BRMC sign gone

BLUEFIELD — With the stand-alone emergency department now established and operating at the former Bluefield Regional Medical Center, the question now being faced is how the rest of the vast facility can best be utilized.

Princeton Community Hospital (PCH), a non-profit, bought the for-profit and financially troubled hospital last year and had plans to consolidate services and maximize the strengths of both.

However, the pandemic’s financial impact forced PCH to start closing departments, with in-patient and ancillary services ending July 30.

The PCH Bluefield Emergency Department remains however, offering full services, including laboratory and imaging functions. Radiation oncology will also remain.

Finding the best use for the rest of the facility is crucial to both PCH and the City of Bluefield as well as the region.

Jeffrey Lilley, PCH CEO, is working closely with Bluefield Mayor Ron Martin, City Manager Dane Rideout and City Attorney Colin Cline on coming up with solutions.

“We want to work together to come up with a collaborative way to make that successful,” Lilley said on Thursday, the day BRMC’s sign was removed from the hospital, adding that discussions will also include Bluefield, Va.

“It doesn’t have to be just what Princeton Community Hospital thinks it should be,” he said.

Rideout said the city does not and has never owned BRMC and lost $750,000 a year in taxes as well as many jobs after the purchase last year, with the switch from for-profit to non-profit.

He said the question he hears now is what does the future look like for the facility. “People want to know what the hospital campus will look like.”

But as the evolvement of health care around the country has shown, it will never be a traditional hospital “as we know,” he added.

“Thinking about the space in the building, there are options out there,” Lilley said. “We have had discussions with folks, but nothing has been solidified at this point. We continue to work through some of those logistics.”

The focus up to now has primarily been to make sure the emergency department was established, he said, with all the services that support it.

Now, the focus can also include collaborating with the city and area educational institutions and see what other options may be available.

“That is more of a collaborative effort,” Lilley said. “There is no hidden agenda. At the end of the day, we are interested in seeing that facility being utilized for something that makes it success, makes the most sense and brings value. I think that is what everyone wants to do.”

Lilley said people have inquired about using the facility, including Bluefield State College.

With more than 90 inpatient rooms that could serve as dorm rooms and the possibility of expanding BSC’s medical field programs, that option is “absolutely” on the table, he added.

“Our educational institutions have needs, and that could be an opportunity to utilize that space successfully” Lilley said. “But we would have to work towards that point.”

There is also the option of bringing in more clinical services in the future.

The radiation oncology service will remain in Bluefield and one of the options may be to expand cancer treatment capabilities.

“We are currently working through the process of looking at capital needs of that service,” he said. “We really want to be able to make that better.”

A cancer treatment center is “something we are trying to consider, the possibility of expanding the radiation oncology service to a full service cancer center, that is something we are trying to explore as an option,” he said.

Rideout said a lot of money was invested in BRMC’s infrastructure over the years.

“I know based on building permits over the last nine years over $90 million … in improvements was invested in that facility,” he said. “There’s a lot of work that has gone into that facility for us to allow to sit vacant.”

Riedout said everyone involved has been charged to go after opportunities and work very closely with PCH to utilize it.

“As a veteran, I would love to see us partner with the VA (Veterans Administration) and put some sort of long-term care in that facility,” he said.

Rideout said there are medical pieces of equipment there that can’t be moved, like a linear accelerator which is set in concrete, and a positive step forward would be to find a way to utilize it.

The facility has a lot of potential, he added, but it’s “not going to be the traditional hospital we are all used to seeing. That is no longer the model for hospitals.”

Rideout said it has been clear the demographics of this area do not support two regional acute care hospitals. The population and economy once did, but that is no longer the case.

“From the city’s perspective, the most important thing is that we have quality health care that is available in our region and we do not want to jeopardize that,” he said. “Just because we don’t have a hospital inside our city limits does not mean we don’t have quality health care. We need to do everything we can to support PCH being successful so we don’t lose it because rural health care across the nation is in a very precarious state right now.”

“We have lost 171 rural hospitals nationwide since 2005,” said City Attorney Colin Cline. “They have lost two hospitals in Wheeling … the hospital still standing up there is in trouble.”

Charleston Area Medical Center was losing $1 million a day because of COVID, he said.

“There are no boogeymen here,” Cline said. “There’s not a bad guy who we can point our fingers at and say this is what happened to Bluefield Regional.”

One of the main reasons rural hospitals struggle, Lilley said, is the “payer mix” of Medicare, Medicaid and, in West Virginia. PEIA (Public Employees Insurance Agency), all of which comprise about 85 percent of payments and do not provide enough money.

“The reality is in rural West Virginia your ability to provide services relates to the payer mix you have,” Lilley said. “Our governmental payer mix exceeds 80 percent, probably in the 85 percent range.”

Commercial insurance in many cases barely pays above those governmental entity rates, he added. Most commercial carriers base their payments on a list Medicare uses for payment of services and pay “only a few percentage points” above that.

That commercial mix is much higher in other areas around the nation, but in West Virginia it’s only about half of what it is in those areas.

With the payer mix combined with a decreasing population it is “just impossible” to keep two acute care hospitals open, Lilley said.

Rideout said it is important to work with legislators on both the state and federal level to address the payer mix problem, especially PEIA.

“The PEIA is a horrible reimbursement platform,” he said. “That is what the cities (and counties) fall underneath as well as the schools … we are part of the problem at that level.”

Lilley said the hospital also uses PEIA.

“This is a complex problem,” Rideout said.

The payer mix had already created a difficult financial dynamic that PCH and all rural hospitals struggle with.

But when the pandemic hit and elective surgeries and other services stopped, the impact added another level of a financial burden, forcing the hand of PCH to move the in-patient and ancillary services from BRMC rather than gradually use an economies of scale model that would benefit both hospitals.

Lilley also said PCH will have a 131-bed capacity and is in a position to handle a COVID outbreak in the area, unless it would be a catastrophic outbreak then every hospital in the region would be utilized.

Rideout said BRMC, which was built more than 40 years ago but had served the community as Bluefield Sanitarium for decades before, at one time had about 250 beds when coal was booming in the region.

But there was little economic diversification.

“In health care, we can’t sit back,” he said. “Health care is changing dramatically.”

Bluefield Mayor Ron Martin described current health care as a “hub and spoke” system.

“One-stop health care is unheard of now,” he said, “unless you are in a major metropolitan area or a school like WVU or Marshall.”

“We refer patients every day to tertiary health care centers in Charleston, Roanoke, Morgantown and North Carolina,” Lilley said.

“This move does bring together more capability of having 24-hour coverage in certain aspects of health care,” Martin said, adding it extends physician coverage time by having services located in one facility.

“This will build synergy within the community,” Lilley said. “Then we can look at opportunities to bring in more specialists and more sub-specialists to provide to this market, whether that is in Bluefield or Princeton.”

Lilley said the possibility of adding more specialists in Bluefield to see patients exists, even if it’s not every day.

This would prevent residents from driving to Charleston or other areas, he added.

In the meantime, all are on board to explore what is in the best interest of PCH, Bluefield and the region. 

“There will be something in there (the BRMC facility), and there will be something that is medically related,” Rideout said. “It’s not going to be an empty building.”

— Contact Charles Boothe at cboothe@bdtonline.com

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