The Times West Virginian

West Virginia

April 22, 2013

Massive overhaul of W.Va. health system urged

CHARLESTON — Few states plow as much money into health care as West Virginia, but you wouldn’t know it from the results, according to a study issued Sunday that urges major change in health services and the government department that helps provide them.

Gov. Earl Ray Tomblin ordered the audit, conducted by the consulting firm Public Works, which had issued a much-discussed review of state public schools previously.

“West Virginia is in the midst of a health-care crisis,” the report concluded. “These facts are not due to a lack of effort to address West Virginia’s health-care challenges.”

The 116-page report details 78 recommendations for revamping the sprawling Department of Health and Human Resources at a potential savings of nearly $284 million over five years. Administration officials say they now want the department and the health-care community at large to weigh in on the findings.

Despite West Virginia’s massive spending — it ranks fourth among states for public health-care funding per person, and residents have the 10th-highest private health insurance premiums — it has among the worst outcomes in the nation.

Only two states have a higher share of adults who are obese or have diabetes, while just one has more adult smokers, the audit’s review of 2012 statistics found. Only five states see more residents die of heart disease. West Virginia ranks 49th for avoiding preventable accidents or ailments that land seniors in the hospital. For overall health outcomes last year, West Virginia ranked 48th among states.

The audit also noted that despite all the spending around 254,000 West Virginians — or close to one in six residents — reported not seeing a doctor in 2010 because of the cost. Private health insurance premiums, meanwhile, exceed median incomes for a quarter of the state’s workforce after rising 62 percent between 2003 and 2011.

The report outlines a range of steps for health-care providers to reduce unnecessary and even harmful services and procedures while improving preventive care, nutrition and physical fitness. But with a nearly $4 billion annual budget and more than 5,700 full-time employees, the Cabinet department’s role in this system receives most of the audit’s focus.

Finding some agencies overburdened and others underused, the audit recommends reorganizing most into two divisions each led by a deputy secretary while shutting down or combining several. The report also details how high turnover, hundreds of unfilled jobs and rising overtime costs combine to hamper the department’s efforts.

Compared to a national average of 3.3 percent, department turnover is 30 percent, the audit said. With a cumbersome, months-long process for filling jobs, more than 600 positions remain vacant at any given time. Overtime spending grew from $5.2 million in 2010 to $7.1 million last year.

“West Virginia’s health-care agencies are largely focused on day-to-day operations and emergencies, with little capacity to collaborate on new efforts or the broader vision of improving health outcomes in West Virginia,” the auditors found.

The Bureau of Medical Services, for instance, oversees the $3 billion Medicaid program but has only 62 employees — 1.4 percent of the department’s workforce to handle nearly 72 percent of its budget. The Bureau for Behavioral Health and Health Facilities accounts for 68 percent of the department’s overtime, even though it receives less than 10 percent of its funding, the audit found.

The Bureau of Children and Families also has high overtime costs, while its child protective services workers have among the worst turnover rates. But the audit also found the caseloads of these workers “well within recommended guidelines,” and suggests their $33,680 average salary is reasonable. It recommends that this agency cut 23 vacant caseworker positions along with 18 supervisor posts through attrition to save $2 million a year.

The audit also says this agency could provide some of the biggest savings, particularly by pursuing an estimated $23.4 million in available federal funds for foster care. It should also cancel its nearly $510,000-a-year contract for operating a toll-free abuse and neglect hotline, and assign it to more qualified staff, the report said.

Tomblin pursued at least one of the audit’s recommendations during the just-completed legislative session, aimed at reducing Medicaid spending on driving patients to doctor’s visits and other non-emergencies. But ambulance services, senior centers and others that now get that money helped kill that bill. But lawmakers did agree to nearly double the salary of the department’s next secretary, from $95,000 a year to $175,000.

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