WV HEALTH
MEDICAL REHABILITATION
CON STANDARDS MEETING
SONIA CHAMBERS: I’m Sonia Chambers, Chair of the West Virginia
Health Care Authority. I have here with
me the rest of the complement of the board, all three of us, Marilyn White and
Sam Kapourales [phonetic]. We are happy
to be conducting these meetings. The,
some of you have heard this, now, for, what, six or seven times, those of you
who have been to all the meetings, but these meetings are being held partly a
joint agreement with the legislative select committee on looking at Certificate
of Need, generally, and our agency. We
are holding them to, you know, as you know, Certificate of Need is being
reviewed by the legislature as to whether it should continue or not, whether
all the services subject to its review should continue to be reviewed or not,
and so we are holding a series of meetings to get, to get stakeholder input as
to whether Certificate of Need should continue to exist for different sets of
services. Today we are going to talk
about rehabilitation and what I’d like to do is have Dayle Stepp, we are going
to go around the room and identify ourselves and, also, those on the phone, and
then Dayle is going to, basically, go over, well, briefly, I guess, go over the
Certificate of Need standards and then we’ll just open up the floor for
discussion. So why don’t we start over
here?
VICKY JOHNSON: I’m Vicky Johnson [phonetic]. I’m the CEO of HealthSouth Western Hills in
RAYMONA KINNEBERG: Raymona Kinneberg [phonetic], Bill J. Crouch and
Associates [phonetic].
WALTER SMITH: I’m Walter Smith.
I’m Director of State Regulatory Affairs for HealthSouth Corporation.
SHARON BOGGESS: I’m Sharon Boggess [phonetic] and I’m the CEO at
HealthSouth Southern Hills in
VICKY DEMERS: I’m Vicky Demers, the CEO at HealthSouth Morgantown
facility and also
NORA MCQUAIN: I’m Nora McQuain [phonetic]. I’m Director of Facility - - and Residential
Care for the Bureau for Medical Services Medicaid.
LINDA GRAHAM: Linda Graham with
SHEILA KELLY: I’m
DAYLE STEPP: Dayle Stepp, Director CON.
CINDY DELLINGER:
NANCY MALECEK: I’m Nancy Malecek [phonetic] from the Insurance
office - -.
SONIA CHAMBERS: Anybody else?
ED HAMILTON: And Ed Hamilton with Mountain State Blue Cross/Blue
Shield.
SONIA CHAMBERS: And who do we have on the phone?
PHIL WRIGHT: Phil Wright at the Health Plan.
SONIA CHAMBERS: Phil has been at all the meetings, too, so, and asks
very good questions.
PHIL WRIGHT: Uh-oh.
SONIA CHAMBERS: Who else?
ANGELA SWEIGER: Angela Sweiger [phonetic] with West Virginia
University Hospitals.
SONIA CHAMBERS: Anybody else?
FRANK WEBER: Yeah, this is Frank Weber with
SONIA CHAMBERS: Anybody else?
FEMALE VOICE 1: We are going to have a physician joining us sometime
in the next 10 or 15 minutes.
SONIA CHAMBERS: Okay, on the phone, okay. All right.
Anybody else, anybody else on the phone?
Okay. Dayle?
DAYLE STEPP: Okay. I’ll
just run through this real quick. Well,
I’m not going to go through all the definitions. We can all do those. The need methodology is real simple. It says there should be no more than 13
medical rehab beds for 100,000 population for the service area. There are a couple of exceptions for this,
for rehabilitation hospitals located on the borders they can request additional
beds to provide for out of state populations and they have to document that
through patient flow studies. And
another exception is an existing facility may add beds if they maintain an
average occupancy rate of 85 percent for the prior 12 months period and they
have a documented - -. We go into the
quality and generally it is you have to have the criteria for preadmission, job
qualifications for all the key personnel, have its own utilization review
committee, proper administration support, follow guidelines of CARF, which is
Commission on Accreditation of
Rehabilitation Facilities, have proper linkages to other required
services, and demonstrate those services and then, of course, you have to show
that it is financially feasible.
