Read the study:http://healthpolicyandreform.nejm.org/?p=13667

Health reform skeptics predict that thousands of Americans will be wandering from doctor's office to doctor's office, Medicaid card in hand, looking for somebody who will take new patients. That might happen in some states, but it's not likely to happen in West Virginia, according to a study published in the January New England Journal of Medicine.

West Virginia is better prepared to provide newly insured citizens with primary care -- nonhospital care -- than 42 other states, according to "The States' Next Challenge -- Securing Primary Care for Expanded Medicaid Populations."

The researchers indexed the number of patients expected in each state to the supply of primary care doctors and health centers in each state, among other things. They estimated 139,000 new West Virginia Medicaid cardholders by 2019, the midpoint of the Kaiser Family Foundation range of 122,000 to 157,000.

Their top 10 "most-ready" list is filled with more prosperous states: Massachusetts, Vermont, Maine, New York, Rhode Island, Connecticut, Washington, Delaware, Hawaii.

Then there's West Virginia, in the No. 8 spot.

"I have to admit I was a little surprised when I saw West Virginia doing so well, because I think of it as a poor state, and these other states have comparatively well-funded health-care systems," said Leighton Ku, lead author and director of Health Policy Research at George Washington University.

West Virginia has definite minuses:

So why does West Virginia rank so high? Two things, Ku said:

"The large number of community health centers your state has is what really helps you, along with the fact that these centers are already seeing a lot of patients," he said.

One in five West Virginians -- 373,000 people -- get their primary care at one of the state's 28 community health centers, which provide care, regardless of income. About 90,000 of those patients are uninsured.

Second, West Virginia has a better supply per capita of primary care doctors, nurse practitioners and other health care professionals than most small states. "Most states have a very poor supply of primary care providers," Ku said. "In comparison, West Virginia has done well."

"West Virginia's ranking in this study is a testimony to a lot of hard work that's been done in this state on rural health care over the years," said Perry Bryant, director of West Virginians for Affordable Healthcare.

"Seventy percent of the people who will receive Medicaid cards are working families," he said, " We're not talking about lazy, undeserving people. They work jobs with no insurance, whether it be a fast-food restaurant, a hardware store or a small contractor."

People who earn less than 133 percent of the federal poverty level are eligible: $14,484 for an individual or $29,726 for a family of four.

Medicaid expansion will save West Virginia hundreds of millions each year, according to a 2009 actuarial study sponsored by the state Health Care Authority.

"The savings are going to be enormous," said Renate Pore, health-care analyst for the West Virginia Center on Budget and Policy.

"People who can't afford to go to the doctor often ignore warning signs till the problem blows up into a crisis and sends them to the emergency room," she said. "Once they start going to the doctor regularly, we'll see a huge drop in emergency room and hospitalization costs that get shifted onto paying patients. This will save individuals, insurance companies and government a lot of money."

West Virginia will pay little for all this, she said. The federal government foots 100 percent of the cost till 2016, and 90 percent thereafter.

"That's an amazing deal," Pore said.

One-stop medical care

Other states could learn from what West Virginia has done, Ku said. Many are now scrambling to build community health centers.

"They're starting a process West Virginia started years ago," he said.

West Virginia built its first center in the 1960s, during the "War on Poverty." Now there is a center within driving distance of almost every part of the state.

They fill the gap left by West Virginia doctors who do not take the state's low Medicaid payment rate, Pore said. "They are a true safety net, a state treasure," she said, "and they provide quality care."

"People ask where all the new Medicaid patients are going to find doctors," said Craig Robinson, CEO of Cabin Creek Clinic in Kanawha County. "Well, some of them are already patients. Almost all the people we serve on a sliding fee will be eligible for Medicaid."

Medicaid will pay the centers "significantly more" than the $15 a visit many sliding scale patients pay, Robinson said. The extra money will let the centers serve more people, add services, and beef up prevention efforts, he said.

The centers do not provide hospital care, he said, "but we prevent the need for a lot of it."

All 28 West Virginia centers expanded facilities and labs with stimulus dollars, said Louise Reese, director of the West Virginia Primary Care Association. "We're thinking ahead," she said.

More docs and nurses

"West Virginia is also doing well, compared with other states, in numbers of primary care doctors and nurse practitioners and physician assistants," Ku said. The state's number of primary care doctors is now 98 percent of the national average.

That also did not happen by accident, said Hilda Heady, former director of West Virginia's Rural Health Education Program. "Years of hard work are paying off."

In the 1990s, faced with a serious doctor shortage, the Legislature required the state's three medical schools to send every student for at least one primary care rotation in an underserved area. The same requirement applies to pharmacists, nurses, physician assistants and dentists.

"The idea was that some of the students would discover they like primary care and rural life and stay there," said Heady, who helped coordinate that effort.

It worked, according to Dr. Don Pathman of the Cecil B. Sheps Center for Rural Health Research in Chapel Hill, N.C. Between 1981 and 2006, "the number of West Virginia physicians trained in West Virginia medical schools increased fivefold," he said.

Pathman surveyed state graduates at five-year intervals, to find out how many were practicing in West Virginia. The number of practicing doctors rose 58 percent from 2,248 to 3,857. "Almost all the growth was from graduates of West Virginia schools."

The percentage of West Virginia-trained specialists in rural areas also almost quadrupled, from 3 percent to 11 percent.

The Legislature deserves a lot of credit for foresight, Heady said. "They expanded Medicaid eligibility and forced the medical schools to put part of their training in rural areas. Now we see the value of those decisions."

Heavy lifting ahead

West Virginians should not think they've got the problem knocked, Ku cautioned. The state ranks high in part because many states are unprepared, he said.

Some areas are less prepared than others, the Primary Care Association's Reese said. "The more urban areas have an over-supply of doctors, but a few areas are still struggling."

If the Legislature OKs the state's health insurance exchange, Medicaid-eligible people can log on in 2014, sign up for Medicaid and find contact information for doctors in their area who take Medicaid.

"We still have heavy lifting to do," Bryant said, "but we can be proud of where we are and how far we've come."

Reach Kate Long at katel...@wvgazette.com or 304-348-1798.