Rural Hospitals Story Archives - West Virginia Public Broadcasting

Senate Pushes Back On Big Pharma

Drug manufacturers have been pushing back at a three-decade-old federal law that helps low and middle income patients get prescription drugs. The state Senate passed a bill Wednesday to combat this trend.

Under the federal 340 B program, health care providers like hospitals and community health centers that fit certain criteria, like being a public or nonprofit organization with a high volume of low income or uninsured patients, can get medicines at a discounted rate.

This allows them to sell the medicines at a discounted rate to low income or uninsured patients and provides extra money to help those patients. Those health care institutions are known in the program as safety net providers.

Senate Majority Leader Sen. Tom Takubo, R- Kanawha, said this program is for patients who make too much to qualify for Medicaid but not enough to be able to afford often expensive prescriptions.

“What this program really does is helps those that are trying to climb out of poverty but they don’t qualify for Medicaid. And they’re trying to afford their medicines, and they have real health problems,” Takubo said.

Pharmacies are able to participate in the 340B program by way of being contract pharmacies of the safety net providers. This is especially important in rural areas where some of those safety net providers are hours away.

In 2020, manufacturers started implementing restrictions on contract pharmacies.

For example, if a safety net provider ordered insulin for its contracted pharmacies, drug manufacturers would refuse to send the insulin to the rural pharmacies.

Drug manufacturers argue that the increase in use of the program has affected their ability to invest in research for new drugs. A study from Public Citizen, a nonprofit consumer advocacy organization, found that many pharmaceutical companies spend more on marketing than on new drug research.

“About a year or so ago, big pharma decided, ‘Well, we haven’t made enough profit,’” Takubo said.

Senate Bill 325 seeks to challenge the restrictions by forcing them to ship to rural contract pharmacies or impose a $50,000 fine per order for failing to do so.

Takubo said this bill will help thousands of rural West Virginians who need affordable prescriptions.

“They (drug manufacturers) never argued that these patients don’t qualify for a federal program that’s been around for 30 years. The only thing they said is now you’ve got to drive 60 to 90 miles to go get it,” Takubo said. “We know that the federal program allows you to get your much needed medicines to literally keep you alive. These are sometimes cancer therapies and blood pressure and diabetes.”

He said that some rural populations can’t afford to drive long distances or cross state lines to procure discounted prescriptions that are no longer available to them in their communities.

Bill Passes The Senate To Amend State Definitions Of Hospital And Certificate Of Need

A bill that was laid over on third reading with a right to amend during the Legislature’s special Saturday Session passed the Senate to the House with all present voting in the affirmative.

A bill that was laid over on third reading with the right to amend during the West Virginia Legislature’s special Saturday session passed the Senate to the House with all present voting in the affirmative.

The laws surrounding how hospitals determine what services they provide in rural counties will change if Senate Bill 613 becomes a law. It passed the Senate Monday with changes to temper the concerns of some who opposed the bill.

The bill aims to amend the state code relating to a certificate of need (CON). Two sections relate to birthing centers, which are healthcare facilities, staffed by nurse midwives, midwives, and/or obstetricians, for mothers in labor, who may be assisted by doulas and coaches.

Sen. Mike Maroney, R-Marshall, explained the bill and its amendments on the Senate floor. He said the bill changes the minimum expenditure and CON for West Virginia from $5 million to $100 million.

In addition, Senate Bill 613 redefines hospital services and adds a definition of inpatient services. The bill also removes constructing, developing, acquiring, or establishing a birthing center as a reviewable service.

Sen. Patricia Rucker, R-Jefferson, spoke in support of Senate Bill 613.

“I want to thank the chair of the Health Committee for his work. This is something that is very important to the Eastern Panhandle and something we’ve been working on for many years,” Rucker said. “Is this perfect? No. Is there more we could do regarding CON? Absolutely. But this is a great first step. And I consider it a really important bill. So thank you and I urge support.”

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.”

Q&A: One Perspective On Why W.Va.’s Hospitals Are Collapsing And What’s To Be Done

This month Fairmont Regional Hospital announced it was closing its doors. It’s the fourth Appalachian hospital to do so in the last six months. Health Reporter Kara Lofton spoke with West Virginia Hospital Association President Joe Letnaunchyn about why so many rural hospitals are struggling and what he sees as possible solutions.

Lofton:Fairmont Regional was the fourth hospital to announce a closure in this region in the past six months. There’re the two in the Wheeling area and one just across the border in Ashland, Kentucky. So, four hospitals in Appalachia in six months is a pretty stunning rate. Talk to me briefly about what’s going on with rural hospitals in Appalachia?

Letnaunchyn: Well rural hospitals, and all the hospitals in West Virginia are facing financial challenges primarily due to the payer mix that we have of the patients. We have now 45 percent Medicare patients, about 23percent Medicaid patients, you throw PEIA in there, you have close to 70 to 75 percent, depending on a specific facility and where they’re located. These are payers that all pay below cost [and] this has been going on for years.

And the difference between payment and costs, the gap has widened over the years. So it’s not getting better. It’s not going in the right direction. And when you have that many patients in your facilities that are being paid below cost, that’s a real challenge financially, and that has a ripple effect on everything else that you do. You have to look at services that you offer, you have to look at the costs that you have of operating your facility. I think our facilities have cut costs so much they’re running out of notches on their belts, in order to provide quality care, on a timely basis and provide the services that the patients need.

Lofton:Following the announcement that Fairmont regional be closing several lawmakers may comment expressing dismay and concern about the closure. Let’s listen to a clip from delegate Linda Longstreth from Marin County.