SONIA CHAMBERS: Okay. And
you—
DAYLE STEPP: And the charts, one chart is just the 37 CO
in-states and the types of beds that each of those states review - - rehabbers.
Twenty-four that do review rehab beds,
thirteen that do not. And then the next
one is just a list of the hospital names and the number of beds and where
they’re located. And understand, now,
that the Fairmont General Hospital, the HealthSouth Mountain View of Fairmont,
and Mountain View, the Fairmont General is, probably, a duplicated number and
that the HealthSouth at Fairmont Health, Mountain View at Fairmont and Mountain
View Regional are, basically, run from the same location, right, just one CEO for
both of those.
SONIA CHAMBERS: So that means that … how many extra beds do we have
on this count?
DAYLE STEPP: I think there is 15 extra.
FEMALE VOICE 1: Just delete the second line.
SONIA CHAMBERS: Just delete the
FEMALE VOICE 1: Because the Mountain View beds are at
SONIA CHAMBERS: Oh, I see, okay.
That brings the total 318.
DAYLE STEPP: And down at the bottom there I just did a rough
calculation. Took the population for the
state at 1.8 and at 13 beds per 100,000 you would need statewide 234 beds - -
and this is because the border, some of the border hospitals have, have
received extra beds because they do serve a, a large out of state
population. And even some of the other
beds, other hospitals have received, have applied and received some extra beds
because of their occupancy levels.
SONIA CHAMBERS: And Dayle, do you know where we came up with that 13
per?
DAYLE STEPP: Oh, it’s been around since ’92, I think. I looked at several other states—
SONIA CHAMBERS: So it was some national use rate?
DAYLE STEPP: Right. I’ve
looked at several other states and, generally, their need calculation is based
on an area, a planning area, or a state - - to the future population of that service
area so—
SONIA CHAMBERS: And how different do you think that would be than
ours?
DAYLE STEPP: Oh, I don’t know that it would be a whole lot
different. I haven't calculated that out
on this but I think an area use rate or a state use rate would probably give
you a better picture than what we have been carrying over since ’92 at the 13
beds.
SONIA CHAMBERS: Did we have someone else join us on the phone?
DR. BIUNDO: Yes, hi, this is Dr. Biundo from
SONIA CHAMBERS: Okay. Spell
your last name, please?
DR. BIUNDO: Biundo, “B,” as in “boy,” “i-u,” “N,” as in “
FEMALE VOICE 1: Okay. And
when we get to comments in order to utilize the doctor’s time wisely we’d ask
that he be able to speak first.
SONIA CHAMBERS: Or else he just needs to volunteer first. All right.
Okay. So and these, these charts
will be available on the website, right?
DAYLE STEPP: Hopefully they’re out there now.
SONIA CHAMBERS: Hopefully they are out there now, okay. All right.
We are trying to provide all of this on the website. Alrighty, well, let’s throw this open, then,
for general comments. Doctor, you can
start.
DR. BIUNDO: Yes, yeah, well, thank you very much. Thank you for welcoming me here. I just have a quick comment or I’m not
exactly clear that, because I came in at the end part of this conversation, it
was estimated there would be 13 rehab beds per 100,000 inhabitant, or 100,000
people, is that correct?
SONIA CHAMBERS: That, those are the current, that’s the current use
rate in the standards.
DR. BIUNDO: Okay. The
only point I have to make is this is since 1992. A lot of the rehab referrals systems that are
in place depends on the referral source that is available and the type of
interventions that they are able to do.
I have been in
DAYLE STEPP: How many beds do you currently have?
DR. BIUNDO: Currently we have 80 beds in the
SHEILA KELLY: Dr. Biundo, this is
DR. BIUNDO: Well, we struggle with that. That is a good point, an absolutely good
point. There is always a, always a
stress level to try to decrease the length of stay, to minimize, the insurance
companies always want to decrease length of stay to decrease cost. As the patients get more and more
complicated, obviously, the length of stay will increase. That length of stay is more global, it
doesn’t reflect, necessarily, just our brain injury patients, our pediatrics or
our adult population. It reflects the
whole hospital system in place, which includes orthopedic patients and patients
with strokes, and amputees, and so forth.
