The Register-Herald, Beckley, West Virginia

June 18, 2014

Committee hears how rate change will affect rural clinic

West Virginia Legislature Interims

By Pamela Pritt
Register-Herald Reporter

CHARLESTON — Numbers of winners and losers haven’t yet been totaled in a lawsuit that will change the rate at which rural health clinics are paid, but count Dr. Mark Tomsho among the losers.

A tearful Tomsho told the Joint Committee on Health and Human Resources Tuesday that his clinic serves 11,000 children — 75 percent of those from low income families — in Nicholas County. Summersville Pediatrics faces not only the burden of decreasing the rate he and his team can charge, but will have to pay back 30 percent of each office visit to Oct. 1, 2012, when the suit was introduced.

The suit was filed by eight Federally Qualified Health Clinics in the state, and sought to recalculate the way FQHCs and RHCs are paid.

It worked.

Seven of the eight FQHCs that were plaintiffs in the suit will see an increase in what they can charge to Medicare and Medicaid for patients. It was not immediately clear which of the FQHCs would see a decrease in its rates.

Tomsho is one of the few clinic operators who has run his numbers.

“The number is massive and it will be crippling to our clinic,” he said. “Right now, I don’t want to think about what’s going to happen to the 11,000 children we see, our employees and the other practitioners who work with me.”

About to decrease his operating budget by $750,000, Tomsho will have to repay about $1 million from previous office visits.

The Summersville Pediatric Clinic will see a decrease in reimbursements of about $29 per patient visit. Some clinics may lose as much as $50 per patient visit.

While some FQHCs knew that the change was coming, RHCs were left in the dark, and Tomsho was upset at the lack of notification from the Department of Health and Human Resources.

“From my standpoint there was no true notification,” he told the committee. “We would never have allowed a huge deficit to have accumulated. We heard a lot here today about transparency and communication; that failed miserably.”

Tomsho was referring to a presentation by DHHR Secretary Karen Bowling, who previously addressed the committee about improvements her agency is working on, among them communications.

The doctor also pointed out that new clinics can charge based on current dollars for their cost basis, while his clinic uses a cost basis 14 years old.

“I’ve been discouraged,” he said. “But I’m hoping there is something, something whether it’s the Legislature or (the Bureau of Medical Services). I don’t believe BMS sought to get a system that was financially harmful.”

Repeated questions and solutions offered by the committee members were met with “it’s federally mandated” answers by DHHR staff attorneys.

Sen. Evan Jenkins, R-Cabell, challenged those attorneys to admit they “were doing it wrong” since the issue has been ongoing since 2001.

“Help these people out,” Jenkins said.

Cost reports from FQHCs and RHCs are due by June 30. The new rates will kick in later this year.

Tomsho hasn’t yet decide what he’ll do in Summersville.

“I’ve yet to consider all my options, but whatever would happen would have to be draconian. Absolutely no way we could go forward to provide the level of care that we do,” he said.

Tomsho said the clinic employs 32 staff and seven practitioners.

Committee chairs Sen. Ron Stollings, D-Boone, and Delegate Don Perdue, D-Wayne, said they will write a letter to the state’s congressional representatives asking for help with the issue.

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