Medicaid funding cuts could literally shut down her hospital, Summersville Regional Medical Center, and other rural health sites across the state, she and other health-care experts say.

Hill is chief executive officer of the 105-bed hospital, which serves Nicholas and Webster counties. "We live very much paycheck to paycheck," she said last week. "The prospect of a cut in our federal funds is downright frightening."

More than half of the Summersville hospital's patients are insured by Medicaid and Medicare, Hill said, so funding cuts would affect the whole hospital. "It's frightening to ask, 'Will we still be here five years from now?'" she said.

Many health-care experts predict that Medicaid, in particular, is likely be cut as Congress and the White House struggle to reach a deficit-reduction deal.

Hospitals are already coping with the poor economy and the demands of health-care reform, Hill said. "It's terrible timing," she said. "If reimbursements are cut, too, what we're going to see, I do believe, is the closure of some of our hospitals -- and maybe even physician practices associated with hospitals -- because we can't operate in the negative."

Many of West Virginia's community hospitals are in the same situation, according to Tony Gregory, vice president of the West Virginia Hospital Association. In 2009, 36 West Virginia hospitals -- 58 percent of all those in the state -- lost money taking care of patients, he said.

They scramble to make up the difference with cafeterias, gift shops, vending machines, parking lots, new outpatient services and investments, Gregory said.

"Under those circumstances, any reduction in funds will have an impact," he said.

"It has to do with our ability to fund operations," Hill said. "We operate on a very slim margin, we serve a lot of low-income people in Webster and Nicholas counties, and we don't have large reserves like the larger hospitals do. We don't have grant funding or large donors."

Smaller hospitals get extra "critical access" funding, she said, "but hospitals of our size, in between small and big, are struggling from day to day to pay our bills and keep up the staffing levels we need to provide quality care, let alone replace equipment and keep facilities up to date."

"If they continue to cut reimbursements, they are going to see hospitals fail," agreed David Shaffer, CEO of Weston's Stonewall Jackson Memorial Hospital. "Hospitals that have no reserves will not be able to meet their expenses. It's that simple, like any business."

Stonewall Jackson has a fund intended to build a new hospital, he said. "We would have to eat into that, to buy time."

On average, statewide, 20 percent of hospital funding comes from Medicaid, and 36 percent from Medicare, Gregory said, "but that can be higher in rural communities."

Summersville is not in trouble if there are no new cuts, Hill said. "We have a modest bottom-line projected for this year," she said, "but a reduction in federal funding could change the picture."

"As the economy gets worse," she said, "we're also finding it harder and harder to get private-pay folks to pay what they owe, because they have so many other economic pressures."

The health-care reform law "requires us to do a lot of things that may well be positive in the long run," she said, "but they require resources we don't have right now."

Under the reform law, she noted, "disproportionate-share" funds her hospital depends on will disappear. That loss would be balanced by the fact that nonpaying patients become insured in 2014, she noted, "but that hasn't happened yet."

If a federal cut were added to this mix at this point, she said, it could be too much to handle.

"If the community hospital's in trouble, that has ripple effects," the hospital association's Gregory said. "Hospitals are often the largest area employer, so they are hubs of not only health care, but economic activity."

Summersville Regional Medical Center employs 500 people, Hill said.

The center's beds are typically filled with Webster and Nicholas county people with heart problems, pneumonia, surgeries and pregnancies. They care for 1,900 emergency-room patients and perform 335 surgeries per month, on average. "We are the only hospital within easy driving range for our area," she said.

"If somebody has an accident on Route 19 or Summersville Lake, they come to us," Hill said. "If somebody has a heart attack in Webster County and they can get to us, we can stabilize them and send them on the [HealthNet] helicopter to Charleston."

Half the center's 105 beds are nursing-home beds. "Almost all Medicaid," Hill said.

Medicaid also pays for 90 percent of the 400-plus births yearly, she said. "We considered eliminating our OB services a few years ago, because it doesn't cover the cost, but the public outcry was so great, we kept those services."

Statewide, more than half of all births are paid for by Medicaid. "When you think about it, if those mothers don't get the prenatal care and OB services, you're going to end up with a lot more babies with million-dollar bills in the Neonatal Intensive Care unit and a lot more kids with problems," Hill said.

In April, the U.S. House of Representatives passed a budget that would slash Medicaid funds by 35 percent. Rep. Shelley Moore Capito, R-W.Va., voted for that budget; Reps. David McKinley, R-W.Va., and Nick Rahall, D-W.Va., voted against it.

"There's no way we could have absorbed a big cut like that," Hill said. The bill was voted down in the Senate.

Medicaid recipients are mainly children and old people, Hill said. "[Members of Congress] should visit the hospitals and nursing homes, then ask, 'OK, if you cut these dollars out, what happens to these people? What are you going to do about these sick children? Are we supposed to turn the elderly people away? Where are they going to go?"

More productive ways to reduce costs

About 40 miles away, along Cabin Creek in Kanawha County, Craig Robinson, CEO of Cabin Creek Medical Systems, also is watching the Washington debate.

"Medicaid funding is just as critical for community health centers," Robinson said. "It's at the heart of our operations. If our Medicaid funding is cut, the ripple effects will hit the whole system and area, not just the Medicaid patients."

Cabin Creek, with 14,000 active patients, is one of West Virginia's 28 federally funded community health centers.

One in five West Virginians -- 373,000 people -- now get their health care through those centers.

 There are productive ways to reduce Medicaid costs, Robinson said. The "Gang of Six" proposal endorsed by President Obama says the government must "spend health-care dollars more efficiently in order to strengthen Medicare and Medicaid."

"The question is: what do they mean by efficiency?" Robinson said. "The devil's in the details, and it's a whole lot simpler to just chop the funds, which would be destructive. But there are also things that can be done to make care more efficient."

For instance, a small segment of Medicaid patients run up a large percent of the bills, he said. "These are people who go to the ER 10 times a month or use ambulance services over and over. A lot of them have no regular doctor. Nationwide, we could be helping them get into early care. That could save a lot of money."

He pointed to the system in Camden, N.J., that reduced Medicaid hospital costs by more than 20 percent by identifying "hot spotters" and getting them into regular care. "Think how much money would have been saved if they'd gotten into care before their problems became serious.

"If deficit reduction pushes us to make health-care delivery more efficient, that could be good for everybody," Robinson said, "but if we just chop the funding, and people end up losing their health care, that will do a lot of damage."

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