BRMC

The Mercer County Commission discussed the impact of the closure of Bluefield Regional Medical Center, pictured above in this file photo.

BLUEFIELD — The future for Bluefield Regional Medical Center is still very much alive as discussions have been under way for the facility to possibly be part of Bluefield State College’s plans and to also retain or bring back as many medical services as feasible.

Princeton Community Hospital purchased the facility last year but recently announced in-patient and ancillary services would be closed by July 30 with the emergency department remaining.

A combination of the COVID-19 pandemic and the hospital’s chronic economic problems resulted in the decision, the PCH Board of Directors said, with 340 jobs impacted. Plans were to have a gradual process, but the pandemic changed that.

Speculation has abounded about the hospital’s future since the announcement as well as how many of those jobs can be retained at BRMC and PCH.

Dr. Wallace Horne, Vice President of Medical Affairs for PCH, said last week discussions and evaluations are on-going on all of the issues, including how the facility may benefit Bluefield State College with dormitories and additional programs in the medical field.

Horne said discussions with the college have been taking place, looking at possibilities.

“They have expressed some interest in expanding some of their health care programs,” he said, adding that not having on-campus living facilities has been challenging for the school.

Horne said representatives of BSC have been exploring the option and have visited the hospital.

“That is just part of the discussions,” he said. “I think it is a creative idea. I hope we will be able to pursue that.”

BSC President Robin Capehart said discussions are ongoing, but he is not yet in a position to offer any details about the options being considered.

Another concern in the community has been whether the BRMC Emergency Department will continue to operate.

Horne, a former ER doctor who has had decades of experience in all operations of many hospitals, said the goal is to retain the ER at BRMC, with laboratory and imaging services.

“The first step is the state Health Care Authority (HCA),” he said. We have been working with the Governor’s Office and HCA in trying to make a case that it is important for the community for us to be able to provide a level of health care services in the community.”

Changes in ownership and the unique situation of the purchase require the approval of the HCA, he said, adding that the aids of Gov. Jim Justice as well as both Sen. Joe Manchin and Sen. Shelley Moore Capito are involved to help with the process.

“It’s a state issue and a health care issue,” Horne said. “They (HCA) have been great to work with. West Virginia is a CON (Certificate of Need) state so the HCA decides why this is needed in order to have adequate services to provide needed care.”

A CON is a mechanism to avoid duplication of expensive services and equipment in an area.

Horne anticipates the process with conclude in a shorter period time than it usually takes because so many people are helping.

If all goes as planned, the BRMC Emergency Department would work as a separate entity but still be under the corporate umbrella of PCH, just as some medical clinics in Bluefield are.

Another CON issue is radiation oncology services, which BRMC provides and has a CON to do so.

Horne said PCH wants to leave that service at BRMC, but must still transfer the CON to PCH to do so.

That approval process is under way.

During a meeting of the Bluefield, Va., Town Council recently, several speakers were concerned about the possibility of the extra drive time to Princeton posing risks if the BRMC ER cannot handle the particular crisis, like a heart attack.

Horne said the process used in such emergencies start with the EMS personnel who are the first responders. They can call the Medical Command System operated out of Raleigh General Hospital.

Each center is staffed 24/7 by paramedics with years of clinical experience, and provides medical direction to field providers. An assessment will be made regarding the course of action needed.

Horne said the first-responders stabilize patients and take them where the service for treatment is available, sometimes using helicopters, depending on the nature of the emergency.

Even with BRMC’s specialized cardiology unit, which provides interventional heart catheterization, patients may not be taken there now because a cardiologist may not be available.

However, Horne said patients with heart attacks can be stabilized long enough to reach the proper care.

In fact, the lack of a physician 24/7 for specialized care is a problem in rural areas.

“One of the challenges for Bluefield and Princeton and Tazewell is the area is rural and it’s difficult to recruit and retain highly trained physician specialists,” he said. That is a problem hospitals in rural areas continue to experience and one reason hospitals often struggle to survive.

But Horne said one of the most crucial factors in the survival if a rural hospital is that more than 80 percent of patients in this area are Medicare, Medicaid or PEIA (the state Public Employees Insurance Agency).

Those three payers, he said, underpay what the real costs are.

That is a point Tazewell County Eastern District Supervisor Charlie Stacy made at the Bluefield Town Council meeting when the town discussed possibly opening another hospital in the area.

Stacy said even if they did, it would not be financially viable because of the high number of Medicare and Medicaid patients.

“The problem here truly is hospitals cannot survive when 90 to 95 percent of those receiving medical care are Medicaid or Medicare,” he said, adding the reimbursements for services are so low too much money is lost.

Stacy pointed out that the only reason Carilion Tazewell Community hospital survives is because it is part of the huge non-profit Carilion organization.

Horne said those low payments for services is one the reasons Mercer County basically could not support two hospitals.

When non-profit PCH purchased for-profit BRMC last year, the economic viability of both hospitals was front and center, he said.

Both hospitals were providing services and the purpose was to see which services were being duplicated and “find the economies of scale.”

For example, in-patient and some ancillary services are being closed at BRMC because PCH can meet the needs adequately.

