BUCKHANNON — West Virginia Hospital Association (WVHA) President and CEO Joe Letnaunchyn made a strategic and informative presentation to invited guests in Buckhannon last week. Each year, the association’s members identify issues they are hopeful to accomplish during the next term of legislation that directly affect public health in various facets.
West Virginia hospitals are among the top employers throughout the state. WVU Medicine is the largest private employer in the state, according to Letnaunchyn, employing 46,000 persons statewide. West Virginia hospitals also support nearly $10.5 billion in economic activity to the state’s economy. A vital part of infrastructure, the hospitals are needed to support economic development. “These are good jobs, jobs that are in West Virginia, that touch the lives of patients. They’re not outsourced, they are right here in West Virginia and our goal is to make sure that we remain as one of the top employers in the state,” explained Letnaunchyn.
There are many priorities for the 2020 legislative session for the WV Hospital Association. With Medicaid being a prioritized matter, urgent issues highlighted include protecting current funding in the state’s budget for care provided to hospital patients, ensuring no payment cuts to hospitals, maintaining adequate and timely payments from Medicaid that are in line with the cost of providing care, and preserving West Virginia’s three to one federal match. Letnaunchyn stated, “Medicaid always comes up and it is not because we are looking for more money, it is to preserve the payments that we have in the Medicaid budget.”
A strong Certificate of Need (CON) Law is also a priority for the upcoming legislative session. Current reforms from 2016 and 2017 are working, reported Letnaunchyn. Streamlining and modernizing the program, reducing costs and timeframes for review, adding several healthcare provider exemptions, and reducing provider costs for CON process are essential. Currently, 36 states maintain CON programs. Free market forces do not apply to healthcare. CON prevents out-of-state healthcare providers from “cherry-picking” West Virginia patients, which helps to prevent erosion of hospitals in the Mountain State. Letnaunchyn asserted that hospitals in West Virginia oppose the repeal of CON. “Certificate of Need is a regulatory program that is kind of a small R. It is not state regulation, but it kind of controls cost access and quality within the state,” Letnaunchyn indicated.
The modernization of non-profit hospital boards is another priority of the 2020 legislative session. Letnaunchyn stated, “Years ago, on the books, a statute in West Virginia was that non-profit hospitals have a certain specific component of what the board makeup has to be.” At least 40 percent of board compositions shall be composed of an equal portion of consumer representatives: small businesses, organized labor, elderly persons and persons with income less than the median income level. In small communities, finding an adequate number of candidates to meet all the requirements is a challenge. “We believe that a more modernized way would be to minimize this requirement, or eliminate this requirement, and allow the local community to have on its board the representatives that they think is best for their community, rather than filling the slots with different positions, and in some cases, it is hard to find people to fill these requirements,” explained Letnaunchyn. Boards want to expand the pool of candidates to ensure hospital boards are composed of diverse community and business leaders who bring expertise in budget and financial management, investments, personnel, public relations, marketing, governance, advocacy and leadership. Through appropriate board representation, hospitals will be able to maximize meaningful community involvement and engagement.
“You cannot go anywhere that you do not hear about surprise billing, either at the state level or the national level. Congress is dealing with it right now,” indicated Letnaunchyn. He used an example of a hospital emergency department and described a scenario in which a patient has a serious accident requiring a great deal of care, and all of a sudden, a specialist is needed for the patient’s specific situation. The specialist is on staff at the hospital, but does not accept the patient’s insurance. Most everything else was covered for the care given, but a surprise bill is received for the out-of-network services. The patient would then end up, in most cases, paying out of pocket for a portion of the allowable amount that was billed by the insurance. If a bill is passed through legislation, patients would be protected from surprise bills and should have certainty regarding their cost-sharing obligations.
A modern tool known as telemedicine, is yet another prioritized focus for hospitals during the 2020 legislative session. Telemedicine provides uniformity and removes barriers. There are two main points for legislative priorities surrounding telemedicine: full private payer parity and originating site. Full private payer parity requires private payers to cover and pay for telemedicine services, comparable to what is covered and paid for consisting with an in-person visit. The originating site would define the term in legal code to help remove limitations on where the patient must be located during a telemedicine encounter. Letnaunchyn provided another hypothetical situation to explain the importance of this tool of modernized medicine. In a rural hospital setting, a stroke patient may come in and time is of the essence, but there is no neurologist on staff. With telemedicine/telestroke, the on-staff doctor can consult immediately with the neurologist on staff at another location and determine what is needed for the patient, rather than transporting them and delaying much needed care. “We have a number of hospitals that have applied for telestroke funding, facilitated through the association as an objective party to review the applications,” furthered Letnaunchyn.
Involuntary hospitalization process with a goal to address gaps related to the current involuntary hospitalization process is another topic of priority in legislative session. Letnaunchyn proclaimed, “Basically, what it is, is Joe comes in the hospital at two o’clock in the morning on a Friday and says he is going to kill you, kill himself, and everyone else in his family, and I need help. A risk to himself, to you, and to society, or this could be an overdose patient. We currently have to contact the mental hygiene commissioner or the magistrate or the circuit court judge to initiate the commitment process for Joe. We are calling this an involuntary hospitalization, not commitment, because hospitals do not commit patients.” The goal of addressing these issues would permit an authorized hospital staff physician to order the temporary involuntary hospitalization, as deemed appropriate, of a person in a hospital emergency department, helping to mitigate delays to initiate the current involuntary hospitalization process, relating to what may occur in the hospital setting prior to when the involuntary hospitalization process is initiated, and having the appropriate judicial contact information provided to hospitals by July 1, 2020. Letnaunchyn stated, “We are working with the supreme court to give us this information so the hospitals can function more appropriately.”
“Healthcare education programs deals basically with the shortage of nurse educators,” indicated Letnaunchyn. Nursing schools are turning away applicants due to the lack of faculty. The goal in the 2020 legislative session is to help grow nursing education programs through faculty development to help fill open positions in nursing schools and attract more nurses to a career in education. With adequate funding of nursing education programs, the various programs will have the ability to meet the growing number of student applicants. “We can’t get enough nurses to become nurse educators because the payment is so low. In some cases, it is between $30-45,000 and they can make twice that on the floor,” explained Letnaunchyn. “We are looking at ways to find the ability to hire more nurses, so if we can have more nurse educators, then we can get more nurses through nursing school.” Hundreds of positions currently need filled and traveling nurses are being utilized for those position.
A final priority for the 2020 legislation is public health. Issues concerning public health are helping to sustain West Virginia’s immunization laws, the combat of substance use disorder, and support tobacco control initiatives. The protection of West Virginia Medical Professional Liability Act (MPLA) is essential. “Our state got very proactive in 2002 and 2003, in implementing strong medical liability laws and reform. People can still sue and get pay out for injuries, that is not the issue. It is to control and have an organized process for medical liability, and we want to make sure that is maintained,” informed Letnaunchyn.
Following Letnaunchyn’s presentation, the floor was opened up for questions and comments from the crowd. Don Nestor, Vice-President of St. Joseph’s Hospital Foundation, provided his thoughts on telemedicine based on his own personal experience. Delegate Patrick Martin, Senator Bill Hamilton and community member Mary Thorp, all participated in this question and commentary portion of the meeting.
The West Virginia Hospital Association asserts that it is attempting to modernize care from the board level, all the way down to the ground, and in addition to these priorities, will continue to address any other legislative issues that are identified throughout the next year.