The Register-Herald, Beckley, West Virginia

Latest News

June 7, 2014

New Medicaid repayment is threat to rural health clinics

Effects of a lawsuit

— A 3-year-old lawsuit that altered how rural health clinics are reimbursed for treating Medicaid patients now poses a threat to those very clinics, a local doctor says.

The resident of Summersville Pediatrics says his clinic is just one of many facing up to this problem.

“Summersville Pediatrics is a rural health clinic,” Dr. Mark Tomsho said. “In West Virginia, there are about 50 or 60 rural health clinics. They can be hospital-associated or private clinics that fulfill certain criteria and fulfill ongoing criteria.

“The benefit of that is that they get an enhanced reimbursement from Medicaid for seeing Medicaid patients. Without that, practices and clinics would not be able to financially see Medicaid patients or they would only be able to see a very limited number. This allows rural health clinics to serve the financially less-fortunate in West Virginia.”

Tomsho said this lawsuit changed the way Medicaid pays back clinics. Clinics are reimbursed by the state which is reimbursed by the federal government.

“The state has used a methodology called ‘The Alternative Payment Methodology’ for several years,” he said. “A couple of years ago some federally qualified health clinics (FQHCs) felt this payment system was not fair.

“They filed a lawsuit. In the evolution of the change, the state has come up with the state plan amendment that amends how they will calculate the reimbursement to FQHCs. They have to treat FQHCs and Rural Health Clinics the same, so it affects us, too.”

Tomsho said it averages out to be about $29 lost per patient, per visit.

“We see in the range of 24,000 Medicaid visits per year in our clinic,” he said. “This is a cut, going forward, of about $750,000.

“Our clinic cannot survive a cut of that magnitude. It would require massive cuts of physicians, nursing staff, ancillary staff. It would just devastate Summersville Pediatrics.”

The take-backs created by the plan pose an even bigger problem, Tomsho said.

“If the new calculation ended up in favor of the clinic, they get more money. If the calculation says the clinic was overpaid, they will have to take money from the clinic.

“This becomes retroactively applied to Oct. 1, 2012. Since then, we have seen about 40,000 Medicaid visits. You multiply that by $30 and you get about a million dollars that has to be paid to the government. That would bankrupt our clinic that I have had for 28 years.”

This doesn’t just affect his practice, Tomsho said.

“If this affects even half the clinics the way this affects me, many of these clinics will have to cut services and staff. If this take-back is enforced, it will be devastating.

“This rule applies to all rural health clinics. Minnie Hamilton Health Care in Calhoun County is also in the same boat. They could be losing as high as $50 per patient.”

Even more importantly, Tomsho said, is how it could affect patients.

“This is the most vulnerable section of West Virginia’s population,” he said. “It’s those who are financially disadvantaged. It would be harming them in a way that would take a very long time to repair.

“They’d have to find new physicians, if they even could. There would be travel concerns for some. There would be those with special needs, chronic conditions and immediate needs that we wouldn’t be able to care for. We’re the only pediatric practice in Nicholas County and we serve several other counties. Other rural health clinics serve the same purposes.”

Tomsho says he hopes the public will step forward and tell the government that this does more harm than good.

“This is a government agency,” he said. “I truly don’t think anyone would want to harm the health care access of the citizens. I think if people called their local delegates and the governor and said, ‘What’s going on with rural health clinics?’ then something would be done.

“People should also call their local clinic and find out if it’s a rural health clinic. If it is, ask if they know about this reimbursement issue and the state.”

— E-mail: cneff@register-herald.com

1
Text Only
Latest News
  • Sunflower 1 Unique sunflower

    July 28, 2014 2 Photos

  • How much will annexation cost?

    City of Beckley officials say annexation would provide many benefits to outlying residents, but exactly how much would annexation cost?

    July 28, 2014

  • Not in my backyard: U.S. sending fossil fuel abroad

    As the Obama administration weans the U.S. off dirty fuels blamed for global warming, energy companies have been sending more of America’s unwanted energy leftovers to other parts of the world where they could create even more pollution.

    July 28, 2014

  • Greenbrier PSD officials worried about State Fair tunnel project

    Plans to raise a section of U.S. 219 and construct a tunnel underneath for the passage of State Fair pedestrians provided a hot topic for discussion at Friday’s meeting of the Greenbrier Public Service District No. 1 board.

    July 28, 2014

  • Beckley man places second in three-day world horseshoe tourney in Buffalo, N.Y.

    One Beckley man knows a thing or two about pitching a horseshoe. He’s been throwing for decades and he’s been to a handful of world tournaments. Recently he placed second in the 2014 World Horseshoe Pitching Tournament.

    July 28, 2014

  • saints garb new Saintly garb

    July 27, 2014 1 Photo

  • tunnel flow Tunnel reopens after fire

    Traffic on Interstate 77 was still backed up about 14 miles in Bland County, Va., Saturday evening, but the Virginia Department of Transportation reported at about 6 p.m. that both northbound lanes of I-77 through East River Mountain were open to traffic.

    July 27, 2014 2 Photos

  • tunnel firefighters Bluefield firefighters first ones on the scene

    Lights in the southern end of the tunnel illuminate an odd design beside the catwalk near the left lane of the northbound tube of the East River Mountain Tunnel that transports I-77 from Virginia into West Virginia. Two firefighters who made the initial assault through the total darkness of the soot and smoke-filled tunnel left those marks as they slid their arms along the catwalk wall on their journey back to the light.

    July 27, 2014 2 Photos

  • Internet service providers talk shop at Broadband Summit

    Call it the Internet 101.

    West Virginia’s Internet service providers, with the help of Mike Holstine, explained how end-users in homes and businesses get the Internet, how and why they use it and the benefits of having high-speed Internet for everybody. 

     

    July 27, 2014

  • tunnel Fire closes I-77 for hours

    East River Mountain Tunnel was engulfed in a cloud of black smoke Friday as a result of a tractor-trailer fire inside the tunnel that ignited just after 3 p.m.

    July 26, 2014 1 Photo