, 2014


Hospital officials discuss healthcare
with First Lady Dorothy McAuliffe

by Audrey Thomasson

KILMARNOCK—Virginia First Lady Dorothy McAuliffe, who stopped here last week on a tour of the Northern Neck, participated in a roundtable discussion with doctors and hospital administrators from Rappahannock General Hospital (RGH) and Bon Secours. She heard about the impact the Affordable Care Act (ACA) and federal cuts are having on a small, rural hospital with 70% of its in-patient business dependent on Medicare or one of the state’s Medicaid programs.

+ A | - A

McAuliffe said Virginia needs to close the health care gap for 400,000 citizens without insurance, including 98,000 parents.

She was referring to the number of Virginians who can’t afford insurance under the ACA, also called Obamacare, but who don’t qualify for Medicaid because their income is too high.

ACA history

When the Patient Protection and Affordable Care Act passed in 2010, the law included a nationwide mandate for all states to expand Medicaid for most people between the ages of 18 to 65 with incomes up to 138% of the federal poverty level. The expansion was intended to offset reductions in Medicare reimbursements that were included in the law. But when the expansion was struck down in 2012 by the Supreme Court, Virginia was one of the states that chose not to expand over concerns the federal government will not be able to meet the fiscal obligations of expansion and the burden will fall on Virginia taxpayers.

Now, many hospitals are facing up to millions of dollars in cuts, the most dramatic Medicare and Medicaid cuts Virginia hospitals have ever experienced.

Impact to rural hospitals

McAuliffe listened as hospital officials expressed their frustration over having to pay into a program that helps other states without any local benefits.

“Eight million dollars has already been taken away from our hospitals and sent to Washington,” said David Belde, senior vice president of Bon Secours Mission. “That’s why closing the coverage gap is so important.”

As a rural hospital dependent on Medicare, RGH was supposed to be held harmless from a federal omnibus tax bill, according to RGH board chairman B.H. Hubbard. “But when the bill passed in 2012, (the exclusion) was not included in the bill...and the hospital took a $1.2 million cut off its bottom line. Now we’re $500,000 to the negative,” in additional cuts through 2014.

At the same time, the feds have a hold on $800,000 in Medicare payments for 12 months, he added.

Hospital chief financial officer John Headly said the financial impact of ACA, coupled with expanded coverage and recent federal cuts to Medicare, is projected to have a negative impact on RGH of some $500,000 to $800,000 per year beginning in 2014 through 2016.

“This hospital is vital to the community,” said Headly. “It provides jobs and services.”

Predicting flat growth for the area covered by RGH, Bon Secours vice president of community affairs Jim Dunn noted the negative financial impact of ACA will have ramifications that cannot be turned around. “If we lose services here, they don’t replace them, so it’s important to keep them.”

Doctors weighed in on the negative impact to their practices.

“It’s easy to get medical coverage under Medicaid for pregnant women, but hard to run a practice under the program because of the costs,” said Dr. Kathryn Stout of the Virginia Women’s Center.

Dr. Stout said discounts under the program make it “prohibitive” to run a practice. “The greater the margin, the less sustainable we are.”

“I hear what you’re saying,” McAuliffe replied.

Food or health care?

“The issue here is making the patient come back,” said Hubbard.

Dr. Barbara Kahler, a pediatrician with the Chesapeake Medical Group, said simply supplying coverage does not mean patients will seek help.

“Will that mother really come in for care?” she asked.

“Parents are making choices of ‘Do I put food on the table or go to the doctor,’” said McAuliffe. “If people are covered and informed and educated about care, it’s a start. You have to start somewhere...People are afraid.”

Dr. Kelly Stuart with Bon Secours Mission noted that it is a major change in thinking for someone who has spent their entire life seeking care from an emergency room and never received preventative care. She noted access to preventative health care, rather than relying on expensive emergency room treatment for unmanaged illnesses, would save money.

“The governor’s goal is raising everyone up,” said McAuliffe. “Virginia dollars are going to Washington and to 27 other states. It’s not a political issue, it’s an economic issue. It’s a health issue. These are people’s lives. These are people’s health.”

For rural hospitals like RGH, it’s a high stakes fight for survival.

“A rural hospital in Massachusetts, about the same size as RGH, and one in Georgia have announced they are closing their doors in 30 days,” said Headley. “It’s a reality around the country. It’s happening now.”


Bookmark and Share


About the weekly Rappahannock Record, to Subscribe, to Contact us, to send E-mail
Box 400, 27 N. Main St., Kilmarnock, VA 22482 Tel: 804-435-1701, Fax: 804-435-2632
These pages have been visited over 12,500,000 times since first publication, July 4, 1997
Webmaster: KC Troise. All design & content on these pages ©2014, Rappahannock Record. Privacy statement