You know, my, my contention is, and I say this humbly, is that since I
have been here since 1991 and have been Director of this hospital since then,
and dealing with catastrophic injuries, that in order to be really good at what
you do you have to have a lot of these patients and you have to have staff to
grow with you so that we all become more and more competent and more and more
an expert. And I think if we begin to
have multiple hospitals that try to do this I think that the quality of care
will suffer. And I think, in my opinion,
that, if anything, our hospital rehab patient will continue to grow because as
WVU, which is sort of the flagship hospital in this area right now, continues
to expand and become more refined, for example, they just started doing
seizure, neurological seizure interventions.
In other words, neurosurgical procedures to oblate seizure focus in the
brain. That, that is relatively new and
no one does this around here and we take care of those patients. Now, those patients won't be best served to
be going to other facilities and I, you know, I’m not trying to say that we are
the best in the whole world, but we have learned and we continue to learn every
day. But I don’t think they will be
served when they go out of the system.
For example, we have spinal cord injury patients that begin rehab here,
they do well, and then they are discharged into the community, especially in
our rural system that we have in place, and they do not get the same care
because, obviously, it is not that they are bad people and they are
incompetent, just that they are not used to taking care of spinal cord injuries
in the outpatient rural physical therapy, you know, field. They are not.
They will call and say, you know, I have never seen a spinal cord. I haven't seen one since I was in PT school.
RAYMONA KINNEBERG: If I can ask a question, this is Raymona Kinneberg
and I’m here with - - people from HealthSouth.
Is what you’re saying that even though you anticipate that there will be
more demand for people with higher acuity that they should stay at the facility
that their, that is there now rather than adding a second facility in order to
have the volume and the quality?
DR. BIUNDO: Exactly, exactly what I’m saying because my, I see
the problem being increase in volume but you don’t, you don’t treat that by creating
more beds out of different hospital systems who are not trained or have
experience in taking care of those patients because it would just be a disaster
because those patients will come back with acute comorbidities, acute care
transfers, and their outcomes will suffer.
And we know that. We know that
now, for example, because there has been tremendous stress of taking patients
from the acute hospital into the skilled nursing facility and nursing homes
because there has been a curtailment by the insurance company curtailing, in
terms of these patients coming into the rehab hospital. They would prefer these patients go to a
lower cost of care but we see that because we see their acute care transfer go
up, their quality go down, their complications and comorbidities go high, their
mortalities go high. We see that
happening right now because, again, we took a patient that really needs to be
in a standard care in a rehab hospital, an acute rehab hospital, and that patient
now is going to a skilled nursing unit or a nursing home. And that care cannot be provided in that
system. And what alarms me is that that
same, that same model is being used right now to create different hospitals and
eliminate the Certificate of Need because you are going to have patient who are
going to places where they shouldn’t be in.
SHEILA KELLY: I apologize for not knowing the answer to this. This is
DR. BIUNDO: Yes, we do have, we do have limitations in terms of
length of stay and we have a DRG type system that limits in terms of the
patient’s length of stay. It also
depends on the patient’s progress and their functional improvement.
SHEILA KELLY: And can, do you have any idea what that average
length of payer stay is? I’m just
curious.
DR. BIUNDO: In terms of our payer mix here in terms of the rehab
hospital?
SHEILA KELLY: Well, particularly in terms of Medicare and
Medicaid. What tends to be the mean
length of stay for your governmental payers?
DR. BIUNDO: Ours, ours is Medicare, I would say 70, 75
percent. I don’t know for certain. I’ll have to clarify that.
FEMALE VOICE 2: Dr. B they are referring to the
DR. BIUNDO: Right, right, the length of stay and the
SHEILA KELLY: And it is my understanding that Medicaid doesn’t pay
for rehab level of care?
DR. BIUNDO: That is correct.
Yeah, Medicare covers only if you are under 21.
FEMALE VOICE 2: Right, they’ll pay under 21.
FEMALE VOICE 3: And based on your diagnosis mix, I mean, each
hospital is going to have an average, for instance, mine is around 14 days and
Morgantown’s is going to be higher because they definitely see a higher acuity
just as he went through with spinal cord and having - - there.
