they couldn't find a way to work together. Now, only one is expected to receive
Hospital officials argue that West Virginia's equipment and
buildings, on average, are about 9 percent older than the national average, and
federal money was available for construction. It is hard to retrofit these
older buildings for new technology and more outpatient services, those
Finally, the public demands high-tech service, even in small
hospitals, said Steven Summer, president of the West Virginia Hospital
Association. One reason managed care failed is because it tried to limit
patient choice, he
"The public said very clearly that we're not willing to accept
that [low] level of service," he
Summer wants to see the government actually pay hospitals the
full cost for treating patients covered by Medicare, Medicaid, Workers'
Compensation and other government programs. If that happened, then hospitals
wouldn't have to charge private insurance companies so much.
Lindsay has another idea, as well. He'd like hospitals to milk
more life from their existing infrastructure. He's not convinced that the shiny
He said he once was treated in an English hospital. The floors
creaked, the television set was ancient, he said, but the patient care was
among the best in the world.
"Everybody assumes, when people at a hospital say they need
something, it's for medical or scientific reasons," Lindsay
times, they just want it."
An unprecedented amount of money
Only half of all states have a Certificate of Need process.
With so few projects being rejected, is it even necessary?
Chambers said the process works. For example, groups of doctors
in other states have opened free-standing "surgi-centers" away from hospitals
to do profitable, routine surgeries — but not in West Virginia, at least not
yet, because of the CON process.
Also, two hospitals recently asked if they could offer open-
heart surgery in Parkersburg, but because of the CON process, only St. Joseph's
will be allowed to do so.
Chambers said the Health Care Authority is beginning to take a
harder look at CON requests. She said hospitals are asking for an unprecedented
amount of money.
"I don't think there was the level of scrutiny [before], as
there is now," Chambers
costs are going through the ceiling? And that I'm really concerned about how
many more people we're going to have uninsured than we already do?
Last year, authority board members considered a six-month
moratorium on new CON applications, but rejected the idea.
The authority is beginning to make the following deal with CON
applicants — we'll approve your project, if you agree not to increase what you
charge patients by too much. Called "benchmarking," the idea is to make similar
kinds of hospitals charge similar rates by tying rate increases to how a
hospital compares with its peers.
Also, the authority is trying to create a map of health-care
an area really needs a certain capital improvement.
Some hospitals might have to change their mission, cut services
or close completely in order to cut health-care costs in the state, Chambers
But hospital consolidation, like school consolidation, is hard on local
"One of the big questions now is: If we're going to be building
asked. "It's a tough question. One of the concerns then is: How long do people
have to travel to get care?"
Lindsay said the Legislature could pass clearer laws that spell
out what is required to build a new facility or renovate a building. He also
But he doesn't expect any change soon. Powerful political
interests — construction companies, some labor unions and the hospitals
themselves — want more construction, more new equipment. Meanwhile, consumers
Smith, the insurance executive, said he doesn't have an easy
answer but that an answer needs to be found.
"I'm not here to tell you which hospitals should or shouldn't
have their requests granted," he
it may be more of a burden than we can stand."
To contact staff writer Scott Finn, use e-mail or cal 357-