WVHCA: 2012 CON Capital Expenditure Minimum

The West Virginia Health Care Authority has announced the 2012 certificate of need capital expenditure minimum threshold of $2,916,104. The new threshold is effective beginning January 1, 2012. The threshold is used as a part of the analysis by health care providers who must determine whether or not a certificate of need is required for a proposed project or health care acquisition. 

Pursuant to W.Va. Code 16-2D-2(h) and (s), the Authority is required to adjust the expenditure minimum annually and publish an update of the amount on or before December 31 of each year. The expenditure minimum adjustment isbased on the DRI inflation index published in the Global Insight DRI/WEFA Health Care Cost Review. The DRI inflation index as of December 31, 2011 is 2.9%.

WVHCA: Notice of Public Comment Period on Proposed Amendments to CON Standards for Megavoltage Radiation Therapy Services/Units

The West Virginia Health Care Authority has issued a Notice of Public Comment Period to obtain comments on proposed amendments to Certificate of Need Standards for Megavoltage Radiation Therapy Services/Units.

Here are the "proposed amendments" to the Megavoltage Radiation Therapy Services/Units. Here is a link to the current CON Standards for Megavoltage Radiation Therapy Services/Unit (Approved by Governor on October 9, 2002).

Written comments must be submitted to Tim Adkins, Director of Certificate of Need, at the West Virginia Health Care Authority, 100 Dee Drive, Charleston, West Virginia 25311, no later than July 15, 2011.

WVHCA: Proposed CON Standards for Megavoltage Radiation Therapy Services/Units

The West Virginia Health Care Authority has issued a Notice of Public Comment Period on a new Proposed Certificate of Need Standard for Megavoltage Radiation Therapy Services/Unit.

Written comments on the proposed Certificate of Need Standard must be filed with the Authority on or before July 30, 2010. Written comments should be directed to Timothy E. Adkins, Director of Certificate of Need Division.

WVHCA: Proposed Amendment to West Virginia CON Law Defintion of "Private Office Practice"

On June 15, 2010, the West Virginia Health Care Authority filed a Notice of a Comment Period on a Proposed Rule with the West Virginia Secretary of State amending West Virginia CSR 65-7, Certificate of Need Rule.

According to the Summary and Statement of Circumstances filed with the Proposed Rule the "amendment clarifies the definition of "private office practice" for purposes of administering the Certificate of Need Program. Those entities meeting this criteria may be eligible for an exemption from Certificate of Need review pursuant to West Virginia Code 16-2D-R(a)."

Written comments on the Proposed Rule are due on or before July 16, 2010.

WVHCA: 2010 CON Capital Expenditure Minimum

The West Virginia Health Care Authority announced that the capital expenditure minimum for calendar year 2010 is $2,767,500.

The capital expenditure minimum is typically used by the Authority when reviewing whether or not certain health relate projects require certificate of need review.

The Authority provided the following announcement via its website:

Pursuant to West Virginia Code §§ 16-2D-2(h) and (s), the Authority is required to adjust the expenditure minimum annually and publish an update of the amount on or before December 31 of each year. The expenditure minimum adjustment shall be based on the DRI inflation index published in the Global Insight DRI/WEFA Health Care Cost Review. The DRI inflation index as of December 31, 2009 is 2.5%.

The capital expenditure minimum for calendar year 2010 is $2,767,500.

WVHCA Report: $1.1B Cost Saving from Adoption of HIT

iHealthBeat reports on the release of a new report prepared by CCRC Actuaries for the West Virginia Health Care Authority.

The full report is available via the West Virginians for Affordable Health Care website and is titled, Health Care Financing in the State of West Virginia: An analysis and Projection of the Current System and Potential Transformations, August 2009.

According to the articles, the report indicates that the adoption of health information technology (HIT) and implementation of centralized medical care through medical home concepts could save West Virginia's health care system more than $1.1B in 2014. The estimates in the report used insurance claims data from more that 800,000 West Virginia residents, including data from Medicaid and Mountain State Blue Cross Blue Shield.