MALE VOICE 1: This is being typed.
SONIA CHAMBERS: Oh, yeah, and also, we are, we are, we will have a
transcript of this so if you’re going to speak please identify yourself so that
your, your comments will be accurately attributed to you.
PHIL WRIGHT: Sonia?
SONIA CHAMBERS: Yes, Phil.
PHIL WRIGHT: Phil Wright.
What, I still didn’t get my question answered. What is the census in
DR. BIUNDO: Well, in
PHIL WRIGHT: How many beds do you have full all the time on the
average?
DR. BIUNDO: Well, on the average we are having difficulties and
the reason why we cannot is that we have had difficulties in terms of
maintaining nursing numbers because in order for us to be able to take care of
the appropriate number of patients we need the appropriate number of nurses and
that is what has been restricting in terms of our ability to admit.
PHIL WRIGHT: You said you have 96 beds in
DR. BIUNDO: I’d say around 70 percent.
PHIL WRIGHT: So you have capacity for more and you’re, you can't
do it because of staff?
DR. BIUNDO: Right. At
this point and in the last number of months that is what we have had our
difficulties with.
PHIL WRIGHT: So that is really
not a problem with the CON?
DR. BIUNDO: No, no, sir.
PHIL WRIGHT: And excuse me, I didn’t get, what are you, an M.D.,
are you an M.D.?
DR. BIUNDO: Yes, sir.
SONIA CHAMBERS: Okay, any other questions for Dr. B, I think, as you
were referred to?
DR. BIUNDO: Right.
SONIA CHAMBERS: For him, do you have a question for him? Okay.
Would you like to add anything else?
DR. BIUNDO: No, I’m, I’m
good. If you have any questions please
feel free to call me. I can help as best I can.
SONIA CHAMBERS: Okay. Well,
so you’re welcome to stay on the line if you have time and listen to the other
comments or go back to patients, whichever you’d like to do.
DR. BIUNDO: Okay. Well, I can, I can stay on the line for a few
more minutes. A patient should be coming in a few, in a few minutes.
SONIA CHAMBERS: Okay.
All right. Who would like to go
next?
SHARON BOGGESS: This is Sharon Boggess and I’d like to
piggyback on that slightly. I think, I’m
not sure who it was on the line a moment ago made a comment regarding staff and
how that connects to CON. I think that
there is a definite connection because, for instance, with myself I have had a
physical therapy position open for five years that I have been recruiting
for. If we did not have the review of
the CON to look at necessity, which, of course, a piece of that is looking at
staffing to be able to treat the patients that will go into those units and it
does become an issue because there’s not enough staff to treat what we have
now. I have 60 beds. My census this year has been averaging around
36. As I mentioned, I have been
recruiting for a position, PM and R, which is - - as a specialty, which is
necessary in rehabilitation. I have been
recruiting for that for two and a half years.
When I look at our state and the programs that we have available and the
students that are coming out of physical therapy and occupational therapy there is not enough coming out to support the beds that we have now to
treat the patients that we have. I also
have the unique situation in southern
PHIL WRIGHT: Why are the physicians leaving, Phil Wright?
SHARON BOGGESS: One is malpractice.
Secondly, is when they do get them in because there are such a limited
number they are not staying. They are
staying for a period of a year or two, 18 months, and they’re back out.
DR. BIUNDO: Can I add something, sir?
SONIA CHAMBERS: Sure.
DR. BIUNDO: This is Dr. Biundo from
PHIL WRIGHT: When you say “sustain them” do you mean on a fee for
service basis or do you mean as a salaried employee of the rehab facility?
DR. BIUNDO: Oh, no, no.
It, in either component, either fee for service or even a salaried
employee. To, to really be able to get a
salaried employee physician here, I have had, since I have been here, 1991,
when I, when we opened the rehab hospital and then we opened the Fairmont
Hospital, I have had six, a minimum of six physicians with me and the average
stay was about two years, one and a half to two years. And the reason was because it is too much
work, it is hard for them to really be able to recoup their income and we, I
paid for all that. I paid, they, they
were a partnership with me and they would stay and after two or three years
they would become a full partnership but they, they, I couldn’t keep, I’ve had
six physicians and right now I’m by myself with a total of, you know, 70 to 80
patients a day plus outpatients, plus the university, so it is really hard to
recruit on a specialty, especially in this state in the current
circumstances. And it doesn’t matter if
you are salaried or fee for service it is just hard to keep them.
