kentucky, based hospital has announced it will be closing at the end of September, resulting in the loss of about 1,000 area jobs.

Our Lady of Bellefonte Hospital announced it will be closing in a press release earlier this week.

Officials wrote in a press release that for the past year, the hospital has been trying to troubleshoot options to keep doors open, but that ultimately they were “not enough to effectively operate in an environment that has multiple acute care facilities competing for the same patients, providers and services.” The hospital is located about a half hour from Huntington in Ashland, Kentucky. Other local facilities include Marshall Health and King’s Daughters Medical Center.

The closure will impact not only the 214-bed inpatient facility, but out-patient care sites and the physician network as well.

On their website, the National Rural Health Association reports nearly 700 rural hospitals are at risk of closure and more than 100 have closed in recent years.

In West Virginia, many rural hospitals have begun joining bigger systems such as Marshall Health and WVU Medicine to keep doors open.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from Marshall Health and Charleston Area Medical Center.