More details in the AP article by Tom Breen from the Charleston Gazette and Washington Post, Report: Health strategy could save W.Va. $1B.

The Washington Post article indicates:

. . . In the case of electronic prescriptions, the report estimates an overall savings of $164 million in 2014, including nearly $51 million in savings to private insurers and $42 million in savings to policyholders. . .

. . . The report estimates that a statewide rollout of medical homes would cost about $45 million up front and incur ongoing costs of about $368 million . . .

. . . Estimates suggest that about nine in 10 health care offices still keep everything in paper. As the new report says, up front costs for physicians run from $25,000 to $45,000 and have annual costs thereafter of between $2,000 and $9,000, steep amounts for small practices . . .

UPDATE: Thanks to a reader comment - you can now read the full report. The report is titled, Health Care Financing in the State of West Virginia: An analysis and Projection of the Current System and Potential Transformations, August 2009.

Following is the Executive Summary of the report which contains some very interesting statistics on the state of health care in West Virginia.


Executive Summary

• A cohort model was developed to simulate health care eligibility, utilization and insurance availability of the projected 1,828,538 West Virginians in 2009.
• The model utilizes 8,640 cohorts to represent current insured status, health care utilization, age, gender, and household income.
• The projected average age in 2009 is 40.2 years.
  
• West Virginia is projected to have a population of 1,806,545 in 2019 and the average age is projected to increase to 42.2 years.
• The number of commercially insureds is 757,884 in 2009.
• The number of non-Medicare PEIA insureds is 175,324 in 2009.
• The number of non-dual eligible Medicaid insureds is 321,113 in 2009.
• The number of dual eligible Medicaid/Medicare insureds is 57,118 in 2009.
• The number of Medicare eligible PEIA insureds is 37,784 in 2009.
• The number of other Medicare insureds is 168,571 in 2009.
• The number of West Virginia CHIP insureds is 24,480 in 2009.
• The number of uninsured West Virginians is 286,264 in 2009.
• Health care costs can be defined as charges or as allowed charges. In terms of allowed charges, projected West Virginia expenditures total $13.1 billion in 2009.
• Allowed charges are projected to grow to $24.4 billion in 2019.
• In 2009, the uninsured population is projected to incur $3.2 billion in allowed charges, resulting in bad debt and charity care of almost $900 million.
• Initiative I, Adult Medicaid Expansion, is projected to cost the State of West Virginia $56.8 million and the Federal Government $162.0 million in 2014, while overall health care expenditures will decrease $611.5 million. Low income residents see the majority of the savings, spending $591.5 million less on health care.
• Initiative II, Adult Medicaid Expansion Combined with an Insurance Mandate for Employers and Individuals, is projected to cost the State of West Virginia $56.8 million in higher Medicaid expenditures and $1,004.3 million in insurance premium subsidy. The initiative will cost the Federal Government $162.0 million in 2014, while overall health care expenditures will decrease $2,176.0 million. Low income residents see the majority of the savings, spending $2,212.8 million less on health care.
• Initiative III, Adult Medicaid Expansion combined with an Insurance Mandate for Individuals, is projected to cost the State of West Virginia $56.8 million, $983.4 million in insurance premium subsidy. The initiative will cost the Federal Government $162.0 million in 2014, while overall health care expenditures will decrease $1,634.7 million. Low income residents see the majority of the savings, spending $1,656.2 million less on health care.
• Initiative IV, Medical Home, is projected to save the State of West Virginia $57.3 million in claim expenditures and the Federal Government $199.3 million in 2014, and overall health care expenditures will decrease $642.6 million. Low income residents and insurance companies see the majority of the savings, spending $170.6 million and $173.2 million less on health care, respectively. This initiative requires $45 million of initial costs and a total of $368.2 million of ongoing physician reimbursement per year.
• Initiative V, e-Prescribing, is projected to save the State of West Virginia $16.0 million in claim expenditures and the Federal Government $53.8 million in 2014, and overall health care expenditures will decrease $164.0 million. Low income residents and insurance companies see the majority of the savings, spending $41.9 million and $45.6 million less on health care, respectively. The cost of implementing e-prescribing has not been projected.
• Initiative VI, Electronic Medical Records, is projected to save the State of West Virginia $28.3 million and the Federal Government $98.5 million in 2014, and overall health care expenditures will decrease $317.6 million. Low income residents and insurance companies see the majority of the savings, spending $84.3 million and $85.6 million less on health care, respectively. This initiative requires around $25,000 to $45,000 of initial costs and an annual cost of $3,000 to $9,000 per provider. However, these cost estimates appear to be declining over time.
  