Although PCH is non-profit, it still must be economically viable, he said, adding that the county has needed only one hospital for many years and there was even talk of that, but nothing every happened.

“The reality of it is they should have built only one hospital 20 or 30 years ago,” he said. “Only one hospital is needed for the county.”

Having one hospital also provides easier service for patients, he added, because of the centralized computer system which can provide a patient’s history quickly without being transferred from one facility to another.

Merging services and equipment is an ongoing processes, requiring an evaluation of what BRMC has in place.

“A fair amount of capital investment (about $40 million between 2010 and 2016, according to the previous owners, Community Health Systems, based in Tennessee) was made in the hospital,” Horne said. “Some of the equipment is very good, but some is past its end of life.”

For now, all of the equipment, including the cardiology upgrades, at BRMC will remain in place.

“Until we find out the HCA is going to allow us to go forward (with the necessary CONs) we are not moving those big capital pieces of equipment,” he said. “We have to move the CON to Princeton (from Bluefield).”

The hope is to use the equipment, whether it’s in Bluefield or Princeton.

“We are not going to just throw away good equipment,” he said, and it will be used “if we can make it happen.”

As far as employment goes, Horne said it is difficult to know the exact number who can be retained, either at Bluefield or Princeton, depending on how the process eventually unfolds.

“We will have 50 to 70 jobs here (at PCH for BRMC employees),” he said, “and another 50 to 70 in Bluefield. We will absolutely keep as many as we can.”

Horne said that by the end of June, “we will have a fair number of answers for our next steps, what we are allowed to do.”

Right now, the focus is on the transition and keeping the ER, lab and imaging services as well the radiation oncology service at Bluefield, and waiting on the CON for the interventional heart catheterization unit to relocate to Princeton.

“Once all of those pieces are clearer, then we will know what jobs will be needed,” he said. “At the end of the day, this is about trying to provide health care services in Southern West Virginia … We can’t save every job, but a good number of them we will keep here.”

Horne said that, right now, it is not as easy as it was before the pandemic for medical personnel to find jobs at other hospitals in this area or many other places because of the impact of the pandemic.

“During COVID-19 hospitals laid off almost 60 percent of employees,” he said, referring to orders for hospitals do temporarily discontinue elective surgeries and other services. “It’s hard to tell right now (how many jobs are available at other hospitals).”

Horne said it is difficult to yet determine the “economic devastation shutting all of this down has done. We will see as it shakes out.”

But the impact already is profound, he said, with loss of jobs, layoffs, cuts and millions in revenue “you can’t get back.”

The City of Bluefield has been trying to work to save the hospital for many years, said City Manager Dane Rideout, pointing out BRMC’s high turnover rate of CEOs and the ongoing financial problems.

In the wake of the purchase, Rideout said communication between PCH and the city continues on the future of BRMC.

“We all recognize we need community health care in our region to survive and prosper,” he said. “We are working very closely with PCH to determine what that facility will look like in the future.”

Rideout said he understands that it does not have to be a full-service hospital and rural health care has changed.

“But we do not want it to be an empty building,” he said, adding that many options for its use are on the table, including Bluefield State College and possibly a regional cancer center. “We do think there is a medical capacity to work out of there.”

Rideout said keeping the emergency room is essential.

“That is our line in the sand,” he said, “There has to be an emergency room capability that has a laboratory and imaging services. We must have it and we will have it.”

Rideout said the city is helping communicate with the state as well to speed up the approval process by HCA.

“Change up the dynamic,” he said of working with PCH. “We need to be shoulder-to-shoulder on this. We need that (ER) for the region.”

Rideout said it will be “horrible” to lose jobs in the area, but the PCH board is making “researched, well-thought-out decisions not based on emotions.”

“We are all upset, but we are trying to stay positive and be focused on what regional health care should look like, not just for Bluefield or Bluefield, Va. or Princeton, but our entire metropolitan area,” he said. “That effects everything we do, including property values, economic development and the standard of living. That is what we are working toward.”

Rideout said there was talk of one hospital for the county to be located in Green Valley 25 years ago.

“We’ve come full circle,” he said of the move to one hospital, and he wants to have a town hall meeting to fully explain what the goals are now with one hospital on the horizon.

“We are not being myopic,” he said. “We are looking long term at what happens if PCH does not survive. Then where would you go?”

Rideout said everyone is “in this together and we are going to figure out a solution.”

Jeffrey Lilley, PCH CEO, said the goal is to work together and do what can be done.

“We have met with the city officials of Bluefield W.Va. and are evaluating options to keep the facility active and occupied,” he said. “Many questions remain as state and federal guidelines must be met to achieve keeping specific components of healthcare in Bluefield. Once we have more information on what we are permitted to do, that will lead us to secondary options for utilization of the facility and space.” 

Horne said it is an effort shared by many.

Everyone is now working together to “make the best out of a bad situation,” he said.

The plan is to bring Bluefield into PCH’s system and during that process look for the economies of scale in a more financially stable way, Horne said.

“I hope and I think it’s to the benefit of the community to have at least one solid, financially strong hospital to provide medical care,” he said.

— Contact Charles Boothe at cboothe@bdtonline.com.

 

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