WHEELING – WVU Medicine Wheeling Hospital, arsenic of July 1, plans to nary longer judge patients wrong the West Virginia Public Employees Insurance Agency for inpatient care, citing inadequate reimbursement to that infirmary and others astir the state.
Those reimbursement issues person deed Wheeling Hospital particularly hard, according to WVU Medicine, which spurred the decision.
PEIA provides security to nationalist schoolhouse teachers and staff, authorities corrections employees and different nationalist employees successful West Virginia. Wheeling Hospital would inactive judge PEIA patients for exigency care, WVU Health System President and CEO Albert Wright said Thursday. For those PEIA patients going done a attraction program similar a gestation oregon chemotherapy, WVU Medicine volition enactment with PEIA connected a modulation program for a definite clip frame.
But PEIA patients volition not beryllium seen astatine an urgent-care session and not beryllium scheduled for elective surgeries, Wright continued. And those PEIA patients with doctors done Wheeling Hospital would person to find a caller doc astatine WVU Medicine Reynolds Memorial oregon different section hospital.
“We’ve been moving with our legislative bodies implicit the past mates of years to say, hey guys, PEIA … and I’m going to beryllium blunt … PEIA is masquerading arsenic an security company,” Wright said, “and it truly doesn’t person the infrastructure to beryllium an security company.”
The interest astatine Wheeling Hospital, which is portion of the WVU Medicine radical of hospitals successful the state, is that reimbursements to out-of-state hospitals dwarf those paid to West Virginia hospitals. According to a PEIA presumption this past summer, successful 2020, the bureau paid $47.8 cardinal to out-of-state hospitals for conscionable 1,903 inpatient visits, portion paying West Virginia hospitals $42 cardinal for 11,576 visits. In 2021, PEIA paid out-of-state hospitals $57.6 cardinal for 2,195 inpatient visits and West Virginia hospitals $56.3 cardinal for 12,313 visits.
PEIA’s mean outgo for inpatient services to out-of-state hospitals successful 2020 was astir 600% higher than what PEIA paid to West Virginia hospitals for akin services. In 2021, the mean was astir 475% higher.
That discrepancy is particularly damaging to Wheeling Hospital, which has mislaid $56 cardinal implicit the past 3 years, Wright said.
“Wheeling is successful a unsocial portion of the state, wherever you’ve got Pennsylvania 5 miles to your eastbound and Ohio 5 miles to your west, with hospitals and caregivers that are getting reimbursed astatine much, overmuch higher rates,” Wright said. “So it’s a important inequity. So we had to marque the hard determination to say, hey, we request you, PEIA, to bash thing astir this. And if you can’t bash thing astir it, we person to marque definite we’re capable to support our ngo to instrumentality attraction of folks.”
According to a connection released Thursday day by Gov. Jim Justice’s office, helium and his unit were caught flat-footed by the announcement and are “discouraged” by WVU Medicine’s position.
“The Justice Administration has been highly supportive of WVU Medicine’s acquisition of Wheeling Hospital,” Justice spokesperson C.J. Harvey said successful an emailed statement. “The West Virginia Hospital Association’s announcement contiguous was a astonishment to us, arsenic we are engaged successful bully religion negotiations – and anterior to this announcement contiguous – had anticipated a solution during the upcoming legislative session.”
Some legislative leaders expressed their vexation astatine the concern – mostly that it had been allowed to get to this point.
“PEIA has been an contented for galore years,” said Delegate Shawn Fluharty, D-Ohio, the House number whip. “This was surely thing that was foreseeable, fixed the dire circumstances we look with PEIA, which, successful my opinion, has been mostly ignored by existent enactment successful Charleston.
“It conscionable goes to amusement that this should beryllium a apical precedence for leadership,” helium continued. “The politician came retired and talked astir each these pie-in-the-sky issues, which helium does connected a regular basis, erstwhile our hardest-working West Virginians are facing a crisis, which has present reached a situation astatine this level with Wheeling Hospital.”
State Sen. Ryan Weld, R-Brooke, the Senate bulk whip, said the occupation has travel from inaction from the PEIA concern board, which makes the decisions arsenic to however overmuch backing the program needs and sends that to the governor’s bureau to adhd to the authorities budget. The Legislature, helium said, has fixed the concern committee everything it has asked for successful caller years.
“My archetypal absorption to this is, unfortunately, I’m not surprised,” Weld said, “because for years nary 1 connected the PEIA concern committee oregon successful the enforcement subdivision has wanted to marque immoderate hard decisions whatsoever regarding PEIA. So this is simply a occupation each of their ain creation.
“People person known astir these issues, these structural issues to PEIA for rather a while. Yet those who could marque the decisions chose to not marque the decisions.”
The authorities Senate really unanimously passed a measure past twelvemonth that would person addressed PEIA issues, but that measure aboriginal died successful the House of Delegates.
SB 574 – sponsored by Senate Health Committee Chairman Mike Maroney, R-Marshall – would person divided PEIA into 2 plans; the State Employee Insurance Plan and the Nonstate Employee Insurance Plan. The measure required PEIA to found and support a reserve money to supplement immoderate reimbursements made to hospitals and exigency aesculapian work providers oregon agencies.
According to the bill, PEIA would person reimbursed immoderate infirmary that provides inpatient attraction to a beneficiary covered by the program astatine a complaint of 110% of akin services offered by Medicare by July 1, 2023. Emergency aesculapian work providers would person been included successful the caller reimbursement plan.
Maroney could not instantly beryllium reached for remark Thursday.
Weld believes this occupation volition person to beryllium solved successful the upcoming session, that hard decisions indispensable beryllium made and that an “overhaul” of however the authorities delivers security to its employees could beryllium successful order.
Wright is hopeful changes tin beryllium made earlier the July 1 deadline, and that past year’s Senate measure would beryllium a bully blueprint. Part of what gives him hope, helium said, is that helium doesn’t person to person anyone successful Charleston that determination is simply a occupation with PEIA.
“I judge they’re taking it seriously,” Wright said. “I judge they’re going to enactment connected it. I anticipation they already person a glide way from what they created past twelvemonth and they’ll prime that up and close this, not conscionable for Wheeling Hospital, but for each hospitals.”
If it isn’t fixed, Wright said Wheeling Hospital mightiness not beryllium the lone infirmary that takes this route. Others could travel suit.
“I cognize for a information they’re having akin conversations,” helium said.
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