PHIL WRIGHT: Really you are talking about a problem that is
beyond the CON regulations.
DR. BIUNDO: No. Yes,
absolutely right, forgive me, but when I said “no” I’m saying that the CON
would only make it worse because if you are already having a hard time
recruiting physicians in our specialty to big hospital centers, next to
university hospitals, and then you’re going to have a CON that is abolished and
every hospital will take care of rehab patients with no expertise in it
it is going to be even harder to recruit those, those doctors who are
specialists in those little hospitals who are taking some rehab patients. So you are going to wind up having patients
who are taken care of by general internists who don’t know rehab fully. And I don’t mean that in a demeaning way at
all, forgive me, because there are a lot of things I need to learn, or every
day I learn, you know. But that is what
happens and then you have other specialists who try to take care of a spinal cord
injury or brain injuries and they are not really trained in it or, or qualified
to do and that is going to be hard, again, it is going to just,
creates a vicious cycle of not enough physicians, not enough rehab
specialists, and the patients will go to hospitals and be taken care of by
people who don’t really understand rehab fully, in the holistic picture. To be able to do rehab, to be able to do
rehab very well you need a whole team.
If you go to acute care hospitals you will see that they do have the
different components. They have PT, OT,
speech and language, but they can't work together in a cohesive team. The rehab hospitals do it well because this
is what they are expert at. This is what
they have been doing since after World War II, you know, that’s how it all
started. That is why they have it down
pat. And when other people try to do it
it always is miscalculated, it is all always unstable and doesn’t flow well.
PHIL WRIGHT: Nobody is arguing that but if you can't maintain
staff how cohesive a group could it be?
DR. BIUNDO: Well, we, no, we do have it because you still have a
central picture of a physician being involved, an integral part of it, and you
still have the teams that work well together.
Yeah, we still have it, even right now.
If you come to our hospital here you, and you’re more than welcome to
come anytime, you’ll see how the whole team works together and jells together,
you know. And again, I think the
fundamental component, in my opinion, is that we have the patient. The patient is the focus and this is how we
learn. This is how we will grow. Every patient is a textbook for me and I
learn from every patient. And that is
how the therapist learns. But if you
don’t have that exposure and that experience over time you won't be as good as
it. That is why we know that patients
who get CABGs, open-heart bypass grafts, in hospitals who are expert at it, who
do large volumes, they do well. if you
take these patients and put CABGs in hospitals that don’t do as many they don’t
do as well. It just, it is a natural thing.
PHIL WRIGHT: I guess the question, Phil Wright again, the
question for this meeting is should the CON be continued 13 beds per 100,000
with the two exceptions, or should it be increased, or should it be, the CON,
be eliminated? You’re definitely against
elimination.
DR. BIUNDO: Yes.
PHIL WRIGHT: So what are you for, increasing or maintaining?
DR. BIUNDO: Well, so, this is Dr. Biundo, again, I’m sorry. If I’m talking too much just tell me to shut
up and I’ll leave, okay.
PHIL WRIGHT: You’re not talking too much.
DR. BIUNDO: I’m kind of getting out of hand here. I’m getting too verbose. You know, in my opinion, I think I would
leave the Certificate of Need the way it is.
looking at the circumstances and leave it, the Certificate of Need is
necessary. That is my opinion. And without getting too greedy or anything
like that because I think, in my opinion, because of the circumstances of, you
know, the cuts and, who knows, in Medicare, with the war, there is so much
political pressure right now that we’re lucky we have what we have right now,
you know. So I think at this point is
that we can even better doing what we do.
We can get more efficient. We can
see more patients and we can provide better care. And that is on our, that is our responsibility
on our side. We are accountable on that
side. But in my opinion, again, humbly,
is that Certificate of Need needs to be in place. That no, I think that only hospitals who
really do this stuff really can do it.