West Virginia Health Care Authority Revises Fee Schedule for Certificate of Need Program

On July 15, 2009, the West Virginia Health Care Authority filed with the West Virginia Secretary of State proposed amendments to the its procedural rule regarding the schedule of fees for the filing of certificate of need applications and exemption requests under the West Virginia Certificate of Need Program.

The amendment revises the fee schedule pursuant to Senate Bill 321 passed during the 2009 Legislative Session. The amendment required the fee schedule contain a maximum amount or cap for certificate of need application fees.

The proposed rule, Fee Schedule for Certificate of Need Matters, CSR 65-10 (redline version showing amendments) has been filed with the West Virginia Secretary of State. Written comments to the proposed rule may be submitted to the Authority before August 14, 2009 at 5:00 p.m.

WVHCA FY 2007 Annual Report: A Summary of Health Care In West Virginia

The West Virginia Health Care Authority's 2008 Annual Report for FY 2007 is now available. The report summary was provided to the West Virginia Legislature by Sonia Chambers, Chair of the WVHCA. The report contains significant information about the state of health care in West Virginia.

The Executive Summary states:

Hospitals:
Overall, West Virginia hospitals remained relatively stable, reporting profits of $184.5 million or 4.4% of net patient revenue (NPR), up from $176.7 million (4.5% of NPR) in FY 2006.

Acute Care Hospitals
The total profit margin for the 35 general acute care hospitals increased by almost 1%, with profits of $165.7 million (4.4% of NPR), up from $123.8 million (3.5% of NPR) in the prior year.

Critical Access Hospitals (CAH)
As a group, the profitability for CAHs continued to improve for the fourth straight year. The aggregate profit was $5.8 million (2.3% of NPR). In FY 2006, profit was $4.3 million (1.8% of NPR).

Long-term Acute Care Hospitals (LTCH)
The two facilities in FY 2007 reported a profit of $1.5 million (5.9% of NPR), a decline from the FY 2006 profit of $3.3 million(12.4% of NPR).

Psychiatric Hospitals
The psychiatric hospitals had an aggregate loss of $8.3 million(35.8% of NPR), with the two state psychiatric hospitals losing $9.6 million combined and the two private hospitals earning profits of $1.3 million. The prior year’s overall loss was $702,000 (2.0% of NPR).

Rehabilitation Hospitals
The five rehabilitation hospitals showed a return to more normal profit levels with aggregate profits of $19.8 million (22.1% of NPR). In FY 2006, these hospitals reported an aggregate profit of $46.0 million (51.7% of NPR) due to the sale of a facility.

Other Facilities:

Nursing Homes
The overall profit margin for the state’s 106 nursing homes increased by 1.5%. Aggregate profits of $44.8 million (6.5% of NPR) were reported, an increase over the $32.6 million (5.0% of NPR) reported in FY 2006.
Aggregate net patient revenue increased $38.6 million in FY 2007; expenses increased $25.1 million.

Home Health
Overall, home health agencies reported total losses of $2.3 million on $84.1 million total revenue; 32 of the 66 agencies were profitable. Eleven home health agencies were acquired during FY 2007.

Hospice
Hospice profits for the 19 agencies were $8.3 million, compared to $9.1 million in FY 2006.

Behavioral Health Facilities
Eighty-nine behavioral health providers reported aggregate profits of $15.1 million, 2.9% of total revenue; 57 of 89 facilities were profitable.

Methadone Treatment Facilities
The aggregate profit for the eight facilities was $6.1 million, 29.7% of total revenue.

