WVU-Wheeling Hospital said it will no longer accept patients with West Virginia Public Employees Insurance (PEIA) due to a financial deficit in its budget.
PEIA provides health insurance for state employees like those in public schools and the West Virginia Department of Corrections among others.
Jim Kaufman, president and CEO of the West Virginia Hospital Association, said PEIA is paying much more in reimbursements to out-of-state hospitals than to in-state facilities like Wheeling Hospital.
“Wheeling Hospital has been struggling financially for several years, having multi-million dollar losses,” he said. “One of the things they’ve looked at is various cost cutting efforts and PEIA is paying them significantly below the cost of care.”
Kaufman said PEIA is paying hospitals in West Virginia 50 percent of the Medicare rate but four to five times more for the exact same service at out-of-state hospitals.
“In West Virginia PEIA dictates the rate they pay providers whereas out of state they actually have to negotiate,” he said. “And they negotiate using United Healthcare which is the nation’s largest insurance plan, and it just shows you the disparity between what out-of-state providers are able to negotiate versus what PEIA dictates in the state.”
Kaufman says Wheeling Hospital wants to avoid disrupting continuity of care and will continue to treat PEIA patients in an emergency situation as well as work with PEIA beneficiaries until they transition out of the network.
Kaufman said he is hopeful the legislature and policy makers can address the issue of reimbursements before it gets to that point.
Gov. Jim Justice’s office released the following statement:
“The governor’s office is discouraged by WVU Medicine’s position to stop accepting patients with PEIA at Wheeling Hospital. The Justice Administration has been extremely supportive of WVU Medicine’s acquisition of Wheeling Hospital. The West Virginia Hospital Association’s announcement today was a surprise to us, as we are engaged in good faith negotiations – and prior to this announcement today – had anticipated a resolution during the upcoming legislative session.”
Kaufman said Wheeling Hospital’s July 1st deadline offers the governor and legislature a chance to fix a serious problem that impacts health care workers as well as patients.
“One of the biggest reasons nurses haven’t recertified in-state is compensation,” he said. “If you think about it, we’re taking West Virginia dollars and shipping them out of state. That puts hospitals in West Virginia at a severe disadvantage in being able to recruit and provide care to treat all West Virginians.”