No one else can just do it because they, they want to do it all of a
sudden. And because with the hospitals
will do it because they want volume and they want money but they won't provide
the best care. Because they will look at
it like, okay, I’m a little hospital in the middle of nowhere, here is a brain
injury patient that comes in, so you’re going to take a 14-year-old pediatric
brain injury, I’m getting today, and you’re going to bring him into a rehab
hospital, they call themselves, when they have no experience, no therapists, I
mean, I think that’s, that’s bad. I
think that is dangerous. I think that is
a crime. I think that is a sin. That is my opinion and I’ll shut up now.
SHARON BOGGESS: This is Sharon Boggess again. I think another important piece to point out
is a fight that we’ve had as, not a fight, if you will, in rehabilitation with
a 75 percent rule, and we are very grateful that was back to 60 percent and
held at 60 percent, but what that does under Medicare and
SONIA CHAMBERS: Well, is that, this is just sort of for
anybody. I was sitting here thinking
about what you were saying and as, as I recall, from our prior annual report,
rehabilitation hospitals, particularly the, the for-profit ones, fair
financially quite well in the state. In
the 20 percent return category, which, I would dare to say, that most acute
care hospitals would kill for that kind of return. So I understand that it may be difficult, in
some cases, but financially it doesn’t appear to be that difficult, in many
cases, based on our annual report figures from the past couple of years.
PHIL WRIGHT: Are rehab facility rates controlled by HCA?
SONIA CHAMBERS: No, they are not.
ED HAMILTON: And what’s the reason for that? This is Ed Hamilton of Mountain State Blue
Cross/Blue Shield. Why are their rates
not controlled?
SONIA CHAMBERS: I don’t know that I honestly, were they ever
controlled? I don’t think they ever
were. I think it was really acute care
hospitals on the non-governmental side.
ED HAMILTON: Is there legislative power under the code to do
that?
SONIA CHAMBERS: No.
ED HAMILTON: Since I’m already speaking the other question I have
is related to the definition of service area.
Does the service area as defined in the CON piggyback on something else
or does the applicant - - their own or shouldn’t there be, has there been, a
definition of service area as used in the CON?
DAYLE STEPP: This is Dayle.
Generally, they present their own service area and I think several of
the facilities have used a 25/10 service area like you use for general acute
care hospitals but because they are more or less of a specialized service they
may have a different service area than would a general acute care
hospital. So they generally present
their own service area and document why they are using that particular service
area.
FEMALE VOICE 4: Brenda - -.
BRENDA: Wait until he comes back in.
FEMALE VOICE 4: Because I know he wants to talk about the 75 percent
rule and also some issues related to our ability to accept patients because of
our fiscal intermediaries.
SONIA CHAMBERS: But that has nothing, really, to do with Certificate
of Need, does it?
FEMALE VOICE 4: Only from the perspective of why their, why the
occupancy rate isn't what we think it should be.
SONIA CHAMBERS: Okay.
PHIL WRIGHT: Phil Wright, again.
Are any of the rehab facilities owned or partially owned by acute care
facilities?
DR. BIUNDO: Yes. That is
Dr. Biundo, again. Can I, here in
PHIL WRIGHT: Okay. Is the
rest the rehab?
DR. BIUNDO: The rest, the rest of the hospitals, the rehab
hospitals in
MALE VOICE 2: That’s right.
FEMALE VOICE 5: That’s correct for the HealthSouth facility.
DR. BIUNDO: For HealthSouth.
That is for HealthSouth.
SONIA CHAMBERS: CAMC, obviously, owns its - - and then
FEMALE VOICE 5: Yeah.
SONIA CHAMBERS: Actually, I’m, I’m curious. Phil Wright and Marilyn, in the northern
panhandle what, what do you do for rehab patients? Where do they go?
MARILYN WHITE: Phil, go ahead. Where do you send them?
PHIL WRIGHT: I often, west or north, out of the state.
DR. BIUNDO: You meet up, I’m, I’m sorry. I’m sorry.
MARILYN WHITE: You don’t send them to
PHIL WRIGHT: Some go to
MARILYN WHITE: Okay.
