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The impact of three federal coronavirus stimulus packages on local hospitals is not yet known, the community CEO of a local not-for-profit hospital said.

But using national data from the Kaiser Family Foundation, The Register-Herald calculated that West Virginia hospitals could provide $76.6 million to around $230 million in care to uninsured coronavirus patients — a wide range that reflects predictions of the national and state outcome of the pandemic that have been moving targets.

Local hospitals are preparing for the peak of coronavirus infections in the state, which is predicted for today, April 12, based on models by The Institute for Health Metrics and Evaluation, an affiliate of the University of Washington.

Hospitals are already feeling a financial squeeze. Because of the need for supplies, personal protective equipment (PPE) and beds to treat COVID-19 patients, many hospitals have been ordered by state officials to temporarily halt lucrative elective surgeries.

Most hospitals, including Beckley ARH and nearby Raleigh General Hospital, stopped elective and non-emergency surgeries last month.

A recent telephone survey of 323 hospitals across 46 states conducted by the Office of Inspector General found that increased costs and loss of revenue were quickly depleting hospitals’ cash reserves and could be disruptive to ongoing hospital operations, according to a National Public Radio report. 

“That’s further impacted by the fact that, since the governor issued his stay-at-home order, we’ve made a lot of decisions to reduce the traffic in the hospital,” Beckley ARH Hospital Community CEO Rocky Massey said of Beckley ARH. “We’ve closed many of our clinics.

“We’ve stopped doing elective surgeries, stopping doing chronic therapy treatments,” Massey reported. “We stopped doing screenings.

“We didn’t think we should have that kind of traffic in the hospital right now,” he said. “Then, certainly, the impact that all of those things can have on our PPE and contributing to the use of those. 

“All those things come into play, in regard to the hospital’s operations.”

On March 27, ARH announced that the move had caused a 30 percent decrease in overall business operations. ARH furloughed 500 of the health care systems’s 6,000 workers. ARH Vice President of Human Resources Sonya Bergman said in a press release that the ARH decision was necessary to “redeploy resources to clinical areas that will be most-needed to effectively address the expected surge in COVID-19 patients who will need inpatient and outpatient treatment and to minimize risk to staff.” 

On Thursday, Raleigh General announced cuts to officers’ salaries and a layoff of 11 percent of its workforce, although Raleigh General employees would keep benefits and receive 25 percent of their salaries.

“We’re a not-for-profit health care facility here in southern West Virginia,” said Beckley ARH’s Massey. “The uninsured issue, right now, is not what we’re focused on.

“What we’re focused on is the safety of our patients and their families and our staff members,” he said. “Certainly, as the number of uninsured patients would increase, that certainly has a detrimental impact on any hospital’s operations.” 

West Virginia hospitals are accustomed to accepting the lower rates paid by Medicare and Medicaid, which reimburses providers at a reduced rate compared to private insurers. Over 439,000 state residents are enrolled in Medicare, and the state had 29 percent of its residents – or 564,000 people – enrolled in Medicaid in 2017, the highest of any state, according to the Henry Kaiser Family Foundation.

U.S. Department of Health and Human Services announced Friday that an initial $30 billion of a $100 billion relief fund that is included in the Coronavirus Aid, Relief and Economic Security (CARES) Act was being disbursed to providers.

Sen. Shelley Moore Capito, R-W.Va., a member of the Senate Appropriations Committee, announced that West Virginia’s share was $247 million or about 0.8 percent of the overall initial dispersement. The fractional award for the state reflects its smaller population relative to other states.

The money will go to hospitals and health care providers which are enrolled in Medicare, a national health insurance program. Facilities and providers get part of the $30 billion, based on their share of the 2019 Medicare fee-for-service (FFS) reimbursements, and do not have to pay back the money.

As state residents lose their jobs and health care coverage because of the coronavirus impact on businesses, hospitals do not yet have a clear idea of the cost of providing care to the uninsured or how hospitals will be reimbursed.

Using data from the Centers for Disease Control and Prevention (CDC), Institute for Health Metrics and Evaluation, The Harvard Global Health Institute and others, The Kaiser Family Foundation made a conservative estimate that 2 to 7 percent of uninsured Americans — 670,000 to slightly more than 2 million — will enter the hospital, at a national cost of $13.9 billion to $41.8 billion.

The foundation warned that the data is uncertain, considering that millions of Americans have recently lost their jobs, increasing drastically from 2018 data that showed 28 million Americans with no health insurance.

The report did not provide data that is specific to West Virginia, but with 1.8 million residents, West Virginia has a population that is a little more than one-half of one percent of the U.S. population of 327 million.

Based on that data, West Virginia’s portion of the share of the national uninsured medical debt might range from $76.5 million to around $230 million.

Massey said Monday that hospital administrators are preparing to treat COVID-19 patients, many of whom could be uninsured. The hospital was providing care for a single COVID-19 case as of Wednesday.

“That’s why we’ve got the Affordable Care Act, to improve access to care and to allow for better reimbursement for the hospitals,” Massey added. “So, yeah, uninsured patients certainly can influence the impact of hospital operations.”

The West Virginia Center on Budget & Policy reported last fall that around 114,000 state residents lacked health insurance in 2018, giving the state an uninsured rate of 6.4 percent. Before passage of the Affordable Care Act and the state’s expansion of Medicaid, West Virginia’s uninsured rate was 13.4 percent, according to the policy research nonprofit, with 255,000 people without health insurance coverage.

The independent nonprofit FAIR Health projects that uninsured Americans or those who leave their insurance company’s networks for care could face $42,486 to $74,310 in medical bills if they are hospitalized for COVID-19. 

Massey cautioned that it is too early to predict how federal funding promised by the Trump administration will offset providers’ costs, which are still not known, of providing hospitalization to uninsured coronavirus patients.

Congress has passed three COVID-19 stimulus bills. All provide funding for hospitals and free coronavirus testing for the uninsured through Medicaid but do not allocate any money specifically for COVID-19 treatment or coverage for the uninsured.

President Donald Trump has said he intends to reimburse hospitals for treatment of uninsured patients by sending out $100 billion to hospitals and health care facilities in the third stimulus of the Coronavirus Aid, Relief, and Economic Security (CARES) Act. 

The Kaiser Foundation noted that the legislation provided little detail about how funding would be distributed, giving significant discretion to the secretary of health and human services, but administration officials have said that hospitals will get reimbursed at Medicare rates, which are lower than rates paid by private insurers.

Massey said Monday that the impact to Beckley ARH and other hospitals in the state remains to be seen.

He said the funding will “filter its way down” to hospitals through the Centers for Medicare and Medicaid Services (CMS), to state government and then through health care organizations.

“Where it would apply across two states in our 13 hospitals, that’s yet to be determined,” Massey said.

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