Longstreth: We need an emergency hospital where we can save lives in our county and not have to go to another county and send them someplace else, because a company in California decides they’re not making a profit. And that’s what this was all about. They’re not making a profit. So they’re going to dump them.

Lofton:She’s calling on the governor to take action saying that we can’t allow a company in California to make these decisions. I mean, is that true? Does the state have any power to step in [and stop] many of these closures that are happening?

Letnaunchyn: I think we have the power and the ability to step in and continue the dialogue. I mean, the governor yesterday indicated that he was meeting with the delegation from the Marion County Fairmont area, was going to have discussions with them. I know Senator Manchin he reached out to us about the situation and I believe he contacted the folks or issued a statement about Fairmont. I mean, that’s his, that’s his hometown. He’s a native of Fairmont. So I think these discussions will occur. What comes out of them? I don’t know.

Alecto bought this facility out of bankruptcy about three, four years ago. And I think they paid somewhere in the range of $15 million for the facility. And then they’re saying over the past three years, they’ve lost another $19 million. So if you do the math, you’re talking somewhere around $35 million of cost and loss in the facility. And so the decision that they make, the owner of that company makes in California, is one that — I think we can have discussions, but we don’t have any power to force him to do anything just like it OVMC. He made the decision. It was very abrupt. The facility was closed quickly. It sounds like this is the path. At least right now.

Lofton: Hospitals are often operating at a very thin margin these days in rural America, partly due to the payer mix. What, I mean we’re talking about solutions, like what are possible solutions to this. We are facing an aging population, we are facing a relatively low workforce participation. So the issues facing these hospitals are not going to go away. Is there an answer?

Letnaunchyn: I think part of the answer is new jobs, more jobs, training, some of the folks that we have right now for existing jobs. I’m being told that there are positions that are unfilled in the state because we don’t have skilled workforce, or folks they can get past the drug tests. Yeah, that’s always an ongoing discussion. We think what we’re going what we need to do is we announced yesterday that we’re going to create a hospital sustainability work group, financial sustainability work group, so that we can bring our hospital leaders together from small hospitals, large hospitals, large system, very rural. Hospitals and really talk to them and let them talk to us about what the issues are that we’re trying to figure out what their concerns are, what their limitations are, what their financial situation is, and see if we can come up with any recommendations to give to the governor policymakers and the legislature.

Lofton: Is this a state issue? like is this an issue that the legislature needs to figure out? Or are we looking at a federal issue that I mean, this is not just a West Virginia problem? This is really a rural America problem. What role do federal policies play and all this?

Letnaunchyn: You know, I think we’ve always said West Virginia’s issues, our West Virginia challenges and we have to find the solutions. I think we’re the best ones to figure out what our problems are and how to solve them. I don’t think I went to the federal government looking for help.

I mean, there’s proposals out there to reduce even further while we get paid under Medicaid – there is a block grant proposal out there. That was just announced by the President last week that we don’t support. There’s litigation out there to eliminate the [Affordable] Care Act. We don’t support that. We have 165,000 people at this point in time or somewhere around there…maybe 155 that are on the coverage as a result of Medicaid Expansion. That’s the working group that have paychecks, but their income is low enough to qualify for coverage under Medicaid, and in some that qualify for those subsidies. If the Affordable Care Act is thrown out in court that’ll have a devastating impact on us because the payments that we get for the expanded population is a 90 -10. federal match. If we pay 10 percent of the cost, the feds pay 90 percent. Our state budget couldn’t handle that big of a hit. It would be billions of dollars.

Lofton: If West Virginia needs to call West Virginia solutions. You have ideas for that? What are some of the possible long term policy solutions for this?

Letnaunchyn: Well we’re going to talk about that in our work group. But if you listen to the legislature, it’s all about jobs, we need to bring jobs into the area. If we had jobs here, look at the “for lease” signs, excuse me, in Charleston. Um, there’s a number of buildings that are for least there’s a number of people that have left the area, we need to bring people back to West Virginia, we need to keep the younger population from leaving West Virginia, we need to be able to train more of our clinicians, we’re looking at workforce issues, whether it relates to nursing and even physician shortages. There’s discussions about ways to attract them here. And to keep them here in a state. That’s all part of the solution on the workforce side, but then when you get them here, you have to make sure you have the right payer mix to be able to to make the payments for salaries and benefits for those employees. So hospitals in this state are a big deal. Sometimes the largest employer in their county or their community Maybe we need to stop looking at counties and communities and start looking at regional delivery of care.

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

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.

Roane General Hospital Expanding To Survive

Roane General Hospital is spending about $22 million to renovate its facilities in Spencer, West Virginia. A loan of $26 million from the U.S. Department of Agriculture will cover most of the expansion.

There will be a new medical office building, offering more preventative wellness care for the community, including a gym and fitness center, free educational classes, health screenings and support groups.

People of Roane County have lower than average health outcomes, quality of life and longevity, compared with other counties across West Virginia, and the country, according to a report last year by the Robert Wood Johnson Foundation.

And at a time when many rural hospitals across the country are closing, or consolidating, CEO Doug Bentz says he thinks Roane General Hospital will be able to stay financially viable by offering more specialty outpatient care, like chemotherapy. Currently, patients in Wirt and Roane Counties have to travel more than an hour to Parkersburg or Charleston to receive this type of care.

“But that’s something that is very, very taxing to a community member that has to drive three-five days a week and sit in a chair and receive chemo for four hours, and then drive back. What a burden that is,” Bentz said.

Roane General Hospital is the county’s largest private employer and has more than 300 employers. That number is expected to grow with the expansion, which is scheduled to be completed by May 2021.