When I was still in that business
SHEILA KELLY: I have a question, since we are waiting
for CAMC. I have heard a spirited
discussion when I came in about fiscal intermediaries and I have no idea how
that applies in this setting. Could
somebody explain that to me? This is
PHIL WRIGHT: What was the question?
SHEILA KELLY: What, what is the role of a fiscal
intermediary in a rehab facility?
SHEILA KELLY: For Medicare or Medicaid.
SHEILA KELLY: So is there a carve out for Medicare for
rehab programs? Like, I’m familiar with
behavioral health and Palmetto pays all of Medicaid and Medicare’s behavioral
health clients so is it similar to that?
It’s your administrator?
[Crosstalk]
SHEILA KELLY: And does everybody have exactly the same
FI or it depends on what region you’re in?
SHARON BOGGESS:
SHEILA KELLY: And do they each have different policies?
SHARON BOGGESS: [Interposing] You wouldn’t think but in
the discussion today it has been very interesting in how they’re different.
SHEILA KELLY: So there is a different interpretation -
-.
RAYMONA KINNEBERG: This is Raymona Kinneberg. The fiscal intermediary for Medicare it’s,
it’s similar with other facilities. For
example, some nursing homes in the state have United Government Services, some
have somebody else, so it’s, it, sometimes it’s dependent upon geographic
location. In some programs corporations
that have multi-state facilities are allowed to have one fiscal intermediary
for all of the programs and sometimes you have got one fiscal intermediary for,
say, a hospital based and then you have a home health and you have a different
fiscal intermediary for that. So it, it,
but there, it, it can only be one of the intermediaries that is designated by
SHEILA KELLY: So they basically do utilization
management and prior authorizations and that kind of payment process?
[Crosstalk]
SHEILA KELLY: Process claims, okay.
CINDY DELLINGER: I have a question. This is
FEMALE VOICE 2: Case by case basis, well, unfortunately,
I will say, a lot of it is Medicaid because West Virginia Medicaid will not
cover inpatient rehab. So probably 95
percent of my charity care is patients that do have Medicaid but will not cover
it. So it is on a case-by-case basis.
SONIA CHAMBERS: So there is no standard income
determination?
FEMALE VOICE 2: That may be facility-based. There is not a standard across the board.
CINDY DELLINGER: I’m sorry, there’s not, there’s not one
policy, company-wide?
WALTER SMITH: This is Walter Smith at HealthSouth. We do have policies for treatment of charity
care patients. Now, there is several
jurisdictions, CON jurisdictions, that we operate and require charity
requirements, Virginia,
FEMALE VOICE 2: And how it fits into that, into that
would qualify.
MARILYN WHITE: Phil, this is Marilyn. I have a question for you. Do private, private payers still have a
calendar year limit on days for rehab like this?
PHIL WRIGHT: Well, we have so many different programs
I’ll have to look, Marilyn. We have
Medicare, we have Medicaid, we have commercial, they are all different.
MARILYN WHITE: No, no, no, not Medicare or Medicaid,
your commercial business.
PHIL WRIGHT: Yeah, I’m, I’m not sure without checking.
I’d have to check. Want me to check
right away?
MARILYN WHITE: No, I was just curious. I know they used to. It used to be, you know, probably a 34 max
you were lucky. Anywhere from 24 to 30
days per year. We all here, do you all
three, you deal with it, maybe you can answer it? Like, let’s say someone had health plan
insurance do you know what their limit is?
PHIL WRIGHT: On commercial.
[Crosstalk]
MARILYN WHITE: Yeah, Ed, do you know what Blue Cross
does?
ED HAMILTON: It varies by plan. My recollection is there’s probably not very
many plans that are less than 60 days but what you run into is medical
necessity guidelines, which is basically the same guideline that Medicare
uses. Once the patient fails to show
improvement then officially their care is no longer medically necessary and
they need to be transferred to another type of care so, you know, the length of
stay that we see here are, you know, indicate, basically, what you would
normally see on the commercial side, too.
You know, 10, 20, 20 days on the average. Usually people don’t exhaust their benefits
on it. They usually fail to improve at
some point and get transitioned to another type of care.
