Rural hospitals in West Virginia may have to repay millions in DSH funds

cost calculation

Many rural hospitals in West Virginia say they are in danger of financial failure if they are forced to repay millions of dollars in possible Medicaid overpayments.

The Charleston Gazette-Mail reported that seven hospitals--Boone Memorial Hospital, Minnie Hamilton Health System, Roane General Hospital, Grafton City Hospital, Jackson General Hospital, Pocahontas Memorial Hospital and Sistersville General Hospital--might be compelled to repay Medicaid payments from the Disproportionate Share Hospital program (DSH). The DSH program is being phased out under the Affordable Care Act.

The catch here is that each of these hospitals also operated at least one rural health clinic. The Centers for Medicare & Medicaid Services is apparently taking back clinic-related DSH payments made to the hospitals from 2011 to 2015. According to The Gazette-Mail, the repayments would total $8 million, with each hospital responsible to repay sums ranging from $28,000 to $1.8 million. At some of the facilities, more than three-quarters of the patients are enrolled in Medicaid or lack insurance.

Rural and critical access hospitals as a whole are already in fiscal crisis. A study by iVantage Health Analytics undertaken last year concluded that 13 percent of such facilities are vulnerable to closure. Some hospitals have taken countermeasures, such as relentlessly controlling expenses, and have been able to thrive as a result.

Some of the hospitals say that being out of business would harm other providers. “If any of us were to fail, you’ve got large hospitals like (CAMC Health System) that are already being overtaxed and already have issues with not having enough beds, their ERs are already overfilled and if any of us go down, it’ll only make things worse for them,” Angela Frame, interim president and CEO of Jackson General Hospital, told The Gazette-Mail.

- read The Gazette-Mail article