Wheeling Hospital plans to stop taking PEIA

By Brad McElhinny, WV Metronews

In an urgent twist on a long-running healthcare financial issue, Wheeling Hospital says it will stop accepting patients covered by the Public Employees Insurance Agency as of July 1.

The hospital is citing its financial struggles, compounded by PEIA’s notoriously low reimbursement rates.

A statement by WVU Medicine, which includes Wheeling Hospital as a member, said the reimbursement rate through PEIA is just not financially feasible.

“Our mission is to provide excellent healthcare. Health insurance companies like PEIA however must be good partners by supporting their members – our patients – by adequately reimbursing their hospitals and caregivers. That’s not the case with PEIA,” the statement contended.

The statement took issue with PEIA’s negotiated reimbursement to out-of-state providers that represent competition along West Virginia’s many border communities.

Meanwhile, the statement indicated the reimbursement rate for in-state providers has contributed significantly to Wheeling Hospital’s ongoing financial challenges.

“PEIA’s practice of underpaying West Virginia hospitals and not covering their actual costs has had an especially hard impact on Wheeling Hospital, which has lost $56 million over the past 3 years,” the statement said.

“While we had outlined our concerns to PEIA on this topic several months ago, no changes have been made. Nonetheless, we remain committed to working with PEIA to change how it reimburses West Virginia’s hospitals.”

The reimbursement rate for West Virginia medical providers has long been an issue. That factor was among the many topics discussed by a PEIA Task Force that was established just a few years ago.

“We’ve seen huge increases in costs, and PEIA has traditionally underpaid hospitals,” said Jim Kaufman, president of the West Virginia Hospital Association, citing payments of only half of what Medicare pays.

“With such low reimbursements, it’s forcing hospitals to look at the services and things they can do. And hospitals across the state are looking at what they can do to cut costs. When you have a patient population that’s paying you less than the cost of care, one thing is to reduce how many services you can provide to that group, like PEIA.”

The move by Wheeling Hospital could be just the beginning, Kaufman said on MetroNews’ “Talkline.”

“I’ve been in numerous hospitals across the state over the last year and because of all the financial challenges that they’re facing, a negative 7 to 8 percent margin, they’re looking at different options,” he said. “Wheeling is the first, but I do know of different hospitals that are talking about a similar effort, but nobody has made that decision other than Wheeling at this point.”

Last year, the Legislature considered a bill that would have reimbursed state medical providers for PEIA at a rate of 110 percent the Medicare reimbursement rate. A fiscal note estimated the cost at $40 million.

The state Senate passed the bill unanimously, but the regular session ended without the bill passing the House of Delegates.

It’s likely the issue will be revisited during the regular session of the West Virginia Legislature that begins next week.

Kaufman noted that Wheeling Hospital “did decide to wait until July 1 to give the governor and the Legislature a chance to fix this problem so we can continue to ensure access for PEIA beneficiaries.”

The Governor’s Office today expressed disappointment in the move by Wheeling Hospital.

“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,” stated C.J. Harvey, press secretary for the governor.

“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.”


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