Ambulatory Surgical Centers (ASC)
Eleven reporting certified ASCs had an aggregate profit of $5.2 million, 21.7% of total revenue.

WVHCA Board Approves Modified Cardiac Catheterization Standards

Yesterday, the West Virginia Health Care Authority Board approved the changes to the Certificate of Need Standards for Cardiac Catheterization. The approved modification will now be delivered to Governor Manchin for review and approval.

Eric Eyre of the Charleston Gazette covers the story today in his article, Smaller hospitals get OK to offer heart procedures.

The new Standards will not go into effect until approved by the Governor. The current Cardiac Catheterization Standards were last updated and approved by the Governor on May 3, 2007.

For more on the process of modifying the standards check out my previous posts.

WVHCA: Proposed Amendments to Cardiac Catheterization Standards

The West Virginia Health Care Authority approved for public comment proposed revisions to the Certificate of Need Cardiac Catheterization Standards (current 3/19/2007 standards).

These revisions were made by the Authority after Governor Manchin rejected the previously proposed standards. The proposed standards continue to modify the requirements for the participants in the demo pilot project involving offering therapeutic cardiac catheterization.

The standards distinguish between Primary (Emergency) Percutaneous Coronary Intervention (Primary PCI) which involves providing cardiac catheterization services within 120 minutes of an emergency myocardial infarction and Elective Therapeutic Catheterizations. The proposed standards also set new need threshold levels for elective therapeutic catheterization.

Written comments on the proposed standards may be submitted to Dayle D. Stepp, Director of Certificate of Need, no later than May 23, 2008.

I previously reported on the modifications to the standards here, here and here.

WVHCA Grants Motion to Dissolve Stay in Manor Care CON

Yesterday the West Virginia Health Care Authority issued an Order Dissolving Stay. The Order granted MCHCR's (Carlyle Group) Motion to Dissolve Stay but denied the Motion to Affirm the Initial CON Decision.

The Authority set January 7 as the date for initial briefs to be submitted by both parties as a result of the Reconsideration Hearing held on December 14.

WVHCA Issues Proposed CT Standards

Yesterday, July 11, the West Virginia Health Care Authority issued proposed CON Standards covering computerized tomography (CT) services in West Virginia.

The proposed Computed Tomography Services CON Standards provide a new need methodology process for new, additional or replacement CT scanning services by hospital and non-hospital applicants. The proposed standards set forth a weighted need methodology threshold of 3,000 scans per year and provide an exemption for CT scanners costing less that $300,000.

Although I've not read anything official from the Authority, today's Charleston Gazette article indicates that the Authority will accept comments on the proposed standards during the next 30 days and the Authority's board will vote on the regulations at its September meeting. The new standards will then be sent to Governor Manchin for final approval. UPDATE: The Authority has now posted information about submitting comments. The deadline for submitting comments is August 10, 2007.

The Charleston Gazette reports on the new standards today in its article, "Doctors' offices to be allowed to buy CT scanners". Additional background information on the development of the CT Standards can be found on the Authority's CT Services Workgroup Meeting site. For comparison, the old 1992 CT Standards are available.

UPDATE 8/22/07: It appears that the Authority has extended the deadline for submitting comments until August 31, 2007 based upon the Notice of Public Comment listed on the Authority's website. Also the Authority has uploaded the comments submitted on the proposed CT Standards.

WVHCA Issues Proposed CON Standards For Bone Marrow Transplantation Service

The West Virginia Health Care Authority has issued new proposed Certificate of Need Standards for Bone Marrow Transplantation Services. For more information go to the "Notice of Public Comment Period".

The proposed CON standards are out for public comment. Public comments can be submitted to the WVHCA no later than July 6, 2007. Notice of the proposed standards were published in today's Charleston Gazette legal advertisement (June 16, 2007).

The proposed standards indicated that West Virginia bone marrow transplants are currently performed exclusively at West Virginia University Hosptials, Inc. The standards state that WVUH "performed 43 bone marrow transplants in 2003, 37 in 2004 and 46 in 2005." The proposed standards indicate that WVUH will be the exclusive provider of bone marrow transplantations service in West Virginia.