SHARON BOGGESS: This is Sharon Boggess again. Typical of what we see is that initial
pre-cert of seven days, hardly ever beyond that and it is continual update
thereafter. It is never really much
longer than seven days.
SONIA CHAMBERS: Now that you’ve rejoined us.
SONIA CHAMBERS: Where do they suggest that those joint
replacement patients go?
FEMALE VOICE 3: I thought that was part of the 13 or 11
required patients?
SHARON BOGGESS: This is Sharon Boggess again and just as
an example, since the single joint piece started, if you will, denials, we have
a total of 96 cases that were denied.
SONIA CHAMBERS: Because it was only one joint?
SHARON BOGGESS: Yes.
And when they went, they went all the way to—
SONIA CHAMBERS: [Interposing] If you are going to break
something break two of them?
PHIL WRIGHT: Who is denying these again?
SONIA CHAMBERS: What, Phil, what did you say?
PHIL WRIGHT: Who is denying these?
SONIA CHAMBERS: The intermediary.
PHIL WRIGHT: The intermediary for Medicare?
SONIA CHAMBERS: Yes.
FEMALE VOICE 2: We’re not complaining.
[Crosstalk]
RAYMONA KINNEBERG: Yeah, this is Raymona Kinneberg. One of the, one of the problems with that is
that the occupancy includes people from out of state and so you’ve got a
projection, particularly when you look where the rehab facilities are, that is,
that may be a larger population than what, than the 1.8 million.
SHARON BOGGESS: This is Sharon Boggess again and I just
want to give this as an example. We have
a hospital in another state that is a non-CON state, in
PHIL WRIGHT: Marilyn?
MARILYN WHITE: Yeah, just one second, Phil. I want to,
SHARON BOGGESS: Um-hum.
MARILYN WHITE: Then we’ve got it wrong on this chart, Dayle.
DAYLE STEPP: That came from the CON - - matrix.
MARILYN WHITE: I’m sorry, Phil. What did you want?
PHIL WRIGHT: That’s okay. I’m answering your question. Took me a while to get the book. Our rehab member cost is we pay the first 30
days, there’s a 20 percent coinsurance after 30, first on, and there’s no limit
on it.
MARILYN WHITE: No limit after that, okay. Beautiful.
You’re good.
PHIL WRIGHT: Yes.
PHIL WRIGHT: Are you for the rehab hospitals being
evaluated by HCA for rates?
RAYMONA KINNEBERG: This is Raymona Kinneberg, again. On behalf of
SONIA CHAMBERS: This is Sonia. Did you all tell us what your payer mix is,
roughly? I don’t remember whether I
caught that.
PHIL WRIGHT: Probably 70/30 the way I see it, Sonia,
70 Medicare, 30 commercial.
SHARON BOGGESS: My Medicare mix at Southern Hills, this
is Sharon Boggess, is 70 to 75 percent.
SONIA CHAMBERS: So 65 to 75 percent Medicare and then
other? How about CAMC, when you have
patients?
SONIA CHAMBERS: On the rehab unit?
MARILYN WHITE: Is that Medicaid, do you think?
MALE VOICE 2: Does Worker’s Comp pay for this service?
MARILYN WHITE: Yes, sir.
MALE VOICE 2: NB, PEIA.
Those are, of course, restricted fee, too.
SONIA CHAMBERS: And those would be in the other category,
right? Medicare and then other.
SONIA CHAMBER: So is that Medicare advantage members?
SHARON BOGGESS: Correct.
SHARON BOGGESS: And that is probably, for myself, is
coming in right after Medicare. It is
beating the commercial payers up - - commercial case but it is definitely of a
higher fee.
SONIA CHAMBERS: Okay, anything else? Everybody said their piece?
PHIL WRIGHT: And more.
SONIA CHAMBERS: Anybody else wishing to speak who did
not? I would also invite you, if you so
wish, to submit written comments, if you would like. I’d ask that you submit them within 30 days. All of the comments and the transcript will
be part of the record we will share with the legislature. If there is nothing else I appreciate
everybody’s time and interest.
SHARON BOGGESS: Thank you for having us.
DR. BIUNDO: Thank you.
[END]