WVU Medicine Wheeling Hospital Plans Not To Accept PEIA Patients As Of July 1
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WHEELING - WVU Medicine Wheeling Hospital, as of July 1, plans to no longer accept patients within the West Virginia Public Employees Insurance Agency for inpatient care, citing inadequate reimbursement to that hospital and others around the state.
Those reimbursement issues have hit Wheeling Hospital especially hard, according to WVU Medicine, which spurred the decision.
Jim Kaufman, president and CEO of the West Virginia Hospital Association, announced that move Thursday morning on the "MetroNews Talkline" radio show. Kaufman said Wheeling Hospital will continue accepting PEIA patients for emergency care and will work with PEIA on continuity of care for PEIA beneficiaries for a certain time frame. The hospital decided to wait until July 1 to give Gov. Jim Justice and the state Legislature time in the 2023 session to fix the problem.
PEIA provides insurance to public school teachers and staff, state employees and other public employees in West Virginia.
"That is a huge step and shows you how big this crisis has been," Kaufman said on "Talkline."
The concern at Wheeling Hospital, which is part of the WVU Medicine group of hospitals in the state, is that reimbursements to out-of-state hospitals dwarf those paid to West Virginia hospitals. According to a PEIA presentation this past summer, in 2020, the agency paid $47.8 million to out-of-state hospitals for just 1,903 inpatient visits, while paying West Virginia hospitals $42 million for 11,576 visits. In 2021, PEIA paid out-of-state hospitals $57.6 million for 2,195 inpatient visits and West Virginia hospitals $56.3 million for 12,313 visits.
PEIA's average payment for inpatient services to out-of-state hospitals in 2020 was nearly 600% higher than what PEIA paid to West Virginia hospitals. In 2021, the average was nearly 475% higher.
"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 three years," a WVU Medicine spokesperson said in an emailed statement. "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 statement continued. "The WVU Health System is making big investments in Wheeling to expand access and services, but Wheeling Hospital must be financially viable to achieve what we want to do there."
Kaufman said on "Talkline" that Wheeling may not be the only hospital in West Virginia to choose that path, though no hospital has yet made a concrete decision.
"I've been at numerous hospitals across the state over the past year and with all the financial challenges they're facing ... they're looking at different options," he said. "Wheeling is the first, but I do know of other hospitals talking about a similar effort."